The Quest for Insulin

You would think the hardest part about a new diagnosis of diabetes is the diagnosis itself, and your coping with the long-term impact. I’m sure for many that may be true, but for me it turns out the hardest part of life on the outside of a hospital wing is just getting the treatment for the disease.

While in the hospital a few days ago, my case manager interrupted my sleep (quite a few times) to help me figure out what type of insulin I wanted when I went home. I had a not-so-simple choice: manually-drawn syringes or easy-to-use pens. Obviously I wanted the pens, given the ease of use; however the price difference was significant (to the amount of $100 or more per month between the two methods). Stewing on my choices for about six hours, I decided on the pen for both my rapid-acting insulin (the stuff I take before meals, if needed) and my nighttime insulin (the longer-acting medicine). My choice was made and I was happy for the ease-of-use I was soon to experience.

An hour or two after I was discharged, I took my five prescriptions (a couple for insulin, needles, etc.) to one of my local pharmacies. “It will be a couple of hours, we’re very swamped today,” they told me. Okay, I’ll just come back later…

Still full of excitement, I returned to the pharmacy a few hours later to retrieve my medication. I was tired, yet anxious to show my wife how well I could do with my self-injections. I gave the technician my name and she came back a few moments later with a box of needle tips, a couple of pill bottles for some non-insulin medications I was getting filled, and a vial for my nighttime insulin. Where was the pen for my rapid-release insulin?!?

Turns out, there was a snafu, one that would cause a lot of heartache over the next 24 hours. Bear in mind that I was just released from the hospital merely hours before. I was told (quite casually) that the pen that was prescribed by my discharge provider was not covered by my insurance. What. The. F*ck. Oh, and I didn’t have any needles for my vial of nighttime insulin.

The pharmacy manager was kind enough to let me know that there was another medication that I could use, but there would have to be a call placed to the ordering provider. To his credit, he said that he would take care of this piece for me. How sweet. But why didn’t I have any needles to draw my nighttime insulin? Simply stated, the provider who placed the orders never actually put one in. Well joyous. Again, to his credit, he gave me a small bag to get me through for a few days. He was going to call and get my pen situation figured out for me. Once it was all set, they were going to call me. Problem solved.

The next day, I received a call from the case manager at my new doctor’s office to confirm my appointment and to see if there was anything I needed. I obviously mentioned the issues with my rapid insulin pen and we discovered that the situation was more messed up than we thought.

As it turns out, the case manager in the hospital dutifully researched the options and determined that the pen I was supposed to get was not covered, but recommended the alternative to the discharging provider. She also indicated that I wanted to have the medication in pen form… for both of my insulin doses. Wait, BOTH?!??! Rather than ordering pens for both of my medications like I asked for (and clearly forgot existed for my nighttime doses), she gave me a vial that I had to draw myself. And obviously ordered the incorrect type of pen. The office case manager said that she was going to get it all straightened out and she sounded nearly as annoyed about the situation as I did.

A few hours later I decided to call the pharmacy to see if they had called the discharging provider to fix the issue (my tired brain forgot that the office case manager was attempting to fix it). The pharmacist I spoke to on the phone told me that the medication was still the same and that it was my responsibility to call the provider, and that they were not going to call to get it resolved. How nice of them.

Eventually the office case manager called back and said they finally were able to get everything fixed. I couldn’t have a nighttime pen for this month, since I already drew from the not-very-cheap vial. Fine, I said, I could draw my own meds for a month. On the flip side, she was able to get me syringes. Bonus!

Once again full of hope that everything was fixed, I returned to the pharmacy. Telling the technician my name, she rolled her eyes and said “I told him this would happen”. I had no idea what she was talking about, but she went to find the same pharmacy manager I spoke with last night. He confirmed with me that I wanted to have the alternative insulin that was covered by insurance. In vial form.

If ever there was a head-slap moment, this was it. “NO!,” I said a bit more loudly than I should have. “I want this in the pen. I wanted a pen. All I’m asking for is a damn pen. This is supposed to be a PEN!!!”. Frustration was definitely setting in and I was on the verge of both tears and complete rage. The pharmacy manager, again to his credit, went back to update the medication from a vial to a pen, which they should have done in the first place. This process took yet another 30 minutes.

Finally my name was called. The medication was ready, it was time to rock. The same technician I worked with earlier in the evening looked at me and said “so you are paying the full price, correct?” Head. F*cking. Slap. “No,” I said, this time as forceful as I felt was necessary. I carefully explained to her, again, that the whole point of going with this particular version of the medication was because it was covered by my insurance. She again rolled her eyes, laughed, and went back to one of the other computers. After a minute or two, she told me that the medication would be over $160, which was twice the amount quoted by the case manager from the hospital.

I finally lost it.

How could this medication be so damn much, when I was quoted only half? And why was she laughing? I’m sitting at this counter, again, for the second day after I was discharged from the hospital after being diagnosed with diabetes, and she’s laughing. I knew she wasn’t laughing at me, but the attitude, the eye rolling, the cavalier attitude was just too much. I yelled at her, and I was not subtle about it. Everyone in the pharmacy could hear me, but at the moment I didn’t care. For 24 hours I had been trying to just get my medication, to get what I needed to get through this disease.

Eventually we both apologized to each other, owning up to our mutual faults in the exchange. I paid the money to get out the door so I could go home; I was just so damn tired, the office was closed, and I had enough. I knew I could get it resolved going forward and if I kept going the way I was I would have made the situation much, much worse.

The medication is now sitting in my fridge, just waiting to be used. It’s now been a little over a day and I have not yet found a need for it.



Categories: My Diabetes Journey, UncategorizedTags: , ,

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