Wednesday, June 20, 2012

Unintended Consequences - Medicine

Many of you may not know that I suffer from diabetes. In the olden days we called it "sugar diabetes". This is not actually too ridiculous since there is a malady called diabetes insipidous which has nothing to do with the sugar diabetes we know and hate.

Anyway, for many years now I have had to take insulin to control my blood sugar. As Willford Brimley suggests, I check my sugar and check it often, and I make dose adjustments to keep my numbers looking good.

According the Obummer administration, I probably should have declared myself disabled years ago, thrown up my hands in disgust, said "Oh, woe is me!" and immediately started sucking on the gubment teat for the rest of my days......but no, I decided to keep working and paying for my own health care. Diabetes care is expensive. I don't like paying for it, but hey, in life we have to play the hand we are dealt. It is nobody's problem but mine.

Up until a couple of months ago I was taking an insulin called Lantus which is long acting and is designed to keep blood sugar near normal during periods of fasting. A couple of months ago I got a letter from my dreaded health insurance company informing me the Lantus had been demoted to a "third tier" medication. I could keep using it if I wanted but they were letting me know that they would no longer pay for it as part of my pharmacy benefit. Instead I was directed to ask my doctor to put me on Levemir, another long acting insulin.

Well, Lantus and Levemir are not quite the same. From what I have read, Lantus has no "peak". Levemir has a peak of around 6 hours. Also it appears that more people have to take Levemir twice daily rather than once daily to achieve success. I had been taking 35 units of Lantus at bedtime so I tried the same with Levemir. After a couple of days, it was apparent that my overall readings were quite a bit higher than before. I tried dividing the dose morning and night but this seemed to make no difference. I finally bumped the dose up to 50 units at bedtime to achieve similar results to Lantus.

This month I ran out of Levemir early and had to call the doctor's office for a new prescription at 50 units daily instead of 35.

The insurance company mandated that I switch from Lantus to Levemir in an attempt to save themselves some money. However, since I had to increase the dose by 43 percent, I am sure they are losing money now in that they have to pay for the insulin more frequently than before.

It is funny how the laws of unintended consequences frequently take their toll on the shortsighted. In this case, the insurance company should have left well enough alone. Toward the end of the year, they will likely come out with other cost saving mandates, which will usually result in wasted time and trouble for their clients and may not save any money in the long run. If very many things go wrong for patients, they will be calling and visiting their docs more frequently and further increasing the cost.

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