Insurance ain’t so great when your insulin copay is $50
My friend has little money. Jim has been coming to my store for a long time, and has job that would be considered “unskilled” because he works in a retail department store. He is always pleasant and its always pained me that as an insulin dependent diabetic, he has to make some difficult choices when it comes to paying for his meds.
DM spares no economic groups, poor and rich alike get afflicted with this disease and anybody who has it (or knows somebody who does) knows that its expensive to be a diabetic, especially when insulin is involved. Newer and cooler insulin and delivery devices have come out to make it “easier” on the diabetic and everyone of them costs a lot of money.
For a while, Jim was covered under his parent’s policy. Then he grew up and lost that insurance. He had a few jobs before this one, but none of them offered insurance. He uses Lantus and Novolin/Humulin. It is hard enough to make ends meet on minimum wage. Throw in a chronic disease for which you MUST take expensive meds to survive and things become way more complicated. Jim was excited when he gave me his new insurance card for this new job he took.
I processed his Novolin/Humulin and it came back $35…not much over the retail price of it. His Lantus came back with a $50.00 copay. $85.00 per month in insulin for a kid making not much more than minimum wage? This insurance isn’t helping too much. Its not like he is doing anything fancy. He is just using bottled insulin and syringes he loads himself, not the pre-loaded pens. He got is machine for free but the strips cost him $35 copay for the box of 100. He has to pay for his syringes.
It bugs me a bit that we have a patient who isn’t making a lot of money, but his insurance isn’t helping much. I dont have a gripe when an insurance puts a tier 3 price on a pricey drug when there are a lot of less expensive alternatives to choose from. But everything that Jim has to choose from is tier 2 or 3. Where are the generics when it comes to Insulin? Will there ever be any? It seems a clever ploy to charge a lot of money in premiums and not have to help the insured much.
At what point does the copay for a drug become too high for the insured to pay? I remember many years ago a major corporation had a 50 cent (yes one-half dollar) copay on every drug prescribed. A big shake down occurred and the copays went to $5.oo, which was actually more standard at the time. It was a big union with a lot of clout. Somehow they lost somewhere. You should have heard the whining and complaining.
Fast forward to 2008. Unless you are on state aid or Medicare-D, good luck in finding plans with copays under $10. We have plans with 50 PERCENT copays on brand meds (tell that to a Temodar or Zyvox patient). Having insurance used to be the safety net. It doesn’t seem to be that way anymore. More and more things aren’t covered, and many that are have copays that make them cost prohibitive. Not EVERYTHING has a generic, and Insulin seems to be that glaring example. For some, its not fair.
Just ask Jim.