TLDR: chose wife’s materially more expensive health plan because it covered Novolog and that was game changer for me. Got letter saying they won’t cover Novolog in 2019. Is this legal? Am I screwed?
Longer version: I’ve had diabetes for the last almost 20 years. Initially I injected regular/NPH, and then humolog in a pump. 16 years ago a doctor suggested I try Novolog in my pump as I’d had some crystallization that resulted in linked sites, infections, and slower absorption. I know it’s a bio similar, but when I switched to Novolog it seemed to start working 10 minutes quicker, my post-meal spikes topped out around 160s rather than slow 200s and my HbA1cs improved from mid 8s to low 7s. This difference was amazing considering this was a biosimilar that is theoretically the same. I’ve continued to use Novolog since 2002.
I’ve been on my wife’s company’s insurance for the last 4 years. We live in the US in Mew York and both of us work full time for large (tens of thousands employees) companies that offer UHC as insurance options for employees, but they are different plans. My company’s insurance is flat rate premium of $380/mo for a couple ($4,560 annually) with a $750 deductible whereas my wife’s is a percent of her salary which would end up being $10,400 annually. Both companies have different levels of coinsurance and prescription cost and so during open enrollment this year I modeled out the financial impact of each plan over our last several years or insurance use. Both plans had a website to check the level and cost of prescription drugs which mattered as I take insulin plus 4 other drugs regularly. In the end I could have saved $5/6k on the premium if we went on my company’s plan but likely netting out to only $3,300 savings once the higher prescription costs of my company were factored in. Then I saw on my company’s UHC plan information portal that Novolog was not covered. This was a deal breaker for me.
I get that Humolog should work the same for me. That being said, it didn’t 16 years ago. I got hospitalized a year ago after getting a stomach bug and ending up with my worst A1c since diagnosis. My last 2 A1cs were just above and below 7% and I’m working toward a goal running in the low 6s by utilizing new tools like the Dexcom G6, my tandem X2 pump, and some aggressive monitoring alerts with my Apple Watch and Sugarmate.
So, since my company’s plan only covered humolog my wife and I decided to continue with her (significantly more expensive) health insurance because it would cover (via mail order only which was fine) Novolog. We enrolled in mid November and everything was all set.
This weekend I got this letter, https://imgur.com/gallery/XPul3Bh , which says that as of Jan 1 my wife’s insurance plan through UHC won’t cover Novolog and that I have to switch to Humolog. Let’s put aside my extreme reluctance to go back on Humolog. Let’s make a big unknown assumption and pretend that it’ll work fine for me. WTF is UHC doing here? Is it legal for them to notify plan participants immediately AFTER they elect coverage that the rules have changed and that coverage levels are changing? Who should I be complaining to: is it my wife’s company’s HR department?, the UHC plan administrator? UHC corporate? Some government agency? Someone else? I’m super pissed that I’m going to be paying thousands of dollars more and still not being able to take the drug that has worked well for me since 2002 and that my doctor prescribes for me. What are my best options for either getting Novolog covered or trying to elect my company’s cheaper insurance without anything illegal or crazy over the top (ie. Not looking to switch jobs, get divorce on paper, or have kid). I believe I can fill one last order of Novolog via mail order December 30 Or 31 and so I might ask my doctor and see if he’s willing to update my suggested dosage to bridge me as long as possible into 2019.
Social Plugin