My mail order company that fulfills my insulin orders just informed me that I can no longer get my Novo Nordisk insulin? They said that Medicare will only cover Eli Lilly’s insulin. Should I choose to continue to buy Novo Nordisk’s insulin, my co- payment will be $200 for my prescription.
My insulin preference is Novo Nordisk because I tend to experience more hypoglycemia episodes when using the Eli Lilly insulin.
How wonderful for you to have refined which insulin works best for you when it comes to diabetes self-management. People do respond differently to the insulin brands; from hypoglycemic episodes to getting allergic skin reactions when injecting.
Since your pharmacy informed you about the insulin formulary, ask them to provide you with information on how to reach out to the Medicare plan to discuss your drug coverage. Then reach out to the plan and request “Evidence of Coverage”. Read this carefully and call them should you need clarification on the description of benefits.
The good news is that you can appeal Medicare coverage for your Novo Nordisk insulin. When speaking to the plan request the “Medicare Prescription Drug Coverage and Determination”. This is going to be the form you complete and submit in asking Medicare to make an exception for your Novo Nordisk insulin coverage. Additionally, speak to your prescribing physician to discuss your appeal. They will need to support your claim as to why an exception should be approved.
Once you submit your request, expect to receive a response in 72 hours.
I have included a link to the pdf form below so that you have an understanding of what will be asked of you and the options that are available for coverage under the exception clause.
You might also be interested in reading these related Medicare coverage articles:
Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.
Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview now Diabetes Health magazine.
Nadia holds 14 nominations for her work as a diabetes advocate.Her passion for working in the diabetes community stemmed from her personal loss. She has used her experience as a caretaker to forge a career in helping others.
Nadia has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business and website have been sited, recognized and published in Herb Caen, WSJ, Ann Landers, Lee Iacocca, Entrepreneur magazine, Houston News, Phili.com, Brand Week, Drug Topics and many other media outlets.