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Navigating the Diabetes Insurance Highway

Feb 17, 2012

Recently we had a patient who was trained on the insulin pen as a new onset diabetes patient in an inpatient setting. The MD wrote the orders for Novolog pen with appropriate orders. When the wife went to the pharmacy the co-pay was more than she wanted to spend so she asked for a more reasonable co-pay option. The pharmacist offered Novolog by vial. What was missing was…

a prescription for accompanying supplies. So the patient went home with a vial of Novolog and no syringes or needles. Obviously the patient and wife were confused and sat for two days at home without insulin administration, choosing not to test his glucose since they knew they didn’t have a way to inject the insulin, until the Home Health nurse arrived.

The Home Health nurse reviewed syringe technique with the patient and they ultimately chose to go with the pen. The Home Health nurse expedited the original Rx and reviewed the sliding scale and glucose results from fingersticks. The patient is doing well.

Lesson Learned:

Navigating what doctors prescribe and what insurance companies charge for co-pays can be a major problem. Copays can range from no cost to more than $100, depending on which tier the medication is in. With so many insurance plans it can be difficult to know what the best treatment and lowest cost for the patient can be.

With the difficulty of navigating the insurance highway of benefits, co-pays and different tiers, following up with patients is imperative. The Home Health nurse visit truly averted disaster.

Janet Howard-Ducsay RN CDE

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