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> Copayment for Insulin
Arlene S.
post Mar 27 2009, 01:39 PM
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We had Empire BC/BS until January 1 of this year at which time we were switched to Oxford. The coverage is essentially the same except for copayments for sensors, pump supplies and strips. We had no copayments with BC/BS but that has changed with Oxford. But what really surprised me was the copayment for Novolog (which is their only Tier 1 insulin). For a Tier 1 med the copay would ordinarily be $15. However, it is $25 because they consider it medical. Isn't this unusual for an insurance company to consider insulin as anything but pharmacy?


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Linda B
post Mar 27 2009, 08:57 PM
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QUOTE(Arlene S. @ Mar 27 2009, 09:39 AM) *
But what really surprised me was the copayment for Novolog (which is their only Tier 1 insulin). For a Tier 1 med the copay would ordinarily be $15. However, it is $25 because they consider it medical. Isn't this unusual for an insurance company to consider insulin as anything but pharmacy?

All the years I had United Health Care, and Aetna before that, my insulin was always considered pharmacy and my drug copays applied.
I now have insurance with a $2500 deductible, after which both medical and pharmacy are paid at 100%, so if considering insulin as medical is something new I have no way to know about it.
Linda B.


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Beowulf
post Mar 28 2009, 02:26 AM
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QUOTE(Arlene S. @ Mar 27 2009, 07:39 AM) *
We had Empire BC/BS until January 1 of this year at which time we were switched to Oxford. The coverage is essentially the same except for copayments for sensors, pump supplies and strips. We had no copayments with BC/BS but that has changed with Oxford. But what really surprised me was the copayment for Novolog (which is their only Tier 1 insulin). For a Tier 1 med the copay would ordinarily be $15. However, it is $25 because they consider it medical. Isn't this unusual for an insurance company to consider insulin as anything but pharmacy?

I would think that is pretty unusual. Of all the different insurances that I have had over the years, 3 different BCBS, UHC, Guardian, and about 4 others, they all covered insulin under pharmacy. One really weird thing was Guardian (that was 17 years ago) covered the insulin, but wouldn't cover syringes. They said it wasn't medically nessesary (I know I spelled that wrong). Exactly what are you supposed to do with insulin, on MDI, without syringes? Break off the top and swig a shot? LOL My Dr had a field day with them on that!

Justin


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Arlene S.
post Mar 28 2009, 02:48 AM
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(IMG:style_emoticons/default/cool.gif) --><div class='quotetop'>QUOTE(Linda B @ Mar 27 2009, 04:57 PM) *</div><div class='quotemain'><!--quotec-->All the years I had United Health Care, and Aetna before that, my insulin was always considered pharmacy and my drug copays applied.
I now have insurance with a $2500 deductible, after which both medical and pharmacy are paid at 100%, so if considering insulin as medical is something new I have no way to know about it.
Linda B.[/quote]



I had BC/BS, Oxford, Aetna, BC/BS (different plan) and now Oxford (different plan) and all the previous plans considered it pharmacy. With BC/BS I paid $10 for a month's supply.Now I pay $25. (They told me that medical is the same as a doctor's visit copay.) Oxford has a strange system. My supplies are medical or DME and it's a $25 copay for infusion sets and $25 more for reservoirs. Sensors are $25 for 3 boxes and my new transmitter was $25. I had no copay for pump supplies or infusion sets with BC/BS. The formulary itself is weird. For example, Protonix (name brand) is $35 whereas the generic is $75. Really. At least they cover the sensors so I can't complain. I'm just confused.

This post has been edited by Arlene S.: Mar 28 2009, 02:51 AM


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Liz
post Mar 29 2009, 04:51 PM
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QUOTE(Arlene S. @ Mar 27 2009, 10:48 PM) *
I had BC/BS, Oxford, Aetna, BC/BS (different plan) and now Oxford (different plan) and all the previous plans considered it pharmacy. With BC/BS I paid $10 for a month's supply.Now I pay $25. (They told me that medical is the same as a doctor's visit copay.) Oxford has a strange system. My supplies are medical or DME and it's a $25 copay for infusion sets and $25 more for reservoirs. Sensors are $25 for 3 boxes and my new transmitter was $25. I had no copay for pump supplies or infusion sets with BC/BS. The formulary itself is weird. For example, Protonix (name brand) is $35 whereas the generic is $75. Really. At least they cover the sensors so I can't complain. I'm just confused.


I've never heard of insulin s being covered under anything but pharmacy. Maybe they consider it a "treatment" rather than a drug?! I had an Oxford plan for several years that had no pharmacy benefits and I couldn't get them to cover anything related to diabetes (other than doctor visits & labs). No strips, no syringes, no insulin. I had to pay out of pocket.

I still have Empire BCBS, the same plan you had before. As of January 1st they moved all insulins, test strips and other diabetes drugs to Tier 2 when they had all been Tier 1 (generic). My co-pay went from $10 to $35 for each insulin prescription. My CDE writes for 3 vials a month so I don't actually refill it every 3 months and that saves me a little money. I now go through Edgepark for my strips and that's removed my co-pay for those as well as bypassing Empire's new 200/month limit.

Are you getting covered for 3 boxes of sensors every 3 months? I just called MM for sensors and the guy took all my insurance info and asked me if I wanted a box of 4 or a box of 10, which made me nervous. I told him I was always sent 2 boxes of 10 and insurance covered them. I think this is only my 3rd order of sensors since I started in June, but they haven't been lasting as long lately so I'm going to call for them more frequently.


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Arlene S.
post Mar 29 2009, 07:45 PM
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QUOTE(Liz @ Mar 29 2009, 12:51 PM) *
I've never heard of insulin s being covered under anything but pharmacy. Maybe they consider it a "treatment" rather than a drug?! I had an Oxford plan for several years that had no pharmacy benefits and I couldn't get them to cover anything related to diabetes (other than doctor visits & labs). No strips, no syringes, no insulin. I had to pay out of pocket.

I still have Empire BCBS, the same plan you had before. As of January 1st they moved all insulins, test strips and other diabetes drugs to Tier 2 when they had all been Tier 1 (generic). My co-pay went from $10 to $35 for each insulin prescription. My CDE writes for 3 vials a month so I don't actually refill it every 3 months and that saves me a little money. I now go through Edgepark for my strips and that's removed my co-pay for those as well as bypassing Empire's new 200/month limit.

Are you getting covered for 3 boxes of sensors every 3 months? I just called MM for sensors and the guy took all my insurance info and asked me if I wanted a box of 4 or a box of 10, which made me nervous. I told him I was always sent 2 boxes of 10 and insurance covered them. I think this is only my 3rd order of sensors since I started in June, but they haven't been lasting as long lately so I'm going to call for them more frequently.


Hi Liz,

Neither have I. Novolog is listed in the formulary as a Tier 1 drug, which should mean there is a $15 copay, but like strips there is a $25 copay per 30-day supply. I also get three vials at a time. With Oxford I use Medco and get my strips (3 month supply) from them but not my insulin. I prefer getting it through my local pharmacy.

Oxford covers everything BC/BS covered but with BC/BS there were no copays for DME or Medical. Even with my pump supplies I pay $50 per 3-month order ($25 for infusion sets and $25 for reservoirs). I get my pump supplies from MM now. Oxford covered my sensors immediately when MM submitted the order and they also covered a new transmitter but I have to have the sensors prescription renewed every 3 months and get three boxes at a time. That's a $25 copay for the sensors. I'm very happy that I'm covered so I can't complain but I am surprised, at the difference between two insurance companies. With BC/BS I always got one box at a time as needed.

One of my doctors (ENT) is not on Oxford and I am trying a new one. The others, including one I previously paid out-of-pocket because he dropped BC/BS, is on the plan. I still get emails from Empire and from Caremark.

I had Oxford back in 1995 or 1996 and they covered strips under DME with no copay but they wouldn't cover pump supplies. I wrote letters to the company and to the NY State Insurance Commissioner and I ultimately received a check for $800 from Oxford. (By then we had US Healthcare.) About two months later I heard from the Insurance Commissioner who said I wasn't covered. I never wrote back to tell him he was wrong. I should have. Oxford was ignoring the NY State Mandate at the time. So was the Insurance Commissioner. Now that Oxford is part of US Healthcare there have been many changes for the better.

How are you doing?





--------------------
Arlene S.
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Liz
post Mar 29 2009, 09:04 PM
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QUOTE(Arlene S. @ Mar 29 2009, 03:45 PM) *
Hi Liz,

Neither have I. Novolog is listed in the formulary as a Tier 1 drug, which should mean there is a $15 copay, but like strips there is a $25 copay per 30-day supply. I also get three vials at a time. With Oxford I use Medco and get my strips (3 month supply) from them but not my insulin. I prefer getting it through my local pharmacy.

Oxford covers everything BC/BS covered but with BC/BS there were no copays for DME or Medical. Even with my pump supplies I pay $50 per 3-month order ($25 for infusion sets and $25 for reservoirs). I get my pump supplies from MM now. Oxford covered my sensors immediately when MM submitted the order and they also covered a new transmitter but I have to have the sensors prescription renewed every 3 months and get three boxes at a time. That's a $25 copay for the sensors. I'm very happy that I'm covered so I can't complain but I am surprised, at the difference between two insurance companies. With BC/BS I always got one box at a time as needed.

One of my doctors (ENT) is not on Oxford and I am trying a new one. The others, including one I previously paid out-of-pocket because he dropped BC/BS, is on the plan. I still get emails from Empire and from Caremark.

I had Oxford back in 1995 or 1996 and they covered strips under DME with no copay but they wouldn't cover pump supplies. I wrote letters to the company and to the NY State Insurance Commissioner and I ultimately received a check for $800 from Oxford. (By then we had US Healthcare.) About two months later I heard from the Insurance Commissioner who said I wasn't covered. I never wrote back to tell him he was wrong. I should have. Oxford was ignoring the NY State Mandate at the time. So was the Insurance Commissioner. Now that Oxford is part of US Healthcare there have been many changes for the better.

How are you doing?


Last month I got my first shipment of Humalog from Empire's new mail order pharmacy, nextRx. They shipped it UPS Next Day Air in a square box that was lined with thick styrofoam. There was a layer of styrofoam on the bottom, a gel pack, a layer of crumpled heavy brown paper, the bag of insulin, more paper, another gel pack and the top layer of styrofoam. The gel packs were still completely frozen solid when the box arrived. While I'm not happy about the increase in co-pay it's still not too bad, especially if I only get it refilled once or twice a year.

I had Oxford from maybe 1996 through 2003 or so. One mail order company tried to work with me to get Oxford to cover test strips & syringes (pre-pump) but Oxford wasn't paying them. I got a different answer every time I called Oxford and had no clue what I was doing at the time. It didn't dawn on me to complain to anyone.

I just checked the status of my sensor order on the MM store site and it says that it's shipped but I don't think it will actually go out until tomorrow. With my last order there was no problem with the billing and I didn't have to call MM or Empire to fix it. I'm glad that Oxford covers them. We have an Oxford plan available at work but it doesn't include prescription coverage.


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Arlene S.
post Mar 30 2009, 03:21 PM
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QUOTE(Liz @ Mar 29 2009, 05:04 PM) *
Last month I got my first shipment of Humalog from Empire's new mail order pharmacy, nextRx. They shipped it UPS Next Day Air in a square box that was lined with thick styrofoam. There was a layer of styrofoam on the bottom, a gel pack, a layer of crumpled heavy brown paper, the bag of insulin, more paper, another gel pack and the top layer of styrofoam. The gel packs were still completely frozen solid when the box arrived. While I'm not happy about the increase in co-pay it's still not too bad, especially if I only get it refilled once or twice a year.

I had Oxford from maybe 1996 through 2003 or so. One mail order company tried to work with me to get Oxford to cover test strips & syringes (pre-pump) but Oxford wasn't paying them. I got a different answer every time I called Oxford and had no clue what I was doing at the time. It didn't dawn on me to complain to anyone.

I just checked the status of my sensor order on the MM store site and it says that it's shipped but I don't think it will actually go out until tomorrow. With my last order there was no problem with the billing and I didn't have to call MM or Empire to fix it. I'm glad that Oxford covers them. We have an Oxford plan available at work but it doesn't include prescription coverage.


I might start ordering my insulin from Medco now that the copayment has more than doubled but I'll have to wait until I see my endo in May. He's with a new group now and in a different office. I'd rather he sent the script electronically.

I'm going to call Medco today to find out why they consider insulin medical. I can understand why they do that with strips, but not insulin. I doubt that I'll get a satisfactory answer. I still can't find out why Protonix is Tier 2 and the generic is Tier 3.

Your plan is a good one, even though the formulary has changed. Once they (MM) got the codes right I had no problem; Empire paid immediately. I guess Oxford has many plans. We have the Freedom and it's also an EPO. I wouldn't want a plan without prescription drug coverage. My out of pocket expenses with Caremark were about $1400 last year even though most of my drugs are generics.

I'm not sure Oxford would have covered the sensors right away had I just been starting on CGMS. There is a person at MM who specifically handles Oxford and she takes care the ordering and getting the prescriptions. I found out that even though I used to get my pump supplies from Edgepark, MM obtained prescriptions for supplies every year anyhow. So when I ordered the pump supplies MM sent them immediately. This time I'm ordering a couple of boxes of Sure-T's. I tried some samples and I liked them. I had problems with the first two but the other two were fine.

Did you get hail last night? Our were the size of quarters. Scary.



--------------------
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JohnG
post Mar 30 2009, 08:25 PM
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QUOTE(Arlene S. @ Mar 30 2009, 10:21 AM) *
I might start ordering my insulin from Medco now that the copayment has more than doubled but I'll have to wait until I see my endo in May. He's with a new group now and in a different office. I'd rather he sent the script electronically.

I'm going to call Medco today to find out why they consider insulin medical. I can understand why they do that with strips, but not insulin. I doubt that I'll get a satisfactory answer. I still can't find out why Protonix is Tier 2 and the generic is Tier 3.

Your plan is a good one, even though the formulary has changed. Once they (MM) got the codes right I had no problem; Empire paid immediately. I guess Oxford has many plans. We have the Freedom and it's also an EPO. I wouldn't want a plan without prescription drug coverage. My out of pocket expenses with Caremark were about $1400 last year even though most of my drugs are generics.

I'm not sure Oxford would have covered the sensors right away had I just been starting on CGMS. There is a person at MM who specifically handles Oxford and she takes care the ordering and getting the prescriptions. I found out that even though I used to get my pump supplies from Edgepark, MM obtained prescriptions for supplies every year anyhow. So when I ordered the pump supplies MM sent them immediately. This time I'm ordering a couple of boxes of Sure-T's. I tried some samples and I liked them. I had problems with the first two but the other two were fine.

Did you get hail last night? Our were the size of quarters. Scary.

Arlene
I order my insulin (Novalog) from Medco and have been using them for about 10 years now.
They have a nice website and there easy to work with. My plan has a Max copay of 120.00
per order. I order 9 bottles for 90 days so that comes to 13.33 a bottle. My RX says use on a sliding
scale as needed 9,000 units. My Doctor believes I need to carry a spare bottle with me so every 28 days
this bottle should be destroyed according to the manufacture so I get 3 extra bottles every 90 days.
This keeps my insulin cost down to 1.3 cents per unit.

JohnG


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John
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Linda B
post Mar 30 2009, 08:58 PM
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QUOTE(JohnG @ Mar 30 2009, 04:25 PM) *
My Doctor believes I need to carry a spare bottle with me so every 28 days
this bottle should be destroyed according to the manufacture so I get 3 extra bottles every 90 days.
This keeps my insulin cost down to 1.3 cents per unit.

John,
Why not just carry your current, open bottle? That's what I always do. Then there is no need to pull one out of the frig and carry it full for a month and then toss it. In fact many pumpers just carry a syringe and plan to use the insulin from the pump in case of a pump malfunction. (of course that doesn't help if your pump runs out of insulin, that's why I always carry my current bottle).
Linda B.


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Arlene S.
post Mar 30 2009, 09:23 PM
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QUOTE(JohnG @ Mar 30 2009, 04:25 PM) *
Arlene
I order my insulin (Novalog) from Medco and have been using them for about 10 years now.
They have a nice website and there easy to work with. My plan has a Max copay of 120.00
per order. I order 9 bottles for 90 days so that comes to 13.33 a bottle. My RX says use on a sliding
scale as needed 9,000 units. My Doctor believes I need to carry a spare bottle with me so every 28 days
this bottle should be destroyed according to the manufacture so I get 3 extra bottles every 90 days.
This keeps my insulin cost down to 1.3 cents per unit.

JohnG


Hi John,

I get everything else (including strips) except pump and CGM supplies from Medco. If I were to have my insulin prescription filled there it would cost me $5.56 a vial as opposed to $8.33 at my local pharmacy. The thing is that at my local pharmacy I get the prescription filled as needed. Recently my endo gave me three samples of Novolog (he gets lots of them). Medco is fine and very efficient. Prior to Medco I used Edgepark. (I go where my insurance company sends me.)

I carry spare insulin only when I travel. Instead I carry a syringe. If my pump fails I can just take out the reservoir and draw insulin into the syringe.

This post has been edited by Arlene S.: Mar 30 2009, 09:24 PM


--------------------
Arlene S.
Type 1
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Dexcom G4, June 2014
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Liz
post Mar 30 2009, 09:29 PM
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QUOTE(Arlene S. @ Mar 30 2009, 11:21 AM) *
I might start ordering my insulin from Medco now that the copayment has more than doubled but I'll have to wait until I see my endo in May. He's with a new group now and in a different office. I'd rather he sent the script electronically.

I'm going to call Medco today to find out why they consider insulin medical. I can understand why they do that with strips, but not insulin. I doubt that I'll get a satisfactory answer. I still can't find out why Protonix is Tier 2 and the generic is Tier 3.

Your plan is a good one, even though the formulary has changed. Once they (MM) got the codes right I had no problem; Empire paid immediately. I guess Oxford has many plans. We have the Freedom and it's also an EPO. I wouldn't want a plan without prescription drug coverage. My out of pocket expenses with Caremark were about $1400 last year even though most of my drugs are generics.

I'm not sure Oxford would have covered the sensors right away had I just been starting on CGMS. There is a person at MM who specifically handles Oxford and she takes care the ordering and getting the prescriptions. I found out that even though I used to get my pump supplies from Edgepark, MM obtained prescriptions for supplies every year anyhow. So when I ordered the pump supplies MM sent them immediately. This time I'm ordering a couple of boxes of Sure-T's. I tried some samples and I liked them. I had problems with the first two but the other two were fine.

Did you get hail last night? Our were the size of quarters. Scary.


My boss was on the phone for a long time this afternoon with the new Empire mail order pharmacy. It seems that one of the drugs he takes used to be generic but now there's no generic, and NextRx had to call his doctor and said the doctor never called back. He still had refills left from Caremark that were transferred. So far I've had no problems with NextRx. I'm not on many medications so I didn't have to pay a huge amount out of pocket, maybe $450 - $500 last year. I only had one brand name drug, two diabetes scripts at the generic co-pay and my Levoxyl, which I paid 100% since it was less than the generic co-pay. NextRx charges the same as Caremark for the Levoxyl. I was afraid they'd charge me $70 for 90 days because they initially had it listed as a brand name drug.

When I called Edgepark to talk about getting strips through them the person I spoke to said that I could also get my pump supplies from them but I'd rather stick with Minimed. It's very easy for me to call them and change my order any time I need to. I was going to cancel the one box of Sure-Ts I was getting (3 Sils, 1 Sure-T) but I've been using them more lately so I'll leave it. I found that if I remove the adhesive pad from the connector on the tubing and let it dangle, I can reach around my back and just slap a Sure-T in and still be able to reach the connection. I have one in there now and it's working great, no pain at all. I put a piece of Hypafix over the insertion part for added security since I don't have the connector taped down. It's not really far around on my back but I can't see it if I look at myself straight on in a mirror. It gives me extra sites to use, which is always a good thing.

The Oxford plan we have at work is Freedom Metro EPO. I believe we switched to that from the original Freedom PPO (?) last year. None of the members complained after the switch and it was a lot cheaper than continuing with the original plan.

I heard some noise last night but I fell asleep early (for me) and didn't really look out the window to see what was going on,


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JohnG
post Mar 30 2009, 09:33 PM
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QUOTE(Linda B @ Mar 30 2009, 03:58 PM) *
John,
Why not just carry your current, open bottle? That's what I always do. Then there is no need to pull one out of the frig and carry it full for a month and then toss it. In fact many pumpers just carry a syringe and plan to use the insulin from the pump in case of a pump malfunction. (of course that doesn't help if your pump runs out of insulin, that's why I always carry my current bottle).
Linda B.

Linda
I think maybe you where not reading between the lines. I was just talking about how I get my cost per bottle of insulin down.
Yes I carry my open bottle with me.
JohnG


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Liz
post Mar 30 2009, 09:34 PM
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QUOTE(JohnG @ Mar 30 2009, 04:25 PM) *
Arlene
I order my insulin (Novalog) from Medco and have been using them for about 10 years now.
They have a nice website and there easy to work with. My plan has a Max copay of 120.00
per order. I order 9 bottles for 90 days so that comes to 13.33 a bottle. My RX says use on a sliding
scale as needed 9,000 units. My Doctor believes I need to carry a spare bottle with me so every 28 days
this bottle should be destroyed according to the manufacture so I get 3 extra bottles every 90 days.
This keeps my insulin cost down to 1.3 cents per unit.

JohnG


When I open a vial of insulin I keep it in my kit in my bag until it's empty. I have gotten to work and discovered my reservoir was nearly empty so I like to have the vial with me, not just a syringe. Last summer I got my own fridge at work and I now keep a vial in there. I continue to carry the open vial with me because I know I'd end up going away for a weekend and forget to pack extra insulin. I've used an open bottle long past 30 days with no problem. When I got my last order of Humalog from NextRx I put a fresh vial in my fridge at work and finally tossed what I had in there, an open vial that expired November 2007. I had been using it for emergencies for well over a year and the last time I used it (just earlier this year!) it still worked great. Even though I get enough insulin, I hate wasting the stuff.


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Arlene S.
post Mar 30 2009, 09:38 PM
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My Pump: t:slim & Dexcom G4



I always make sure there is sufficient insulin in my pump. If I'm down to below 25 units I change my set. If I'm going to be gone all day I carry a vial with me; otherwise I just carry a syringe. Back in 1995 I went to an ADA convention in Atlanta and I had a fridge in the hotel. I put my insulin and some fruit inside and I went to the convention center. When I returned the fruit was frozen. The insulin was just on the verge of freezing. The next day I went to the NovoNordisk booth to see if they could give me a vial (my reservoir was full but I didn't want to take any chances). I told them my story but they didn't have any real insulin. They had empty boxes on display. The hospital would have been my other option. I think it was possible to buy R without a prescription there. I was fine but when I got home I tossed my 3 vials.

This post has been edited by Arlene S.: Mar 30 2009, 09:40 PM


--------------------
Arlene S.
Type 1
Pumped with Minimed 1993-2014
MM CGMS 2006-2014
Dexcom G4, June 2014
t:slim, June 2014
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Mitch(formerly C...
post Apr 2 2009, 04:36 AM
Post #16


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After reading problems about Medco's delivery of insulin, I received my first 90 supply from them. Thanks to what I read on this site, I decided to have them deliver it to my office. From the date of the order to my door was only 3 days. It was wrapped in bubble wrap, surrounded by ice packs and in some type of space age envelope. It seems to be fine. Thanks to everyone, I was able to avoid a problem with them

Chef K


--------------------
Diabetic since 1993
Taking control in 2009
A1c:
11.3 in 1/09
8.7 in 4/09
7.6 in 7/09
? in 10/09
"What if the hokey pokey is truly what its all about"
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Arlene S.
post Apr 3 2009, 03:51 AM
Post #17


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QUOTE(Chef K @ Apr 2 2009, 12:36 AM) *
After reading problems about Medco's delivery of insulin, I received my first 90 supply from them. Thanks to what I read on this site, I decided to have them deliver it to my office. From the date of the order to my door was only 3 days. It was wrapped in bubble wrap, surrounded by ice packs and in some type of space age envelope. It seems to be fine. Thanks to everyone, I was able to avoid a problem with them

Chef K


I have found their delivery of meds and strips to be very fast. It took a long time before I received my first order of strips but this last one arrived in one day. They sent me an email with the tracking number. I think, however, that I'll probably stay with my local pharmacy for insulin.


--------------------
Arlene S.
Type 1
Pumped with Minimed 1993-2014
MM CGMS 2006-2014
Dexcom G4, June 2014
t:slim, June 2014
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Arlene S.
post Apr 3 2009, 04:06 AM
Post #18


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QUOTE(Liz @ Mar 30 2009, 05:29 PM) *
My boss was on the phone for a long time this afternoon with the new Empire mail order pharmacy. It seems that one of the drugs he takes used to be generic but now there's no generic, and NextRx had to call his doctor and said the doctor never called back. He still had refills left from Caremark that were transferred. So far I've had no problems with NextRx. I'm not on many medications so I didn't have to pay a huge amount out of pocket, maybe $450 - $500 last year. I only had one brand name drug, two diabetes scripts at the generic co-pay and my Levoxyl, which I paid 100% since it was less than the generic co-pay. NextRx charges the same as Caremark for the Levoxyl. I was afraid they'd charge me $70 for 90 days because they initially had it listed as a brand name drug.

When I called Edgepark to talk about getting strips through them the person I spoke to said that I could also get my pump supplies from them but I'd rather stick with Minimed. It's very easy for me to call them and change my order any time I need to. I was going to cancel the one box of Sure-Ts I was getting (3 Sils, 1 Sure-T) but I've been using them more lately so I'll leave it. I found that if I remove the adhesive pad from the connector on the tubing and let it dangle, I can reach around my back and just slap a Sure-T in and still be able to reach the connection. I have one in there now and it's working great, no pain at all. I put a piece of Hypafix over the insertion part for added security since I don't have the connector taped down. It's not really far around on my back but I can't see it if I look at myself straight on in a mirror. It gives me extra sites to use, which is always a good thing.

The Oxford plan we have at work is Freedom Metro EPO. I believe we switched to that from the original Freedom PPO (?) last year. None of the members complained after the switch and it was a lot cheaper than continuing with the original plan.

I heard some noise last night but I fell asleep early (for me) and didn't really look out the window to see what was going on,


Liz,

I can't quite figure out Medco's pricing on some drugs. Three-month supplies of one of my drugs comes out a lot cheaper than twice the retail cost. As for generics a lot of weird things are going on. Someone at Medco told me they review the formularies every quarter.

The Freedom Metro must be a special plan without prescription drug coverage. The Freedom we have is almost identical to the Empire EPO, except for copayments for medical and DME. My son switched to the Oxford Liberty which is cheaper but he has a frozen shoulder and needs PT so it's costing him more than it would have if he'd kept his Freedom plan. We don't have a choice; we take what my husband's employers decide on.

One of the reasons I wanted the Sure-T is that I'd like to try to use different sites. I guess it's almost time for me to place my order.

This post has been edited by Arlene S.: Apr 3 2009, 04:08 AM


--------------------
Arlene S.
Type 1
Pumped with Minimed 1993-2014
MM CGMS 2006-2014
Dexcom G4, June 2014
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Liz
post Apr 3 2009, 04:31 AM
Post #19


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QUOTE(Arlene S. @ Apr 3 2009, 12:06 AM) *
Liz,

I can't quite figure out Medco's pricing on some drugs. Three-month supplies of one of my drugs comes out a lot cheaper than twice the retail cost. As for generics a lot of weird things are going on. Someone at Medco told me they review the formularies every quarter.

The Freedom Metro must be a special plan without prescription drug coverage. The Freedom we have is almost identical to the Empire EPO, except for copayments for medical and DME. My son switched to the Oxford Liberty which is cheaper but he has a frozen shoulder and needs PT so it's costing him more than it would have if he'd kept his Freedom plan. We don't have a choice; we take what my husband's employers decide on.

One of the reasons I wanted the Sure-T is that I'd like to try to use different sites. I guess it's almost time for me to place my order.


Well, despite Empire restructuring of some drugs, at least it's pretty easy to know how much the co-pay will be. I got new prescriptions from my CDE and need to mail in the one for Advair soon and can't find it. When I mailed in the Levoxyl script in February I should have just sent in the Advair as well even though I didn't need it yet. They had a box to check for them to hold the script until you requested that it actually be filled.

I can't remember what our Oxford plan was before we switched to the Metro EPO last year. I know it was a Freedom PPO, supposedly the best one. That also had no prescription coverage although it could have been added but it would have really driven the premium up. I'm in a good position at work because somehow the job of dealing with insurance was dropped in my lap at some point. It means I have a lot of input in what plans we ultimately go with. The broker said that we're allowed to offer a maximum of three different plans. If the time comes when Empire is too expensive overall and my boss insists that we go to another carrier I can still argue to keep Empire, if only just for myself. I can totally guilt him into it if I have to. I do try to keep premium costs down overall, though.

I've really become a big fan of Sure-Ts after discovering how easy it was to slap them into my back. There's no way I could ever manually insert a Silhouette there, or even a sensor. Completely painless even when I sleep on my back. I just have to make sure I can reach the connector


--------------------
--
Liz
Type 1 4/27/87
Minimed Revel 723 + CGMS
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Arlene S.
post Apr 3 2009, 03:32 PM
Post #20


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From: New York
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QUOTE(Liz @ Apr 3 2009, 12:31 AM) *
Well, despite Empire restructuring of some drugs, at least it's pretty easy to know how much the co-pay will be. I got new prescriptions from my CDE and need to mail in the one for Advair soon and can't find it. When I mailed in the Levoxyl script in February I should have just sent in the Advair as well even though I didn't need it yet. They had a box to check for them to hold the script until you requested that it actually be filled.

I can't remember what our Oxford plan was before we switched to the Metro EPO last year. I know it was a Freedom PPO, supposedly the best one. That also had no prescription coverage although it could have been added but it would have really driven the premium up. I'm in a good position at work because somehow the job of dealing with insurance was dropped in my lap at some point. It means I have a lot of input in what plans we ultimately go with. The broker said that we're allowed to offer a maximum of three different plans. If the time comes when Empire is too expensive overall and my boss insists that we go to another carrier I can still argue to keep Empire, if only just for myself. I can totally guilt him into it if I have to. I do try to keep premium costs down overall, though.

I've really become a big fan of Sure-Ts after discovering how easy it was to slap them into my back. There's no way I could ever manually insert a Silhouette there, or even a sensor. Completely painless even when I sleep on my back. I just have to make sure I can reach the connector


I know what my copayments are going to be when I fill the scripts at my local pharmacy but Medco offers discounts. For example, quinipril is $15 per 30 day supply at my pharmacy; at Medco it's $25.29 for a 90-day supply. The reason we use my husband's insurance is the prescription plan. Otherwise we would go with Medicare and a Medigap policy but I take a lot of meds.

The reason they switched to Oxford was Empire's rise in premium costs, which were based on the number of claims the year before. I might have contributed to this with my very high hospital bill. But as I said, Oxford covers everything that Empire did. The only difference is the copayments.

According to my letter from MM I'm not due for another order until the end of the month but I am definitely ordering Sure-T's. Since I insert my sets manually I can insert sils in my back. I'm going to insert my sensor in my stomach tonigh to see if I still get lots of weak signals.



--------------------
Arlene S.
Type 1
Pumped with Minimed 1993-2014
MM CGMS 2006-2014
Dexcom G4, June 2014
t:slim, June 2014
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