I've recently been introduced to the complexities with insurance companies and patents regarding medicines that don't just treat, but "allow" us diabetics to live!
I'm not impressed.
I started this journey when I got a call from my doctor trying to explain why her prescription was denied. The message was, insurance would not cover my insulin (Novolog), or it WOULD, but it would be at the "non-preferred" price. Meaning for me it would be $75. This is nothing compared to some, but I have a problem... People being taken advantage of or otherwise assaulted, I find simply impossible to resist fighting!
My first reaction was to lash out at my insurance company with statements like:
How can you just "adjust your formulary" for medications that people have adjusted their entire lives around, not just THAT but they need to survive?!
Trouble is, insurance companies are trying to save costs while production companies are trying to boost profits. This is the fundamental issue within the relationship between insurance companies and the companies that offer the solutions.
How in the name of all that is good and pure can WE as lowly consumers help to fight back?
- Do we lobby to enact laws enforcing pricing?
- Do we march the streets demanding such laws?
- Do we boycott the companies producing the medications?
I felt like my right to live had been violated thus I'm outraged!
You may be thinking like I was at this point. There needs to be some kind of legal repercussions around the ethics for medications that keep people alive! Some kind of classification, enforcement of this classification, SOMETHING!!!!
Well... Truth is... Legal action in this type of case only serves to increase costs of the manufacturers and insurance companies thus increasing our own costs. Frustrated? Feeling even more trapped, right?
The trouble here is that our insurance companies are performing the same actions we would take upon ourselves if the local market that we frequent started gouging on milk, bread, etc... We would go somewhere else!
The difference is that insurance companies require medical professionals (in many/most cases through pharmacy benefit managers, aka PBMs, a future article to be sure) to look at each product they are covering for assurances that switching these medications will result in minimum impact to their clients. I so want to call BS on this last statement, but based on my recent experience in the battle of my insurance vs Novo Nordisk US, I simply can't.
The fact is simply by switching to Humalog from Novolog the insurance companies are saving around $220 per vial (or better) and the actual affects of the change have proven minor or non-existent.
A tearjerker to be sure! This young girl is on a brand of insulin that is even more expensive than Novolog called Apidra. Just blows my mind!
Hear Me Out. The Journey Was Enlightening!
For me personally, the switch to Humalog meant adjusting basal (slow, or constant) delivery rates a bit, but my bolus (fast, or "mealtime" dosage) rates seem to be covering my needs just as well as before without additional side-effects. I'd like to point out again that everyone is different and it has been documented that people are allergic to certain brands of insulin. For me, this change has had minimal affect on my life so far. However, when I adjust my basal rate, my bolus rates very likely will need adjusting as well.
Does that mean I'm suddenly ok with this type of sudden change? Absolutely not!!! It just means that during the course of my outrage, I've reached a level of understanding.
In my mind insurance companies (and/or PBMs) should NOT be the ones changing medications and price shopping at ALL, let alone for life giving/saving medications. For me it's no different than you or I walking into a market and finding our most basic products (i.e. milk, bread, water...) at a price of $100 vs the next market offering it at a price of $5. The decision should be up to you and your doctor! Where would YOU go?
In truth, I feel the fact that insurance companies exist to be offensive. They exist because of the extreme cost of vetting the product(s) through, basic tests, animal tests, human tests, finally running all of that through the agency or agencies for approval, and finally distribution along the way.
This sounds like I'm advocating for just creating a product and sending it out there! I'm not. All I'm suggesting is that "human" prices be established for these processes, not "government" prices.
I have personally been a part of companies with government contracts where I heard statements like, "it's a government contract, we need to use ALL of the money!"
To put it bluntly... To me that is stupid! If it's government or individual producing bread, why would the prices vary just because one CAN pay more? I know why, it's just absurd to me!
The brutal reality is that we currently live in a world where money is king which causes insurance companies, the "go-betweens" (aka PBMs), and manufacturers to be in a constant fight with each other as well as with their individual clients.
That doesn't mean, we as the affected, are without power or the ability to contribute to change!
Even now the government is looking into the effectiveness of PBMs.
Call to Action
I will post more as I learn, and I appreciate any insight, advice or even your stories that you'd like share.
At this point public outrage on social media is about all I can offer as advice because, believe it or not, it DOES get noticed as it shines a light on the situation and focuses us as a people!
I look forward to your comments, suggestions, and stories.