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Subject: [Hangout - NYLXS] Time to end the kickbacks and the control
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Why Am I Being Asked to Change My Test Strips or Meds?
Learn what=E2=80=99s going on behind the scenes that could affect your
prescriptions and your health=E2=80=94then find out how to fight back.
By Mark Harmel No Comments
Why Am I Being Asked to Change My Test Strips or Meds?
Mark Harmel, MPH, CDE is a diabetes educator and clinical research
coordinator at the USC Westside Center for Diabetes and a contributor
for Medscape. His public health training drives his interest in soda
taxes and participation in the Diabetes Prevention Program to prevent
type 2 diabetes. Mark=E2=80=99s research projects and patient education foc=
how people with type 1 diabetes can best use continuous glucose meters
and insulin pumps. -at-MarkHarmel
Did the New Year bring a letter from your insurance company telling you
that you have to change the brand of glucose meter, oral medication, or
insulin that you use? You are not alone, but why does this happen and
who is responsible?
You can thank your pharmacy benefit manager (or PBM). These are the
companies who partner with your insurance carrier who claim to have the
goal of reducing drug costs and improving care. Your PBM is likely to be
Express Scripts, CVS Health, or OptumRx.
The ole switcharoo
On the plus side, PBMs can save money by switching patients from the
branded cholesterol drug Lipitor to the generic atorvastatin, for
example, but it can get much more complicated when a person with type 1
diabetes (a T1D) is switched from Humalog to Novolog.
People with diabetes trust their routine and many have only used one
brand of fast-acting insulin or one type of meter their entire life.
Being forced to make a change can be a big deal. A switch from one
leading brand like OneTouch to an Accu-Chek meter doesn=E2=80=99t affect
accuracy that much, but being asked to use a less-accurate generic brand
meter can be dangerous for a T1D=E2=80=94or a burden if a meter is paired w=
an insulin pump.
Either you=E2=80=94or with luck, your healthcare team=E2=80=94can help figh=
t the bad
changes, but these battles can take hours fighting through phone trees
and trading faxes to get the proper treatment approved. This can waste
countless hours, increase you blood pressure, and have mixed results.
Rebate or kickback?
To make the situation even more complicated, the deals cut by your PBM
to get cheaper drugs could be making them money as well. The discounts
are paired with sales incentives and =E2=80=9Crebates=E2=80=9D back to the =
PBMs that can
look a lot like kickbacks. These rebates are hidden in a black box and
some think this is one of the reasons for increased insulin prices,
while these same companies complain about the need to cut costs.
When and how to fight
When your health is at risk, take the time to fight and try to enlist
your healthcare provider to help. Even if you do your research, the PBMs
don=E2=80=99t always listen to reason. They have people in front of a compu=
checking boxes deciding whether to approve your request=E2=80=94or, too oft=
not approve it. Often it is as simple as saying, for example, that you
tried taking metformin and it failed so you need to take another drug.
The metformin box needs to be checked before you can move on to an
alternative, so try to recall that diarrhea episode back in 2014.
Having a meter that pairs with a pump can also be approved after a
fight, but some of your wrath should also be vented at Medtronic, who
made the deal to pair their pumps with the high-priced Bayer/ Ascensia
strips. You can also try ordering the strips directly through Medtronic
to get the strips approved.
Savings cards and sites
All the drug and major strip companies offer savings cards that could
help you continue with your favorite brand. These can work if you have
commercial insurance (not Medicare or Medicaid), but may drive up
overall prices. The website GoodRx can help you shop for a better price
and deals can be found at Costco pharmacies where you can fill your
prescriptions without being a member.
Good and bad changes
Metformin is cheap, safe, and still considered to be the initial drug
choice for treating type 2 diabetes. It is also weight neutral and has
heart-health benefits. Try it or try it again to see if you can get past
the mild gastrointestinal side effects.
The TZD class of drug Actos (pioglitazone) targets insulin resistance
and was a wonder drug when it came out, but a heart-risk scare in 2007
caused it to fall out of favor. After additional research, the cloud
lifted and there is new interest in the now generic pill.
Basaglar is the new biosimilar basal insulin that is equivalent to a
generic Lantus (insulin glargine). The 15 percent savings could help
break the spiral of rising insulin prices and be a good choice for
people with type 2 diabetes. But T1Ds may want to fight to stay on the
new and longer-acting Tresiba (insulin degludec) or Toujeo (insulin
glargine U300) that reduce the risk of low blood sugar.
A change to Jardiance (empagliflozin) in the SGLT-2 inhibitor class
could be good for your heart after recent news showed a 38 percent risk
reduction for heart-related death in people with type 2 diabetes who
have a high risk of heart disease. Similar good heart health and kidney
news was reported for Victoza (liraglutide). This is a once daily
injectable in the GLP-1 agonist class. It you were switched off one of
these drugs you should talk with your doctor and fight to go back on them.
Have you had coverage problems with your preferred prescription brands?
Share your experience and advice by commenting below.
So many immigrant groups have swept through our town
that Brooklyn, like Atlantis, reaches mythological
proportions in the mind of the world - RI Safir 1998
DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
http://www.nylxs.com - Leadership Development in Free Software
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Being so tracked is for FARM ANIMALS and and extermination camps,
but incompatible with living as a free human being. -RI Safir 2013
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