LogFAQs > #876635314

LanHikari10 posted...

Oh god yeah insurance can be awful sometimes. Some insurances will throw a fuss if you try a refill too early, some won't do more than a 30 day supply, occasionally it'll just reject for seemingly no reason and you gotta figure it out. Insurance is like a whole different world. There has gotta be a better way to do it, because I don't think anyone really likes dealing with it.

Speaking of this: Let's talk long-acting insulin. Say Lantus Solostar.

Some patients on it only use around 10 units a day. So a box of pens (15 mL/1500 units) lasts well over 90 days. And probably the majority of patients use less than 50 units a day, so a box lasts more than 30 days.

Sanofi, if asked, will explicity direct you that Lantus Solostar should always be dispensed as a sealed pack of five pens. Insurance companies, however, will limit patients to 30 or 90 day supplies, as always. Additionally, it's very common than Medicare D plans charge another monthly copay (often $47 or so) the moment the days supply exceeds 30 days or 60 days (so 31 days costs the patient literally twice as much as 30).

So do you:
a) Incorrectly dispense the product as individual pens to satisfy insurance limits and minimize patient costs
b) Falsify the days supply because there is no way to dispense a 30 day supply or less to a patient that only uses a little insulin
c) Call up the insurance company each time this occurs and explain that you cannot dispense the days supply they are asking for and get them to override it
d) Something else

I already know it's not c because that's a joke option, so maybe you have some idea as to how this farce is supposed to work.
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"That is why war is so tragic. To win means to make victims of your opponents and give birth to hatred." - Kratos Aurion, Tales of Symphonia