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Topic Title: Trick of the Trade - Filling Insulin Scripts
Created On: 12/05/2008 03:30 PM
 12/05/2008 03:30 PM

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Often we are encouraged, forced or hounded into using mail order pharmacies such as Medco and Express Scripts. They are frequently sold as cheaper than retail because you can get three months of supplies for a one or two month copay. Ok sometimes it is cheaper.

That's all fine and dandy until you actually try to have your doc fill out a prescription and get the mail order pharmacy to fill the script - especially if that mail order pharmacy is chosen as a managed care provider by your insurer.

Doctors who realize that insulin volume varies fill out scripts to say, for example, 20 units a day (1 vial per month), etc. Unfortunately, that doesn't coincide with the motivation or abilities of the mail order pharmacy and our scripts are underfilled.

Remember, they are hired by the insurer as a managed care provider. We are NOT their customer. The insurer is. They are there to save them money.

So, what happens? They see 20 units per month x 3 months. They multiply 20 units x 90 days and send you 2 bottles - saving the insurer an entire bottle. Wrong! Insulin products expire in 3 months. You need 3 bottles/vials not 2. Try and convince them of that. Or try and convince them it is physically impossible to use every unit in the bottle or that there is waste because of x, y and z.

So what does a patient do about it? I suggest you skip trying to give a pharmacist a technical explanation on insulin expiration or the high blood pressure I've gotten in the past arguing. I suggest you instead have your physician overstate the prescription so it comes out to a rounded bottle amount.

For example you need one vial per month, each vial has 1000 units. Take the 1000 units divide it by 30 days and say you use that many units per day. And of course, if you're doing 90 day supplies, say xx units x 90 days. Again, it will come out to 1 per month or 3 per 3 month supply.

Unfortunately, we have to learn to play their "game." Sorry 'bout that.

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