Friday, April 2, 2010

Wowzers---lots of them!

Man, its been almost a month since my last---and what a month it's been! L's diabetes is keeping us on our toes, up all night burning the midnight oil. I'll keep things succinct by saying her insulin dose is completely wrong and we are at odds with her endocrinologist. We will be having a new one.

Yesterday we made rounds to two pharmacies to pick up the month's meds---L's have to be in a 24-hour place, the rest of us have ours at a convenient place. At the end of it all, this is what we had:

Mostly diabetes supplies, a few of which won't require monthly refills but mostly, yeah, this is what a month will look like. A few of the rx bottles are allergy and daily meds that Rob and I take and are 90-day supplies. Still, total damage? $300. WITH "good" insurance.

I will say that this load of meds cost less than last month---it seems like our insurer has adjusted our generic medication co-pays by half. Crazy. The pharmacist said lots of people had seen unexpected changes in their co-pays---how about ya'll?

Health Care Rant
Diabetes is definitely among the diseases that has a distinct socio-economic divide---Medicaid simply doesn't pay for an adequate number or quality of supplies. Medicaid covers the cost of a low accuracy blood glucose test strip, 100 per month. That allows for about 3 tests per day----with L's new diagnosis and facing many many years of disease that could become complicated, we've been testing at least 10 times per day. Now, if she were an established patient, if she were stable, we'd still be testing at least six or seven times a day MINIMUM to calculate insulin for meals and corrections...we'd want to measure to compensate for activity, we would want to test more should she become many things can change blood glucose and effect the amount of insulin that should be given. Giving too much insulin: big problems right away---giving too little, big problems over time. Its surprising to me that Medicaid would scrimp on the part of disease management that would save them money in the long run. Go ahead---let them develop kidney disease---pay for dialysis, heart surgery. Shit makes NO sense. And more than just being infuriating, people with uncontrolled Type 1 Diabetes DIE from it. Forty years ago, the life expectancy of a Type 1 diabetic was about 40 years from diagnosis and those people had at least SOME wasn't great or even good but it was infinitely better than nothing.

Final bitch about diabetes: glucose test strips cost (retail) a little over one dollar a strip for the meter we use; I'd imagine they're all about the same. At diagnosis, the endocrinologist prescribed 200 per month, "test 6 - 8 times per day". Between learning the idiosyncrasies of the machine and our concerns about her blood glucose being very unstable, we blew through the first 200 in under 2 weeks. We got an override on the 30-day interval after the pharmacy tech got all legalistic on us and we called our insurance company ourselves (from our cell phones, right in front of him). Those were gone about 2 days before we were eligible for the next installment. Did I mention that paying out of pocket is over $200? So I called my endo and asked her to increase our monthly allotment to 300; done. Pharmacy wouldn't issue the additional 100 so we waited out two days by pulling strips from the least used of our meter packs... and then the Pharmacy SAID our insurance wouldn't cover the cost of 300 strips because the doctor's order to test at 6 to 8 times per day doesn't add up to 300. The ballsy little Pharmacy Tech had the audacity to ask "how many times per day do you NEED to measure her blood glucose?" . My answer was the kind of answer meant to tell someone they were overstepping their role and they should get the eff back where they belong. It was good and I didn't curse :) Finally, he answered my thrice asked question, "do I need to have my physician call you?" in the affirmative. But seriously: it took WAAAAYYYY too much effort and distress to get the supplies I need to care for my daughter. And I am tenacious, and I understand the rules, and I'm not afraid to go toe-t0-toe with anyone who doesn't understand or doesn't want to help in the ways they should. These are the kinds of things that effectively reduce access for other people who have coverage but don't receive all the benefits to which they are entitled and which they sorely need.

As of now, L is on Day 2 of a 96-hour continuous glucose monitoring study---should help us sort out why her insulin dosing is so difficult. We are advocating strongly for not only an insulin pump but also a personal continuous glucose monitor for her. She seems to be the right kind of patient and I'm sure it would ease our concerns a great deal.

Not Diabetes or Health Care
Spring is in full swing---the pollen count is like 7 bazillion units per cubic centimeter of air (relatively too freakin' high). Our spring break dreams of bicycling, hiking and basking in sunshine have been seriously derailed in favor of arriving at the right OTC allergy/sinus cocktail: runny nose/post nasal drip? Dry it up with psuedoephedrine. Sinuses congested (and yes, you can have a runny nose and be congested)? Take Allegra D or Claritin. Itchy throat, watery/irritated eyes? Throw in some benadryl. Good grief.

Have I mentioned, though, that its extremely beautiful? Yes, indeed. Sixty-five degrees, sunny, no humidity and flowering trees...from behind my windshield or windows, everything looks great. Seriously: today when I went out, I covered my nose and mouth with my shirt sleeve hoping to filter out some of the pollen. I tried to not touch my face at all until I'd returned home and washed my hands...I still feel like crap....

1 comment:

Don said...

Hang in there.