"I Don't Like the New Changes at All"

Oct 30, 2013

Editor's Note: We received this e-mail yesterday from a long-time reader. As we read it, we realized that she may be expressing thoughts and feelings shared by many of our readers. That's why we would like to invite you to respond to what she says, and add your own observations. Please feel free to comment. (To protect this writer's privacy, we are not publishing her name.)

Nadia Al-Samarrie, Publisher and Editor-in-Chief

 

Dear Nadia:

My husband and I have Blue Cross and Blue Shield, and we have Express Scripts that covers our prescriptions.

Recently I got a note in the mail that they would no longer cover any glucometers except OneTouch. I am on the OmniPod insulin pump and I use FreeStyle test strips that go along with my glucometer, which is better known as the Personal Diabetes Manager.

The OmniPod is an insulin carbohydrate ratio insulin pump system. Before that I used AccuChek test strips. [However] Express Scripts will no longer cover any tests strips except OneTouch.

I would love to know what other diabetics think of these changes. I don't like the new changes at all. I can see the President helping people get insurance that can't afford it, but for the people who can afford and have insurance, and pay a portion of the insurance out of their own pocket, I don't think they should be denied the right to use any glucometer they want.

Testing your blood sugar sure helps you stay in control and keeps you out of the hospital. I think it is a shame that with the new insurance changes they will only cover one brand of test strips. I also got a note that they only insulin they will cover now is Humalog insulin. What about all the other people that use Lantus and other long-acting insulin?

I sure thought we were past all these stages in the game with diabetes. I remember years ago when I first started working after college I always had to have the more expensive insurance plan or none of my diabetes supplies would be covered. I remember when some people I worked with had insurance plans where when they took their children to the doctor the office visit was only $5. I could not have that because that insurance wouldn't cover any of my diabetes supplies because they claimed they were disposable. Many years later all our diabetes supplies were covered.

Now with the new prescription plan changes we are going backwards again instead of forward with the changes being made. Very few of our things are going to be covered now by Express Scripts. I don't think it is fair for the people that have diabetes. I have had diabetes for over 40 years. I would love for you to do an article in you Diabetes Health magazine and hear from other people what they think about all this.

L.S., Delaware

 

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Categories: AccuCheck, Blue Cross, Blue Shield, Express Scripts, FreeStyle, Omnipod, Personal Diabetes Manager


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Comments

Posted by Anonymous on 21 August 2014

I am running into the same issue as you are with the insurance company - BCBS Anthem. I ordered, for the past 7 months, my insulin pods and my Freestyle test strips thru Edgepark and paid 10%, which is more than I have paid EVER in the past for my supplies...however, didn't have a choice. Then last week I log on the BCBS Anthems website site and see that I have several claims that were denied. The total is over $2000, and its for the Freestyle test strips. I have been going thru Edgepark ordering thinking that I'm paying a total of 10% for pods and test strips, however I wasn't. Anthem just made me aware that they do not cover Freestyle! Then why the hell didn't anyone let me know, after all my orders placed. Anthem said that I will have to order thru the pharmacy and pay the co-pay $25 per box. This is terrible news and now I am going to be billed another portion for the last 7 months, that I was unaware of. I'm agree with you, how can they pick and choose for us which supplies we use and how we manage our disease!! I was doing just fine with managing my blood sugar levels before I started being "insured" by Anthems!
Chrissy
Type I - 31 years

Posted by Anonymous on 22 August 2014

I am a Type 1 diabetic and use a minimed insulin pump. I also have BCBS and Express Scripts and have been affected by these recent changes. Before the "Preferred and Non Preferred" List I used Novolog insulin and FreeStyle test strips. I switched over to Humalog and One Touch after they became the only preferred prescriptions. Although Novolog and Humalog are used interchangeably by Express Scripts they do not work the same for all individuals. I experienced an immediate increase in my blood sugars. Despite my attempts to increase my basal rate and adjust my carb to insulin ratio, my blood sugars continued to climb. I consulted my doctor and he agreed that I needed to switch back to Novolog. He wrote a prescription a month ago and I am still in the process of getting Express Scripts to approve and mail it. My doctor's office has called on multiple occasions. I have have called an upwards of 5 times. They have been stalling for 2 weeks now telling me, the doctor's office hasn't submitted all the information. My doctor's office has called and they have told them that everything is approved and all they need is for me to call and request that the prescription be "rerun." It has become obvious to me that the hope is I will just let it go and continue with the "preferred" prescription Humalog. Furthermore, I have found that the One Touch test strips required more blood, which is more than inconvenient when I test my bloodsugar 5-7 times a day. I selected the insurance plan that gave me the most flexibility and choice which was consequentially the most expensive. I am willing to pay more for something that I know will help me control my diabetes. However, it appears I have little say in my healthcare decisions.

Posted by Anonymous on 24 November 2014

I hope someone can help me understand what is happening to my health coverage through BCBS of GA in regards to covering my daughters diabetic medical supplies. I was told by Edgepark medical supply company that BCBS will not process a continuous glucose monitoring device (CGM) under my medial policy. BCBS states that this medical device has to go through my express scripts pharmacy plan. Express Scripts states that they may not pay for the DEXCOM CGM because it is not the preferred OnTouch system. BCBS never let me know that these changes were taking place, and that this device would not be approved through my medical plan. This is my first year using BCBS Gold Plan. This plan has been very disappointing compared to when I had United Health Care (UHC is not offered as a choice through my employer anymore) Are these changes because of the government affordable health care act?

After reading the earlier posts about the one Touch test strips not being covered, I am now worried about this benefit going away.


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