Nothing makes me madder than having to arduously fight the insurance bureaucracy to stay alive. And the NPR report I read today has my heart racing with indignant rage on behalf of diabetics everywhere who KNOW what a struggle it is to cry, beg and plead with the insurance company in an effort to coerce them into doing the very thing they’re charged with doing: keeping you alive and well.
If you have diabetes, you probably (like me) burst into tears at least three times per year after ending a call with a customer service representative who insists your life-saving diabetes treatment isn’t covered by insurance. Before you continue reading, get your game face on, because this is going to piss you off.
In 2017, diabetics who get their meds through CVS Caremark or Express Scripts are in for some blood boiling adjustments to diabetes (and other) drug coverage.
NPR’s got the full story, and you can read it here. For my part, I’ll summarize the CVS diabetes drug denial list for 2017 (because it’s bigger than the Express Scripts list), and discuss why denying people the drugs they need to stay alive is so awful.
Both companies are choosing to remove brand name drugs from their formulary and instead are choosing to cover generic versions. Fine. We’re all accustomed to that. That isn’t news. Substituting generic for brand name happens ALL the time. I’m not upset about that.
Here’s what I AM upset about: the prescription insurers are choosing to replace some of your current meds with biosimilar medications (this happens from time to time with all insurers, but not to this degree). Replacing a drug with a biosimilar is NOT the same thing as replacing a brand name drug with a generic drug that has the exact same ingredients. In this particular context, biosimilar means, “Drugs that are designed to do the same thing, mostly, but each drug is actually different from the other, and they each have their own interesting side effects, and there are some people who can tolerate a certain drug but CAN’T tolerate its biosimilar competitor drug(s).”
To see the full list of formulary changes for CVS Caremark and Express Scripts, visit these sites:
(Consider taking a xanax before you click, though. Oh, wait. That isn't covered.)
CVS Caremark Full List of Formulary Changes
Express Scripts Full List of Formulary Changes
For the purpose of this article, I’m going to use CVS Caremark as my example. Below is a table of CVS Caremark’s diabetes treatment changes and what should have been considered (see notes/comments) before implementing the restrictions.
Look, I see biosimilars as treatment options, and I hope I will always be able to get my hands on the best drugs & treatments that will help me, as an individual, control my diabetes. I want options. I NEED options. And so does every other diabetic.
Unfortunately, the insurers see biosimilars as an opportunity to negotiate lower drug prices, which I can certainly understand (diabetes meds are hella expensive), and I *know* there are factors involved in these decisions that I’m not privy to, but, as a patient on the receiving end of these new restrictions, I feel like I’m being stuffed into a regimented care plan box, which will inevitably result in an uncomfortable and less healthful life. I need the freedom to use the treatment options my doctor and I decide will keep me alive for as long as possible. I don’t know how to solve the myriad of problems insurers face with regard to ever increasing drug prices. But I want prescription insurers to realize that what they’ve devised as a viable solution to THEIR problem has created a BIG problem for ME. And I implore prescription insurers to actually care about this.
Look, you guys. It’s an obnoxious battle to try and keep my blood sugar in target range every single hour of every single day, especially when I’m trying to eat healthy, exercise regularly and still maintain a flat baseline. I use three different pieces of medical equipment to stay alive. I use the test strips and insulin that work best for me, as an individual. And I *really* depend on this stuff to stay healthy. It’s difficult, but I’m not gonna complain, because at least I’m lucky enough to be alive. But. I can’t understand why I constantly have to fight my insurance company for the stuff that keeps me alive. This shit wears me down. Makes a diabetic want to just hold up her hands and say, “I give up.”
So, to CVS Caremark and Express Scripts, for restricting diabetes treatment options, and to United Healthcare, for restricting insulin pump options, and to the drug companies who charge way more for drugs in the US than they charge anyone else, I have a challenge for you. I’d like to invite you to spend a few days with me (or better yet, sign up for my Diabetes Education Course) so that you can better understand how potentially devastating your new 2017 restrictions are.
With as much diabetic love as I can muster in this dire situation,