Insurance - Supply & Insulin Costs


(ThePancreanator) #1

Of course no one has to respond to this.  I'm just curious as to how different insurance policies handle diabetic supplies and insulin.  

Right now I'm on my mom's insurance plan but I know as soon as I'm through with school I'll have to find my own insurance plan, probably through my job.  I'm just wondering what kind of costs I may have to expect and if there's any discrimination against diabetics from insurance companies.  

Right now I can get

5 Epipens of Lantus for $30

100 One-Touch Testing Strips for $10

100 Needle Caps for Epipen for $10

...after insurance. 

These costs aren't that high so I'm hoping this is what I'm looking at on my own as well. 


(golfpapabravo06) #2

I have BlueCross BlueShield of Illinois and right now they're covered completely.  I'm worried about when I leave my parent's coverage too :-/

Separately, Walgreens made a mistake twice and gave me 7 vials of humalog in one refill, i didnt have to refill a prescription of humalog for like 3 months back to back (2 refills in 6 months) it was great


(Sugar-FreeInYYC) #3

I'm with Empire Life (in Alberta) and it covers:

Everything cept:

Glucagon = 0%
Lancets= 0%
Ketone sticks = not sure
Pump = 1000$ PER lifetime!?!??!?! HOW DOES THAT MAKE SENSE

but they cover ALL pump supplies to no limit.

weirdos.


Luckily in August I will be on my bfs plan and be covered 100% for my pump. phew


(Dwight Elkin) #4

Matt, there is a secondary insurance called Gateway that covers everything 100%. JDRF can give you information and how to go about it. Also it doesn't matter how much income you make. There are some steps that you have to go thru, but it is well worth it.

30 dollars here and there adds up pretty quick, so i would definitley look into it. Goodluck!!

Dwight


(system) #5

I have Pacific BlueCross coverage through work. All diabetic supplies are covered 80% to start, along with Phsyio, etc..but once you've spent $1,000 of your own money paying the 20% they don't cover..you get everything covered at 100%!

Canadian Pharmacare is the same. They cover 80% of your prescriptions, and once you spend $1200 covering the 20%, they switch it to 100% coverage.

I would suggest seeing if there's some kind of state insurance plan you get for cheap if your job doesn't end up having one. I donno about the states..but in Canada if you make under $20k a year(it might be $25k..) you are eligible for Pharmacare.

I donno about the pump but I'll be finding out about that soon. It doesn't say anything about not covering a pump..but it also doesn't mention an insulin pump...

I end up paying no more than $20 when I go in to get supplies..but I also buy needles one day..then a week later test strips..


(Woo Its Pat) #6

[quote user="Greg Borkman"]

I have BlueCross BlueShield of Illinois and right now they're covered completely.  I'm worried about when I leave my parent's coverage too :-/

Separately, Walgreens made a mistake twice and gave me 7 vials of humalog in one refill, i didnt have to refill a prescription of humalog for like 3 months back to back (2 refills in 6 months) it was great

[/quote]

That's funny...I have BC/BS of Maryland and I get repeatedly screwed seemingly. Do you know if you're on the PPO or EPO plan?

I pay $37.50 for 4 viles of insulin

Haven't had to pay for test strips yet due to an abundance leftover by my sister for the Freestyle Flash after she switched to the Ping.

They only cover 80% of my pump supplies so I end up paying about $220 each time I resupply.

Endo appointments aren't really covered that well either. It depends how much of the deductible they want to use. After my Q1 appointment, I had to pay $140...after Q2, only $24. Makes no sense to me. They don't cover bloodwork 100% either so I end up paying about $25 for that too.

I'm glad I have a job or else I'd be bankrupt trying to stay alive :P

 


(Monique H) #7

Hey, Matt,

We've got Aetna through my husband's group-plan company policy (we're in GA, USA).  We're new to this, but so far our costs have been:

$35 for glucagon kit (retail $143.99)

$23.98 for 100 keytone test strips

$33.98 for 204 Multiclix lancets

$25.00 for 1 vial Humulin N HI-310) (retail $46.49)

$12.00 for 100 syringes (retail $15.99)

$25.00 for 250 Freestyle Lite glucose strips (retail $349.94)...OMG are they kidding?!?

$25.00 for 1 vial Humulin R (retail $46.49)

$25.00 for 1 vial Humalog (VL-7510) (retail $113.99)

$12.00 for 4 doses Promethazine (retail $23.69)

$25.00 for 1 vial Lantus U-100 (retail $103.99)

(I like Walgreen's RX because they list the retail cost for each prescription).

Also, of the estimated $15k for our son's emergency hospitalization (onset), we're looking at about $1,500 in out-of-pocket hospital/dr/lab expenses.  Thankfully, we also have a secondary plan through hubby's work that covers our out-of-pocket up to $4k per year.  Don't know what we'd do without it. 

Blessings,

Mo

Mom to William (8) with T1 dx 5/13/09

 


(DDrumminMan) #8

I have a pretty good plan through work.  I get all of my stuff (insulin, syringes, test strips, and some prescription pills) for around $250 every 3 months. I get way more insulin than I need and probably have a year's supply in the fridge.  If I ever lose my insurance, I can survive for while without it!


(kbuckleync) #9

My husband and I are on the best (most expensive) plan his company offers, and our out of pocket expenses just for the plan inteself are $1000ish per month.  

For everything else we pay:

$35 for endo visits

$150 (for 6 vials of insulin - 3 month supply)

$210 (for 6 vials of test strips - 3 month supply)

My pump supplies are covered at 100% since they're considered "durable medical equipment" instead of prescriptions.


(Joshy84) #10

The best way to cut down on your co-pays is to see if you can get three month supplies of your items. Only have the co-pay for the insulin you need every three monts. I pay 45 dollars for 8 bottles of insulin. Not sure on my other stuff but my insurance pays really well on it too. Guess, I am a lucky one.

 


(poodlebone) #11

I have Empire Blue Cross Blue Shield. 

9 vials Humalog/90 days = $70.  I don't need 9 vials and plan on asking my CDE to cut it back when I see her next month, but the $70 for 90 days will still be the same no matter how many I get.  I get them through the mail order pharmacy.

Pump, infusion sets, reservoirs, sensors & IV Prep wipes - I get these from Minimed.  Sets/wipes every 90 days, sensors as needed (2 boxes a few times a year) and I have a stockpile of reservoirs so haven't had any ordered in a long time.  All covered as DME 100%.

Test strips - 1200/90 days from Edgepark as DME, covered 100%.  I had been getting them as prescription/pharmacy but insurance just imposed a 200/month limit and raised the co-pay from $10 to $35.

I could also get lancets, alcohol swabs, ketone strips and a few other items through Edgepark as DME with no co-pay but I don't need any of those things.

Doctor/specialist visit co-pay = $25.

There are ER and hospital admission co-pays but I'm not sure how much.  Maybe $200/ER, $500/hospital.  I hope to not have to take advantage of those!  Lab costs covered 100% as long as I use Quest Labs.  Any other lab I'm responsible for the cost.

[quote user="Matt Johnson"]Right now I'm on my mom's insurance plan but I know as soon as I'm through with school I'll have to find my own insurance plan, probably through my job.  I'm just wondering what kind of costs I may have to expect and if there's any discrimination against diabetics from insurance companies.  [/quote]

Whatever you do, do not let your coverage lapse.  If you go more than 63 days without coverage you will end up with pre-existing condition clauses (they will not cover anything diabetes related for a year) and you may have a very hard time getting insurance unless it's through a group plan.  Even then, the pre-existing condition will apply.  People who aren't offered insurance through their job find it nearly impossible to get insurance on their own.  It's extremely expensive and coverage is minimal.  I don't know what the rules are regarding students aging off their parents' plan and COBRA, but if you can get COBRA then do it.  Even if it's expensive, just until you get a job that offers group coverage.


(ginny) #12

I have Blue Cross and Blue Shield, not good.

all prescriptions $35 and they will only give me one vial of insulin at a time, great for an insulin dependant.

specialist copays $35

Insulin pump supplies $100/ 2.5 mths

CGM $70/ month

Any Canadians want dual citizenship?


(Woo Its Pat) #13

[quote user="ginny"]

I have Blue Cross and Blue Shield, not good.

all prescriptions $35 and they will only give me one vial of insulin at a time, great for an insulin dependant.

specialist copays $35

Insulin pump supplies $100/ 2.5 mths

CGM $70/ month

Any Canadians want dual citizenship?

[/quote]

Ginny, I used to have BC/BS (PPO). They really only give you one vial of insulin at a time? What is the Rx for? My Rx is for 4 vials at a time and the copay was still $35.  Insulin pump supplies with BC/BS  used to destroy me (over $200/copay).

Now I'm with Aetna...still a sh*tty insurance company but our company went with it to cut costs...at its employees' expense mind you. But with Aetna, my insulin pump supply copay has gone down to $70 while insulin copay for the same 4 vials has gone up to $50. I use MedCo for Synthroid and that's $10 for 90 days worth.

From my experience with my mom's health insurance growing up...be a nurse or guys/girls, marry a nurse...they have great health benefits and copays are next to nothing...my insulin copay used to be $10 and 100% of my pump supplies were covered. Now, not so much :-(


(billyd380) #14

Hey Matt,

Im on my companies HDHP plan from Anthem Blue Cross Blue Shield.  it kind of sucks b/c it seems like I pay a ton for meds but the take out of my pay is lower than traditional plans and in the long run I save.  The key is to put the right amount in your HSA account so you don't pay double tax on your meds.  The other nice thing is if you meet your deductible everything is covered at 100% after that.  I did this last year due to some other things, but haven't done it any other time.  

 

So, before the pump here was what i was paying....

5 Novolog Pens- $189 about every 1 1/2 mo

5 Lantus Pens- $199 about every 1 1/2 mo

100 Test Strips- $95 about every 3weeks

100 Pin Needles- $25 about every 1mo

 

W/ Pump

2 Vials of Novolg- $200 about every 1 mo

100 Test Strips- $95 about every 3 weeks

Pump Supplies- $110 about ever 1 mo

I hope this helps and it just goes to show that it really depends on what plan you get on that will determine how much you spend.  When you get out of school and get a job just be sure to look at there Insurance coverage before you accept it and take that into account for you salary and budget.  It will help with any headaches later.  

 

Bill


(kimi) #15

Great info. about keeping ilnsurance and not letting it lapse!!!!  You can get left out in the cold.  My husband lost his job last year.  We did keep Cobra just to be covered.  With the new laws on Cobra we only paid about 35% for the months we needed.

 

Kim


(Boston_Rich) #16

In Mass i went longer the 63 days without coverage and had NO issues when I started work again getting insurance

 

 


(hild0078) #17

I have Blue Cross and my copays are $70 each for a 3-month supply of my test strips, Novolog and needles. I think the lancets were $15 or so. My office copays are $25.


(ThePancreanator) #18

I need to look into getting on some clinical trials and possibly get some free meds.  My local pharmacist has actually been pretty good about hooking me up.  The first time I got 5 flexpens of Lantus I went in and it was going to be a $90 copay but my pharmacist made it look like it was a month's supply so I'm only paying $35 every few months for Lantus and same for Novolog. 

Looks like BCBS doesn't really appreciate pumps.  I think someone pointed out they pay 20% of pump supplies which is the same for me after my $600 deductible if I choose to start.  Other crappy thing is that if I start now, my plan renews in July, and I would have to pay the $600 deductible again.  Does anyone have any more info on the "gateway" plan that was mentioned earlier in the thread?

 

*This is a repost from the Apidra thread into the correct one ;-)


(Jessica L) #19

I added up Rileys monthly supplies and it came to 160 a month. I think..

Levermir 1 vial=$40.00

5 novolog pens=$40.00 (which is cheaper cause 1 vial of it was 40 as well)

Syringes 100=$12.00

the needles for the pens 100= $40.00

200 test strips which doesnt last a use a month but its suppose to=$40

keytone strips I buy off the self they are 7 bucks for 50 of them at walmart

the 2 glucagon kits I got were 40 as well but that isnt monthly.

 

I have Anthem BCBS.


(awesomealex) #20

I also have Anthem Healthkeepers and I use the mail order for his BD ultrafine pen needles.  It is much cheaper for me that way.  We get 3 months supply ( 630 needles ) for 60.00