What You Probably Don’t Know About Prescription Medications

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If it doesn’t scare you enough to be pre diabetic, the prospect of being on multiple lifelong medications should shake you up a bit.

Aside from the fact that adults with diabetes fill about 4 times as many prescriptions as the general population, they also end up spending much more money on diabetic products within the drug store.  Diabetic patients are some of the most sought after patients in Pharmacy. I have talked to Pharmacy Executives that anticipate the average diabetic patient spending $350 in non-reimbursed products every time they come in for their medications. These are products where they have profit margin and it’s the reason they actively pursue the diabetic patient.

When you are on prescription medications over the long term, the costs associated with them are only part of the battle.  Dealing with doctors, pharmacies, and insurance coverage is not a fun process.

Here is a scenario that the Diabetic Patient routinely faces:
What to do when your insurance company decides they are no longer going to cover your established insulin:

Essentially, this means they changed the item on their formulary primarily because they have a better deal from the manufacturer of the new item..  It’s the one that you are used to taking.  The manufacturer of the drugs typically try to get the payers to put their products on various plans.

The impact to you, the patient?  Confusion, potential for a gap in your medication compliance, and multiple calls to the pharmacy and doctor to make sure you still get what you need.  Have you ever received a letter in the mail saying, sorry this is no longer on your plan?  Or even worse, you arrive at the pharmacy to pick up your scheduled refill and they announce that there is no longer coverage?  So were you just going to say “oops, sorry, it’s a Friday and we can’t fill your insulin?”  (FYI, insulin is a refrigerated item in many cases and isn’t likely to ship overnight from most distribution centers if it is over a weekend).  Luckily, my father had a few days left in his vial.

Ideally, your pharmacy will be on top of it and contact the doctor when an regular prescription had an issue with refill or the refill runs out.  However, what I am starting to see with these new “automated” refill programs, the process loses the manual aspect of them having a clue what the status is on your medications until it is too late.  The idea of their prescriptions coming from a “central fill” location already labeled and filled for the patient makes me think the pharmacist may be less engaged.  Which is one of the benefits of central fill for pharmacy chains, to “free up” the pharmacists time to spend it with the patient.  I guess spending the time talking about the script that wasn’t filled wasn’t part of the plan.

I have come to this conclusion that pharmacists and doctors don’t like it when we have intelligent questions about this very frustrating process.  When I ask, what could we have done different here?  Or who is responsible for keeping the process seamless?  They get defensive, but finally confirm, ideally, it is them who should notice a drop in coverage and initiate a change or a call to a doctors office.

What you can do to help make this process flow smoothly:

  1. Contact the doctors office immediately if you get a notice of a medication that will no longer be covered.  They can then make the change to the prescription and call it in.  If there is no letter or notice and the pharmacy alerts you of the rejection, confirm if the pharmacy will contact the doctor or if they are relying on you.
  2. In the case of an item simply changing coverage with no alternative available, contact your insurance company and plead your case.  Many companies will cover it.
  3. There are moving parts here that all need to come together.  Stay close to your insurance company, the pharmacist, and your doctor and make sure you understand what their expectations of the patient are in cases of medication changes.

Jumping back on my “why you don’t want to take pre diabetes lightly” soap box – if you make the necessary lifestyle changes and manage your blood sugar, you are less likely to have to deal with any medication to begin with!  Don’t let yourself be exposed to a process that will treat you like a cash cow.  Save your time, your money, your sanity and take control while you still have it.

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