QUOTE(Liz @ Dec 18 2008, 10:35 PM)
I really hope the transition to your new coverage goes well. Empire really has been great as far as covering diabetes related things. I had Oxford before Empire but it didn't have a prescription plan. People told me that they were still required to cover certain diabetes related supplies but I could never get an answer from them about how to do it. I didn't know anything about it at the time but I guess I needed to get strips covered as DME. Oxford kept telling me to get a prescription and send it to their mail order pharmacy, which then rejected it because I didn't have prescription coverage.
I just got the new card & pharmacy info from Empire tonight. Not only did they move Humalog & Novolog to the brand name/Tier 2 co-pay but they even put OTC human insulins in the same category. I'm pretty sure you can still get a bottle of NPH or Regular for less than $35. AND, they've moved test strips to the same tier. The only good thing I saw is that Levoxyl is back to being listed in Tier 1. When I checked online it was in bold and was shown to be the brand name co-pay.
When I had problems with the way my insulin prescription was written a few years ago my CDE ended up writing it for 3 vials/month so I haven't been getting it refilled every 3 months. I was going to ask her to write for 2 vials/month but now I won't bother since the co-pay has more than tripled. Might as well get the extra vial and refill it 3 times a year instead of 4.
Thanks. I hope the transition is smooth but I doubt that it will be without problems. I can't do anything yet because the contract will be signed tomorrow and I won't have a card or an account number until next week.
We had an Oxford plan years ago and there were no problems with getting strips as DME but they wouldn't cover pumps (my first pump was about to go out of warranty) or pump supplies. I appealed using the NY State mandate to back up my appeal. I even wrote to the state insurance commissioner. Somehow I won my appeal in spite of the insurance commissioner and my claim got paid. Months after I received a check for $800 from Oxford, I received a letter from the commissioner telling me Oxford didn't have to pay. It was such a hassle. It was a different plan and they were an independent company at the time; now they are owned by United Healtcare. Still I was shocked and upset by the change.
My ENT and my husband's allergist are the only doctors we use who are not on the new plan. The prescription drug plan is similar to that of Empire. Novolog and Novolin vials are the only Tier One insulins ($15 copay). Novo pens and cartridges are Tier Two. Even Humulin ($54 at drugstore.com) is on Tier Three with a 75 dollar copay. (The only advantage to that would be if one would get several vials at a time.) Apidra isn't even on the list. I'm going to stick with my three vials of Novolog at a time but what with stockpiling I won't need any for a while. Synthroid is Tier Two but I think it costs less than $35. It's the sensors that worry me. I should have stockpiled them. Instead I ordered them every two months.
I've been very happy with Empire but apparently the firm switched because Empire's rates went up 23%. Until this year the employees of the company my husband works for had a choice. This plan is also an EPO. This time there was no choice. The customer service at Empire was great. I just ordered my last prescription from Caremark. Oxford uses Medco. I hope they are as efficient as Caremark. And I hope they accept electronic submissions.