Living with diabetes blog

Diabetes prescription challenges

By Nancy Klobassa Davidson, R.N. and Peggy Moreland, R.N. February 4, 2011

As a nurse educator, I'm not a medical provider, and I'm not able to write prescriptions for diabetes supplies. But I've witnessed the hassles that patients experience with diabetes products. You may need to continuously address these types of issues with Medicare or Medicaid, with multiple insurance plans who provide varying coverage, and with different types of pharmacies. It can be challenging.

Here are some examples of the challenges I've witnessed with diabetes supplies and prescriptions:

  • Mail order pharmacies often require a 3-month supply of a prescription. You might have to wait a number of days for the order to be filled, and meanwhile you go without the prescription. Alternatively, you can get an additional prescription for a 1-month supply to be filled locally. However, this option may be more expensive or may require you to pay out-of-pocket. As another option, in some cases, your doctor might be able to give you some medication samples to cover the gap.
  • The doctor may be uncertain of various types of diabetes supplies and products and may recommend the wrong item or one that your insurance doesn't cover. Check your health insurance plan for specific coverage of durable medical devices. And ask a certified diabetes educator (CDE) at your health clinic if they know the preferred providers in your area for diabetes blood glucose testing supplies.
  • You might be asked by your doctor to test a certain number of times a day, and the insurance company may not cover that amount. For example, if you're on an intensive insulin program, you might be asked to test six to 10 times per day, and an insurance company may only cover three to four test strips per day. Your health care provider can sign a medical waiver to cover extra blood glucose testing supplies if medically necessary. Many insurance companies require proof of extra testing and may request copies of blood glucose meter downloads or record books.
  • Diabetes mail order companies may switch products on you — and it may be to an inferior product. Try calling the company ahead of time to be certain you're given the product you want.
  • The cost of diabetes supplies and medications, even with insurance coverage, can be expensive. You may want to ask about whether a generic option — or two, if replacing a brand name combination drug — are appropriate for you. You also might ask if insulin is an option instead of multiple oral diabetes medications or other non-insulin injectable drugs, which may be more expensive.
  • Pharmacies may require a single dose for the insulin prescription. This doesn't allow flexibility for you to adjust the dose to goal-range, adjust for illness, or adjust for differing insulin-to-carbohydrate ratios. Ask your health care provider for an initial insulin starting dose with a range, so dose adjustment is feasible.

What have your prescription challenges been, and do you have any coping tips to share?

Have a great week,
Nancy

11 Comments Posted

Feb. 04, 2011