# The Medicare maze



## Son_of_Perdition (Nov 12, 2015)

Had a little case of sticker shock this afternoon.  I have started using my last vial of long acting insulin two weeks ago.  I get it in a 30 day supply vial and I also take a short acting insulin at meal time in 60 day vials.  I have plenty of SA to last until Dec 31, 2015.  I called Walgreens for a 3 month refill and when I went to pick it up I was floored by the cost.  Over $800.  Seems like I am in the doughnut hole and need to pay full price.   The short acting is less costly somewhere near $345 or $172.50 monthly.  Monthly retail costs for both is $441.50.

I began researching because I had a feeling the PC Doctor was prescribing the most expensive insulin for whatever reason.  I found I can buy a intermediate acting insulin for $25 a vial (30 day) supply outright without a prescription at Walmart.  It has been used since the early days of insulin and made by a reputable drug manufacturer.  The intermediate works for up to 12 hours so instead of giving myself 4 (3 SA and 1 LA) shots a day I can now give myself 2.  

My A1C was 5.4% - great, below the 6% they want you to shoot for.  My average BS count was 108 for the same time period.  Based upon my counts, the results of the A1C, my diet and my commitment to resolving my health concerns, I can see no problem with a change to the lower cost insulin.  I use Walmart's brand of strips, meters and syringes anyway.  My meter shows exactly what my PCP's shows or at least in the same ballpark.  I have existed for the last 100 days on a 1500 cal/100 carb diet daily and plan to remain on that until I expire.  

Based upon the insulin costs I will hit the doughnut hole each year sometime in July and that doesn't include anything else.  Note, I do have a drug supplement plan but no plan pays while you are in the Medicare hole.  Mine is limited to $3310 annually and if my drugs retail at what I found on the receipts I will easily pass that limit every year.  We called our Healthcare Vantage Plan & found out that I can continue to purchase the same syringes, strips, meters and insulin at Walmart and probably only pay a small monthly fee (much less than the sum of everything) by getting my prescriptions moved to Walmart rather than Walgreens.  And it's within walking distance.

Getting to understand Medicare, Healthcare plans and the creative accounting done by the government is nothing short of trying to become a Physics professor.


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## RoseLight (Nov 12, 2015)

Sounds over the top expensive and quite complicated.  I am not going to think about until absolutely necessary.  Good luck and happy you found a better option to minimize cost at Walmart.


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## Son_of_Perdition (Nov 14, 2015)

Medicare drug coverage is another maze that only the brave should enter.  I explained about the sticker shock I experienced filling my insulin prescription at Walgreens the other day.  I have dedicated myself to the task of trying to understand the limits and coverage I had and will have in 2016.  My health plan has several plans.  First I found out that our plan is not the preferred provider for Walgreens but is for Walmart.  So I was paying high end retail prices.  

My provider had a plan for diabetics and have moved me to that plan for 2016.  The old plan didn't pay for strips, something every diabetic has dealt with and is a must for management of the malady.  They can be anywhere from 18.2 cents up to $1.15 each.  I researched and found that Walmarts were totally acceptable along with their meter, but without all the features.  Your main concern is the count, everything else is fluff.  I had a small amount of strips the hospital had 'given' me ( I was charged full price for them later on my final bill).  I used the few I had left for an arbitrary double check of my count over the following few weeks.  Same results were noted.

They will now pay something for everything needed insulin, strips, lancets & meters.  Then comes the doughnut hole and the government's gotcha.  (That's what caused my sticker shock.)  The magic numbers for the doughnut hole is $3310.- $4850 & you pay a co-pay of any drugs beyond the upper limit.  Switching over to Walmart's pharmacy and changing my insulin to the lower cost intermediate brand and having my provider run everything through the system, I will have to pay out-of-pocket co-pays of only $360 annually without a concern of the diabetic supplies pushing me into the doughnut hole.  If I had stayed with the same pharmacy and same medication I would have to come up with an additional $2,480.00 annually.  $30 monthly versus $206.67???  Also the new plan has a $.00 monthly premium beyond what is held out of my SS, the old plan was going up by $19.


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## Mrs. Robinson (Nov 14, 2015)

I just went through this myself this last week. I have been getting my prescriptions at Walmart for several years because their insulin is so affordable and my other prescriptions were all $4.00 each. But now that I have Medicare and with having breast cancer,I have more prescriptions,so decided to have my prescriptions transferred to my local grocery store instead,given that our closest Walmart is 40 minutes away. I had to have a couple filled when I was sick last month-antibiotics and such-and the cost for each was $4.00,so same as Walmart. So I had them transfer all my precriptions. Went to get my insulin the other day and it was $220.00 for the 8 vial "package" that they filled. What about my insurance?? I already met my $320.00 deductible earlier this year. Ooooooh,the "donut hole" thing,apparently. I`m so confused. But I do know that I would pay $199.04 at Walmart for the exact med (Novalin N) that Safeway says has a retail price of 500 and some dollars. So it looks like I am going to be going back to Walmart-at least I can buy the insulin one or two vials at a time there. SOP,I have a question. Is Novalin N the one you get as well? I always thought it was long acting. I had never heard of intermediate acting insulin. But that would be good for me as well as I could split my dose up into two shots a day,which my doctor had talked about having me do.


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## Son_of_Perdition (Nov 14, 2015)

Mrs. Robinson said:


> SOP,I have a question. Is Novalin N the one you get as well? I always thought it was long acting. I had never heard of intermediate acting insulin. But that would be good for me as well as I could split my dose up into two shots a day,which my doctor had talked about having me do.



I have been looking and researching Novalin 70/30 which is the intermediate.  Don't take this to the bank but as I understand it you take it twice a day 1-2 hours before meals.  If I take one at 6 AM then again at 6 PM,  (I can only assume it is like a controlled release and stablize my BS at the mid-day meal),  I will be eating around 7-8 AM - Noon- 1 PM and again at 7-8 PM.  Each dose contains a portion of short acting (SA) and long acting (LA) & lasts up to 12 hours.  I will still need to monitor my BS before each meal and at bedtime.  *I HAVEN'T TALKED ABOUT THIS WITH MY PRIMAY-CARE PROVIDER YET!*, it looks like I will need to make another visit before the end of the year.   I talked with the druggest yesterday about price, he quoted me $28 retail for a 30 day (?) supply, compared to $441 for Lantus/Novolog.   

I was going to get a permanent magic marker and draw a grid on my stomach for a insulin target, my wife thought I needed to get a life.


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## Mrs. Robinson (Nov 14, 2015)

Son_of_Perdition said:


> I was going to get a permanent magic marker and draw a grid on my stomach for a insulin target, my wife thought I needed to get a life.



Well actuallywha happened was,I saw an Endochronologist at my Primay`s suggestion,just to see I maybe he/she would want to change my meds to something "newer". he ended up prescribing me insulin pens-70/30 Novalog. I picked up the prescription and it was $108.00 for a 15 day supply! That was my first "insulin/donut hole" shock. But he prescribed what the pharmacy tech said were the incorrect syringes for the pens,so they are sitting in my fridge unused as it took 9 days for the Endo to call me back to get it corrected! So I had told them to go ahead and just refill my Novalin prescription so that I had SOMETHING. But 70/30 is what he actually wanted me to try. I was trying to ask him if there was something a little more reasonably priced that would do the same thing-and I don`t need it to be a pen,I have no problem with regular injections- but A)There was a bit of a language barrier and B) Doctors apparently have no clue about the cost of drugs-or at least this one doesn`t. I may have to just talk to the Walmart pharmacist to get what I need.


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## SifuPhil (Nov 14, 2015)

I know this isn't very fleshed-out but I take Levemir once a day (16 units). The retail cost shows as $225 for 1000 units (10 ml) - roughly a 2-month supply - luckily (?) I am on a program for low-income types so I don't pay a penny, but I know that if I'm still on it in a few years I'm going to have to start paying attention to things. 

Oh joy.


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## Son_of_Perdition (Nov 14, 2015)

When I first had to face the reality that I was a full blown type II diabetic while in the hospital they wanted me to watch a few videos.  I watched them with my wife at bedside.  "So, you have diabetes?  You are not alone, we are in this together you, your doctor, your pharmacist and your family/friends."  First lesson learned was that you are the one in control of the management the rest are bit players.  You have to monitor, record, chart your carbs/calories and research what you are supposed to do.  

One of my neighbors stopped by, he was also type II and after telling him what I had learned he became frustrated and upset because he had been told he was diabetic and now he has to watch his sugar, not much else.  My sister also Type II said she went to classes and still never was made aware of some of the things I had learned on my own.  She was unsure of the restrictions and different type of carbs (slow digesting or rapid) what some fruit & vegetables can do to your tests.  No one had the idea that strips are not an exact science and has a tolerance of 20% high or low, the strips react to altitude and humidity, chemicals and dirty hands.  When to take your tests, pre-meal, postprandial, 3 hours after injections.  How an A1C results happen.  Nothing, I guess it depends upon your healthcare system. 

I found positive results with apple cider vinegar, cinnamon, flaxseed, steel cut oats are better than rolled oats, now my recent discovery of hemp hearts/seeds are beneficial for BS.  Can't eat potatoes sweet or russet.  Carrots and peas play havoc with my spikes.  Bread in any form sabotages my diet and BS.  Meals at Olive Garden are very restrictive.  Nuts and berries in small quantities are also a plus but too many can put you in 'Gimble Lock'.  I did learn one lesson you are your best support and what works for some don't necessarily work for you.  It all trial and error, and when you find something that works you have to convince your support that doing or eating it everyday is a must, anyway for me.


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## SifuPhil (Nov 14, 2015)

How very true.

I only learned of my diabetes after a hospital visit several months ago, and they gave me a pamphlet - that's it. I think it was printed in 1949.

I still have no idea what A1C is, but I'm an old-school type who believes that if it wasn't being spoken of a few years ago then I have no interest in knowing it. No idea if the amount of insulin I take - or the associated meds - are the right dosage, as I haven't been to the doc in over 2 months. And don't get me started on strip testing - that is truly one of the banes of my existence. Of course, I don't monitor or restrict my diet any way close to what you do - if it doesn't move, I eat it.

And I'm NOT talking veggie diet, here ...


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## Son_of_Perdition (Nov 14, 2015)

When we were at WinCo discovering hemp hearts, we were checking out and the clerk asked me if I was a veteran, yep I replied.  She then told me I can go to the bakery and get a free doughnut.  I laughed and said being diabetic I don't think that would be a good idea.  I then asked her if I could go get a free steak instead.  She tilted her head and said I'll bet they never considered that, I bet a lot of the older veterans would have diabetes.  I said a salad bar made more sense.


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## Son_of_Perdition (Nov 17, 2015)

Just back from my visit with my PC Doctor, consulted with him about changing my long and short term insulin & changing pharmacies because of the 'Preferred' pharmacy of my Healthcare Vantage Plan.  I had been taking Lantus & Novolog together at a full retail price of $441 for a month's supply.  My new insulin Novalin N and Novalin R retails for $24.88 each at Walmart for a month's supply.  You take the same dosage of each 30 U and 5 U.  I asked about the Novalin 70/30 but the doctor indicated it was too hard to regulate the mixed doses.  

So the figure of $441 is no longer on the table and now I'll have a $49.76 retail expense, I should never hit the doughnut hole at these current levels.  I was paying a $15 co-pay at Walgreens and the co-pay at Walmart will probably be 1/3 of that $5.  I figured to hit the doughnut hole sometime in July on the former medication versus never reaching the hole on the current medication.  My out of pocket expenses will be $360 deductible + $60 pharmacy co-pay against $360 deductible + $180 co-pays + $426 extra monthly full retail price.  $420 vs $540 + $2130 = a difference of $2250 annual savings.  Now figuring the 25% co-pay I would have to come up with when I reached the upper limit of the doughnut hole.  $4850 - 3310 = ($2130-$1540=$590X.25=$147-$2250=$2103)  Saving $2103 of the projected out of pocket expenses above what I will pay for the new medication.


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## hossthehermit (Nov 18, 2015)

In the process of signing up for Medicare right now, got a seminar to go to this afternoon ................Seems like every day I get 3-4 offers in the mail for supplemental and prescription coverage, turning 65 in January ........... My wife is hoping I live long enough to walk her thru it in another 10 years


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## Ken N Tx (Nov 18, 2015)

hossthehermit said:


> In the process of signing up for Medicare right now, got a seminar to go to this afternoon ................Seems like every day I get 3-4 offers in the mail for supplemental and prescription coverage, turning 65 in January ........... My wife is hoping I live long enough to walk her thru it in another 10 years



Some advise.....do your homework!!!!!!!


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