Pharmacy and Health Insurance Tips

Learn to navigate your health insurance coverage and make your plan work for YOU.

Talk to your endocronologist/doctor about adjusting your prescriptions

Ensure that your prescriptions are written for the proper amount of each item you need.  If you are running out of supplies each month (or near it), you should ask to have the amount in your prescription adjusted.  Since different people need varying amounts of insulin and other supplies, most prescription amounts can certainly be adjusted to match your needs.  Many plans charge a flat rate per month (or 3-month supply) so the increased supply could cost you exactly the same amount! 

Prescriptions for CGM sensors and pump sites can also be adjusted to be changed more frequently than the standard time set by the manufacturer.  Fpr example, the Dexcom G6 sensor is marketed to last 10 days, but the prescription can be written to cover sensor changes every 7 days.  If you know you are going to meet your deductible regardless, this would be an additional FIFTEEN sensors a year for the same price!*

*By doing so, you will incur more costs upfront, but you will meet your deductible quicker, allowing you to build a larger supply, and many medical distributors offer payment plans to help defray the costs into the future.

PharmacyUse a mail order pharmacy

Check if your health insurance plan covers the use of a mail order pharmacy and compare the cost of your monthly supply to their 3-month cost.  Many mail order pharmacies will provide a discount and only charge the cost of 2.5 months’ worth of a 3-month supply.  For example, a month RX of test strips that costs $20 woul be $50 for a 3-month supply ($20*2.5). 

Added benefit: the insulin comes right to your door with some free freezer packs!  Some retail pharmacies are trying to compete and are starting to offer their own 3-month supply deals, so be sure to do your due diligence and compare prices with your local pharmacies as well.

Refill your prescriptions as early as possible

Pharmacies will let you refill most prescriptions a couple of days early (and maybe even more than that for 3-month supplies).  Most auto-ship programs don't ship early so you may need to manually re-order.  Keeping notes in a planner or reminders in your phone is a quick way to schedule it for the future and get it off your mind.

Emergency refills are also under offered under certain conditions, such as during hurricane warnings and state of emergency executive orders, so check your local laws to proactively know what you are entitled to during emergencies.

Tip: If you have met your deductible and are trying to maximize your diabetes supply stock, aim to get your last 3-month order right before your plan ends/deductible resets.  If your ordering cycle doesn’t line up that way, it may be wise to order a 1-month supply once or twice so that your last possible order is that larger 3-month supply.

Anaylze the tier/cost program for your prescriptions

Insulin vials and pens can fall into different tiers and drastically change the cost of your prescriptions.  Vials usually fall into a lower, cheaper tier than pens.  This could influence your choice of the two if you are on MDI.  Often when you switch to a pump, you'll end up with more insulin at a cheaper rate (since vials tend to fall into a lower cost tier and endos tend to prescribe plenty of backup insulin for potential pod issues).  The difference in the cost (and the amount) of insulin that you would get in pens vs. vials and for MDI vs. pump could make a big difference in your therapy decisions.

Check if your CGM or pump is covered via pharmacy benefits or as durable medical equipment (DME)

Depending on your insurance plan, CGMs and pumps can be covered through two different options: pharmacy benefits (as a prescription) or as durable medical equipment (DME), which is ordered from a medical distributor.  If covered under pharmacy benefits, you would need to check what tier it falls under and the cost of prescriptions in that tier.  If covered under DME, you will need to check how your insurance plans handle DME benefits, as it varies per plan and depends on the deductible and co-insurance.

Other Ways to Save Money

  • Check if any of your medical supply manufacturers offer cost-savings cards. Baqsimi has one for their nasal glucagon here.
  • Check if your CGM and pump companies offers financial assistance, such as Omnipod (based on income)
  • Ask hospitals if they have any financial assistance programs
  • Set up payment plans for medical bills
  • Take advantage of a FSA or HSA if your health insurance plan offers it