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[IP] Re: insulin-pumpers-digest V3 #284
Title: Re: insulin-pumpers-digest V3 #284
I don't know that there is any solution for this mess, but I find it very
frustrating and need to sound off. As a member of the insurance committee
where I work, I hear about what changes are coming in our health insurance
long before they happen. Last year at this time, I was paying $8 for a
month's supply of test strips. Effective October 1, 1998, we went to a
split copay, $10 for generic and $20 for brand name. Since there are no
generic test strips, I have been paying $20 a month copay for my son's test
strips. Now, effective October 1, 1999, they are going to a 3-tier program
with a !0/20/35 split. This means $10 for generic, $20 for "preferred"
brand prescriptions and $35 for non-preferred brands. Naturally the strips
my son uses(Accuchek Comfort Curve) are in the non-preferred column.
The preferred strips are the Lifescan One Touch and Surestep. I had a long
discussion with a pharmacist today and it seems that Lifescan and my
insurance company have worked out a deal whereby my HMO will get kickbacks
from Lifescan for pushing their product.
The interesting thing here is that One Touch strips, according to 2 area
pharmacists, account for only about 15% of the strips sold in my area--
I guess that is why they need a push.
Accuchek holds a much greater share of the market. One pharmacist actually
told me he sells 15 boxes of Accuchek strips to every single box of One
Touch strips. So Lifescan stands to gain a greater share of the market by
working out this deal with my HMO. And the HMO gains by getting a larger
copay out of me for the Accuchek strips, provided I refuse to switch to One
Does anyone else find this system absolutely maddening?
One pharmacist told me he doesn't even sell the One Touch machines because
their technology is archaic. He called them dirty machines because the
blood still comes in contact with the actual machine whereas with the Accuchek
Advantage and the monitors Bayer makes (Elite and Dex), the blood is only on
the strip and never actually touches the monitor. He really favors the Dex,
but I am fairly certain it is in my $35 per month tier, along with Accuchek.
Has anyone experienced similar problems with insurance/HMO's? Do I have any
recourse or stand any chance of getting any positive action if I try to
fight it? Or will I only succeed in raising my blood pressure?