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Question:

From Indiana, USA:

What can be done to make insurance companies cover the cost of insulin pens? Regardless of the age of the patient or the type of diabetes they are forced to control, they should be able to afford the latest form of testing and insulin delivery technology available! With the millions of people dealing with this, and the havoc such detailed management can wreak, how dare they keep this out of reach for any diabetic? Please forgive me forcefulness and disgust. I have a 16 year old with type 1 and a mother with type 2.

Answer:

Insurance companies are in business to make a profit. They cover as little as they can, and charge as much as they can. The marketplace then determines whether one company will survive in the face of competition.

If you want to change the policy of an insurance company, you must either prove to them that a particular expense will save them money or you must convince the state or federal government to impose new rules. Either requires a significant amount of effort and the combined resources of many, many people.

I suggest that you write to your elected officials and make your feelings known. I also suggest that you write to your insurance company and explain why using a pen is better than using a syringe. You might argue, for example, that the convenience of the pen helps make it easier for your child to take insulin to cover meals while at school, thereby improving blood sugar control, thereby reducing the risk of short-term hospitalizations due to hyperglycemia and reducing the risk of long-term complications, the costs for which would otherwise be paid by the insurance company.

JSH

Additional comments from Dr. Deeb:

Really the only way is to pass legislation that forces coverage of prescribed items. You might ask them to cover the cost of the equivalent items, insulin and syringes. I find the box of pens will last longer than one or two vials of insulin. That reduces the cost.

LD

Additional Comments from Heather Speer, CRC Coordinator:

Write letters to your insurance company and follow them up with statements of medical necessity from your diabetes nurse and endocrinologist. Include the fact that your 16 year old is on the go and the pen would make it easier to keep good blood glucose control, be more compliant and reduce complications.

HVS

[Editor's comment: Actually, before you write, ask your child's doctor to write a "letter of medical necessity" explaining why the additional care (or device, in this case) is needed. Sometimes a letter from the doctor is all that's needed to convince the insurance company to provide coverage. WWQ]

DTQ-19990405142554
Original posting 27 Jun 1999
Updated 1 July 1999
Posted to Social Issues: Insurance/Costs

  
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Last Updated: Tuesday April 06, 2010 15:09:06
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