Navigating Insurance Mayhem ⁉️

Navigating the ins and outs of what your health insurance may or may not cover can be tricky (AKA, painful 🤕). At One Drop, we’ve seen it all first-hand. To help, we’ve gathered a list of pro-tips for you to use when traversing your health insurance coverage!

💡Inform[ulary] yourself

Insurance companies each have their own formulary (or, preferred medications lists) that they cover. This means they may pay for one brand of medication but not the other, even if the medications do the same thing. For example, one insurance company may cover Humalog, but not Novolog, even though they are both rapid-acting insulins (raise your hand if you’ve been here, too 🙋‍♂️). To make things even more complicated, co-pays for the same medication can be wildly different depending on your plan. Make sure you stay up-to-date on your insurer’s formulary list. It can change on a dime. By staying on top of your formulary, those Surprise!-Your-medication-is-no-longer-covered moments will happen less frequently.

💡Do your insurance research

Yep, we’re goin’ old school. It’s all about getting into the weeds with the research! 📚 Some insurance companies have a list of the medications they cover on their website. If you can’t find the information online, you can always call and talk to a representative to find out if a particular medication is on the formulary. If they tell you the medication you’ve been prescribed is not covered, ask if there is a similar medication on the formulary list that they do cover. Then, take all your research to your doctor. He or she will be able to use this information to find the best meds for you that also fit your budget.

💡Talk to your pharmacist

Your pharmacist is your friend. Really. We know, we know: they’re the ones giving you the tough-to-swallow news. But pharmacists are just the messenger! When you get the bad news at the counter, ask for more info. Your pharmacist is one of your best resources for navigating the maze of medication coverage. If your pharmacist tells you the price of the medication you’ve been taking is going up, ask them to clarify a few things:

1) Is your cost going up because your insurance no longer covers your medication?
2) Is the increased price due to increased co-pay?
3) Is there another, similar brand that costs less?

Remember: your pharmacist has access to this (and more!) information. They are there to help.

💡Insulin & test strip options

You do not have to spend $700+ per month on insulin. If you don’t have health insurance or you learn your insurance no longer covers your insulin, you have other options. You’ll need to work with your doctor on this one to adjust your dosing, but you can make it work. Your doctor can help you convert your current dose of insulin to the generic brands (NPH, R) that you can usually find at Walmart for $25 per vial. Because these insulins have different life spans and peaks, it is important that you work with a medical professional to properly and safely convert your current dose.

For a full insulin breakdown, check out our comprehensive guide below 👇

One Drop Guide to Insulin

Just like insulins, test strips can have steep price tags. In many cases, you can work with your doctor to up your daily test strip usage. Your doctor will (more than likely) need to submit a prior authorization request to your insurer; once submitted, you should be good to go. However, if you’re still not able to get the test strips you need, check out our unlimited test strip option. At One Drop, we’ve been denied test strips too many times to count. So, we decided to offer people unlimited test strips, without any health insurance needed. Again, no need to spend the big bucks: you have options.

💡Additional resources

Many community health clinics may have a Patient Advocate expert on staff that can help you review your eligibility for health coverage and insurance. They can, quite literally, advocate on your behalf and help you navigate through and negotiate with the healthcare system. Also, feel free to reach out to your One Drop | Expert for more help! Your Expert can guide you through the maze and help you get the coverage you need. We are here to make sure you don’t run into the mayhem.

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Alexandrea Hickey Robinson
Alexandrea Hickey Robinson

Alexandrea Hickey Robinson is a Registered Dietitian and Certified Diabetes Educator, specializing in insulin pump and continuous glucose monitors (CGM) as a certified trainer. Alex is a current member of the American Association of Diabetes Educators (AADE) and of her AADE Local Networking Group (LNG). Alex received her Bachelor of Arts in Sociology and Latin American Latino Studies from UC Santa Cruz in 2005 and her Bachelor of Science in Dietetics and Food Management from San Francisco State University in 2011.