Shifting Coverage

I have diabetes.  If you do too, don’t be secretive about it.  You should let people around you know, so if you experience side effects such as passing out or becoming less than lucid, they’ll have some idea what’s going on.

As with many people who have diabetes, I take a lot of medicine for it and the medicine is expensive.  I’m fortunate to have excellent prescription drug insurance, although the company that manages that coverage for my supplemental drug plan leaves a lot to be desired.

Lately, they’ve been changing the formulary for what drugs they cover.  Sometimes there are good reasons for that.  Sometimes. Less so.  As an example, if your doctor wrote you a subscription for Synthroid, a medicine to help with thyroid problems, and allowed the pharmacy to fill it with a generic, you still got Synthroid, which is a brand name.  Why?  Because Synthroid was judged to be more effective than any of the generics available.  That’s changed this year.  Now, if a generic is allowed, I get a generic.  So, I hope the generics are improved.  I guess we’ll see with my next blood test.

The latest issue is with another brand-name drug, Invokana.  Although my insurance has been paying for it over the last six years or more, and paid for it in February, they’ve decided they won’t anymore.  They will pay for Jardiance or Farxiga.  Nobody told me if it’s because those newer drugs are more effective in lowering blood sugar, because they’re less expensive, or both.  It’s not because the replacements are generic.  Both are brand names as well.  And make no mistake, Invokana is expensive—somewhere between $500 and $600 a month for the dosage I take if I buy it at retail.  I’m pretty sure the insurance gets a discount though.

I’m all for reducing cost.  I try to do it in my personal life, and I used to be a municipal auditor and a municipal treasurer, so I did it in my work life too.  The problem is, Invokana is superior to Jardiance or Farxiga in at least one respect.  I’m neither a doctor nor a pharmacist, but from what I’ve read, Invokana has benefits for the kidney disease that often results from diabetes while the alternatives do not.

So, not I am jumping through hoops to get my doctor to get a prior authorization and get my prescription filled before I run out of pills at the end of next week.  And because of the COVID 19 pandemic, it’s harder to find hoops or to find someone to hold the hoops so I can jump through them.  I hope this is all resolved within the next two weeks, before I run out of Invokana and/or patience.

Author: Tom

I know by ABC's, I can write my name, and I can count to 100.