OOT: Meds and the VA System
SickleYield
Posts: 7,634
Any American diabetics around?
My Dad is a veteran and a very insulin resistant Type II diabetic. This weekend Mom and my sister took him to the Veterans Affairs emergency room 50 miles away from our house because they persistently have failed to send his insulin in the mail for the last month. They kept sending test strips, insulin needles that were the wrong type for him to use, etc., until he was down to using expired Novolog instead of the Humulin R 5X they've had him on for some time now. Naturally his blood sugar went up to 500 or so (this would kill anyone who wasn't already insulin resistant, and it's very dangerous even for him).
We couldn't just go buy some at the pharmacy because Humulin R 5X costs around $1000 a bottle. It'd be cheaper if he was on crack. (And we'd have a better choice of suppliers.)
Has anyone else been through this situation of needing the expensive insulin but finding it hard to get through the VA? What did you do? Is there an equivalency for cheaper types that is reliable? We're desperate not to let this happen again.
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Please keep this thread to the requested practical advice and don't turn it into a political discussion.
Definitely not my aim at all. The politics are irrelevant to me at this moment - I just want to know if there's a way we can secure Dad's insulin supply against further accidents in the mail. I was hoping someone had a chart that could equivocate dosage of U-500 with U-100 or something, since there are so many diabetics that must have such issues.
I can't speak to the VA system, but two things you might try are:
1) contact the manufacturer of the medication -- they usually have a program for the needy to either supply the medication temporarily or to talk to the insurer to try to move things along
2) charity organizations specifically to supply expensive meds for the needy
I was on the Manuf. programs for some time until I got insurance. You qualify if you make under a certain amount a yr AND have mo medical insurance. We just looked into it for my meds again but our medical was approved so I didn't need to do it. They won't even take an application now until you been off your current medical plan for 30 days.
How can I find out more about this, Frank?
The thing is, Mike, we're not actually "needy." Between the three of us we make a good amount every year (I'm the highest earner now, but Mom is an adjunct professor, and Dad is on disability; they are self-supporting and it's all I can do to persuade them to let me help with rent and groceries).
The problem is that you don't have to be under the poverty line for $1000 a bottle to be high. I could take money out of my car/new computer savings for that in order to ensure we have a backup bottle or so for incidents like this, if I could persuade them to accept it, but then we're still talking about a perishable molecule that may have lost viability by the time he needed it, making it a waste of the money. It's a dilemma.
How can I find out more about this, Frank?
The thing is, Mike, we're not actually "needy." Between the three of us we make a good amount every year (I'm the highest earner now, but Mom is an adjunct professor, and Dad is on disability; they are self-supporting and it's all I can do to persuade them to let me help with rent and groceries).
The problem is that you don't have to be under the poverty line for $1000 a bottle to be high. I could take money out of my car/new computer savings for that in order to ensure we have a backup bottle or so for incidents like this, if I could persuade them to accept it, but then we're still talking about a perishable molecule that may have lost viability by the time he needed it, making it a waste of the money. It's a dilemma.
I don't know how long the 500 unit stuff lasts, but I use a 100 unit pen over two and a bit weeks and a box of five keeps OK for that in the fridge - if you used the emergency pen and put the next regular pen into store, then sued that with the next regular in store and so on you should have a buffer without having a single pen sitting there going off. Not that that solves the rest of the issue.
How can I find out more about this, Frank?
The thing is, Mike, we're not actually "needy." Between the three of us we make a good amount every year (I'm the highest earner now, but Mom is an adjunct professor, and Dad is on disability; they are self-supporting and it's all I can do to persuade them to let me help with rent and groceries).
The problem is that you don't have to be under the poverty line for $1000 a bottle to be high. I could take money out of my car/new computer savings for that in order to ensure we have a backup bottle or so for incidents like this, if I could persuade them to accept it, but then we're still talking about a perishable molecule that may have lost viability by the time he needed it, making it a waste of the money. It's a dilemma.
Just type in the the manuf. into your search engine. Go to there site, and there should be something on their site about the program. If you don't know the manuf. just do a search on the med and it will give you the manuf. The manuf will give you the guidelines of the program. The money earned is different with each company. You would need to have your Dr. fill out a portion of the paperwork and normally if you qualify they mail the meds to your Dr and you have to go pick them up every month. It may have changed though and maybe they mail to the house but I somehow doubt it.
There are many questions I could ask but they are best asked of your father's VA rep. You need to find out who that person is, make an appointment with your parents and have a long talk with that person so you, your parents and the VA are clear as to who is responsible for what.
This needs to be done at least once per year if not more so. As the military's budgets change, so do the benefits they will and will not cover. Do not depend on someone's say so. You want it in writing. In this case, a paper trail can be you best friend. Although I hate to say it, what was once routinely covered by the VA is no longer covered.
Hi,
I don't know if this information will assist you but here is Eli Lilly's information about their patient access programs: http://www.lilly.com/Responsibility/access-to-medicines/Pages/access-to-medicines.aspx
Trish
Have you tried enrolling into Tricare? If he is retired, he and his family should be able to enroll. It is costing us about 50 bucks a month out of my husband retirement pay. I do know they have some options. Tricare is not the best, but at least its something.
Even if he doesn't qualify for the manufacturer's program, they may be able to do some of the legwork of advocating for him.
Thanks for the suggestions, you guys. I'll talk to Mom and Dad and see if we can figure out what to do.
Any decent pharmacist should be able to tell you this over the phone. Give them a call, and if their explanation isn't clear enough or they don't know, call another. Doesn't matter whether or not you fill scripts there. Answering difficult questions is part of the job, and this sounds like something a pharmacist would know more about than a regular family doctor.
I found this here online; it converts U100 to U500:
http://www.diabetesincontrol.com/articles/features/11872-conversion-chart-for-humulin-r-u-500-insulin-dose
It also has the printable PDF chart for the same purpose: http://www.diabetesincontrol.com/images/issues/2011/12/humulin_r-500_conversion_chart.pdf
Here's one that goes into a bit of detail: http://www.humulinhcp.com/Pages/dosing.aspx
And http://www.diabetesincontrol.com/articles/54-/15233-understanding-the-u500-strength-conversion-and-days-supply-conundrum
and http://www.uspharmacist.com/content/s/126/c/20822/ which has some in-depth info for pharmacists, and calculation formulas, and which I personally found rather informative.
Not sure if this is usable for your purpose, though.
This link should give you a starting point
http://www.benefits.va.gov/benefits/
Under Locations you should find a listing for your closest regional benefits office.
Have your parent's and/or their MD been depending upon the e refill system (aka My Health e Vet)? If they are, it has been having some major FUBAR's and is currently off line. You or the MD need to find the nearest VA Medical Center or Clinic and call them for refills. No one knows when the problems will be fixed or it will go back on line.
They changed all my dads meds cause they didn't carry his old one and now they can't get him squared away cause the meds they switched him to aren't working. I refuse to go there cause our local one is horrific. I'd rather pay for private insurance or go through the manufacturer programs.
They changed all my dads meds cause they didn't carry his old one and now they can't get him squared away cause the meds they switched him to aren't working. I refuse to go there cause our local one is horrific. I'd rather pay for private insurance or go through the manufacturer programs.
I'm leaning toward this, but can one even get him ensured that way? Type II diabetics are often long-lived and very expensive (his meds for one month would rent a very nice house), and I imagine any private insurance carrier is going to look at him and go NOPE.
I'm leaning toward this, but can one even get him ensured that way? Type II diabetics are often long-lived and very expensive (his meds for one month would rent a very nice house), and I imagine any private insurance carrier is going to look at him and go NOPE.The Affordable Care Act open enrollment starts November 15. Preexisting conditions are not a consideration for denial of insurance or higher prices. Please read up on it. It may be what you need for your dad.
I'm leaning toward this, but can one even get him ensured that way? Type II diabetics are often long-lived and very expensive (his meds for one month would rent a very nice house), and I imagine any private insurance carrier is going to look at him and go NOPE.
Couple of things so I can begin to figure where to point you in the right direction. What Branch of Service, Active or Reserve, if Reserve was he called up from Reserve to Active Service by Congressional Order? If you don't know if there was a "call up" can you list the years he served so maybe I can figure it out (there were a number of call ups that aren't talked about but still covered).
This is a minefield. No doubt about it. I found it much easier to pay out of pocket up front and submit the paperwork myself. That way I get my meds and the paperwork gets in on time.
Well do I know the expense. My pharmacy bill runs well over $500 a month. Drug companies are the worst price gougers around. A drug I paid less than $10 per 30 pills 30 years ago now runs over $150 per 30 today. The most annoying part is that the drug is made from pregnant horse pee.
What state do your parents live in? Maybe I or my Dad (he's a retired general with a lot of contacts) can find someone who can help.
I'm leaning toward this, but can one even get him ensured that way? Type II diabetics are often long-lived and very expensive (his meds for one month would rent a very nice house), and I imagine any private insurance carrier is going to look at him and go NOPE.
Couple of things so I can begin to figure where to point you in the right direction. What Branch of Service, Active or Reserve, if Reserve was he called up from Reserve to Active Service by Congressional Order? If you don't know if there was a "call up" can you list the years he served so maybe I can figure it out (there were a number of call ups that aren't talked about but still covered).
This is a minefield. No doubt about it. I found it much easier to pay out of pocket up front and submit the paperwork myself. That way I get my meds and the paperwork gets in on time.
Well do I know the expense. My pharmacy bill runs well over $500 a month. Drug companies are the worst price gougers around. A drug I paid less than $10 per 30 pills 30 years ago now runs over $150 per 30 today. The most annoying part is that the drug is made from pregnant horse pee.
What state do your parents live in? Maybe I or my Dad (he's a retired general with a lot of contacts) can find someone who can help.
We live in Washington State. I'll have to talk to him when they get home tonight. I know he never went overseas or was in combat (he joined toward the end of Vietnam), but he was in the Army for several years. Thank you for asking!
No problem. As my parents like to put it my family has been rabble rousing this country since before it as a country. We know well the issues and FUBAR's of the VA system. Toss in all the budgetary problems and changes of late and you have one big cluster-you-know-what.
The more info you have the better. If you don't want to post it, PM me. I'm in NY and my parents live in VA. Some things are managed on a regional basis and others are covered on Federal level. We just need to figure out who is currently responsible for what. Is your Dad close enough to a VA Medical Center or has he been seen at one of the VA Outpatient Clinics? WA state has VA Med Centers at Spokane, Vancouver and Walla Walla. Any chance you can get him to one of those? Since he is out of his prescribed insulin, it would constitute an emergency and allow him to be seen on an emergency basis. The Med Center's pharmacy should be able to fill the scripts. If he goes, have him take along all his scripts and testing equipment. The MD seeing him should be able to write the scripts for what he needs and the pharmacy fill them.
If these three are too far away, let me know. I'll see what else I can come up with.
They changed all my dads meds cause they didn't carry his old one and now they can't get him squared away cause the meds they switched him to aren't working. I refuse to go there cause our local one is horrific. I'd rather pay for private insurance or go through the manufacturer programs.
Frank
Can you get your Dad to a VA Med Center? That's my recommendation. Make sure you take the scripts that were working and the ones that he was switched to. Explain things to the MD. If your father is already enrolled and entitled, you do have the option of paying out of pocket and submitting the forms yourself. This is my preferred method as I am not depending upon some over burdened clerk to file the proper forms on time. It's not cheap and you have to set aside time on a regular basis to go through the paperwork and make any calls required. On the surface manufacturer programs sound wonderful but they are not all they are cracked up to be. Some companies will not accept anyone who is VA qualified (even if they are not receiving benefits), shipping expired medications to participants, excessive paperwork for you and the MD, demanding your father seek assistance from Medicaid before they will even consider him. The list goes on but you get the idea.
The other thing that can help is to rattle the cages of your local congressman and US senator. Go through proper channels first, but make sure that the person you're talking to knows that you're writing down their name and their supervisor's name should their be any bureaucratic snafus. If you find it necessary, it is best to find out where the congressman and senator's state office is located and visit the office personally. Even of they're not there, you can speak to their local staff manager or whatever it is they call themselves these days. It may be best to make an appointment. My mom was able to do this for one of my younger brothers years ago and get a successful outcome at the state level.