This was a particularly aggravating week for both my patients and insurance companies. The new year has brought copays and deductibles to many of my Part D patients. Most of them had no idea that they now had a $200 deductible and swore that their plan did not tell them that. In addition, some of our patients had only $2800 worth of drug benefits before they went into the donut hole and for one of them it meant he met it in the first 12 days of the month.
But the most frustrating thing that I dealt with all week occurred on Friday when I started a patient on a new V-Go delivery device. These devices are preset to either deliver 20, 30, or 40 units as a basal rate over a 24 hour period. Because of the newness of these devices the clinician had to obtain a prior authorization. This is very routine these days and no problem was expected. However, this one got really goofy really fast. The PA was written for the 40units/24hr device. I am not sure who oversees these approvals but this patient, who was on 100 units of insulin a day, was told they could only get the V-Go 20 with a basal rate of 20 units/24 hours, with the reason being given as step therapy. Evidently, the insurance company thought that these devices were medication and the fact that the patient was on 100 units/day meant nothing, he had to start on the 20unit/24hr V-GO first. What made this even more ridiculous was that the cost of the 20, 30, or 40 unit devices are the same, and they now still had to pay for Lantus and Humalog because we had to background dose the long-acting one to control his levels.
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Dave Joffe, Editor-in-chief