Step therapy.

By that name you’d think I started a new exercise program. Not exactly.

New insurance means new preferred medications. Overall my new insurance is a nice improvement over my old plan and as good as can be expected in the current healthcare climate. The out of pocket costs for my new insurance are much better than my old, but they have some “different perspectives” about what they should cover.

First, iBGStar strips are not covered at all. I really like the iBGStar meter (and carrying a smaller purse) but I have to keep the bottom line in mind and it is not financially responsible to pay for strips when there are brands that are covered. I’ve already been in contact with my local Sanofi rep. His unofficial advice was to not hold my breath.

Of course, the second issue is the coverage for insulin. I have been taking Apidra for a little more than five years. On my old insurance, it changed tiers a few years ago. Paying extra for an insulin that is predictable and reliable in my body was a cost I was willing to pay. Sanofi has a discount program that also helped for the past year.

I was curious what tier that Apidra would land on in my new insurance and apparently it is on it’s own “step”.

In their words –

Step Therapy programs require a trial of a “front-line” medication before a more expensive “back-up” brand-name product will be covered.

That’s funny – both products in this case are brand-name, aren’t they?

It does feel like the insurance companies are trying to play both sides of the table at this point. If it is so easy to suggest exchanging one insulin for another, then they must be extremely similar. Otherwise, it would be dangerous for a company (not a doctor) to suggest that taking one would be just as easy as taking another. Right?

But on the other hand, if the insulin brands are similar enough to switch then why do two brands receive “front-line” status while a third is a “back-up” product?

Thankfully the insurance company does offer some advice to my doctor –

The information provided is only a guideline to assist you in planning the best course of therapy for your patient and does not replace your clinical judgment. We hope this information is helpful.

I know I’m not the first to face this decision and I think it makes me even more frustrated.

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Just scheduled my first appointment with the new endocrinologist. We’ll see what he has to say about all this.