Aetna Is No Better
How dare me believe Aetna would be better than United Health Care!
A couple of years ago, I broke my foot. Fun was had all around. At the time, I had UHC, and boy was that a nightmare to deal with. I had to get surgery to fix my foot (it was a Jones Fracture). UHC decided only the surgeon was required for the operation and billed everything else to me.
This was on top of how much trouble I was having getting them to cover my diabetic drugs. Oh, I also have Type 2 Diabetes. So, yeah, had to fight with UHC over figuring out how to treat that.
When I talked to HR about all the trouble I was having with UHC, I learned I was not the only one complaining. It was so bad that my company decided to leave UHC and switch to Aetna. Yay, right?
Which leads me why I'm posting here. We found a regimen that worked and was covered by insurance. When the insurance switched to Aetna, no changes were necessary, all was covered. Under UHC, my HbA1C fluctuated between 7.8 and 10 as we were trying to find something that worked that was also covered. In the end, I got a downward trend, hit 6.3, and my doctor said don't come back for 6 months. We were meeting every 3 months for adjustments.
July, 2020, as my pharmacy dutifully refills my prescriptions, they get a PA request for one of them. Well, that's weird, but the doc will take care of it. Doc sends PA. Radio silence for 2 weeks. I built up a small supply so that wasn't a big deal.
Nurse calls me to inform me they were not getting a response from insurance. I call insurance and their only comment is they need a PA. Doc resends PA. Insurance rejects it.
I took my last dose today. It lasts a week so I'm good for the next week. But what happens after that?
The drug in question is Trulicity. It's an injection taken once weekly. It was an upgrade from Victoza, which works similarly, but is a daily injection. According to Aetna's 2020 formulary, it's covered with a quantity limit of 4 pens covering 28 days. No other restrictions are listed. Not even PA. As of July 2020, Trulicity requires a PA and Aetna is rejecting it. Trulicity costs anywhere from $750 to $1000 per month. Even at my income, that's hard to swallow. Aetna is not offering an alternative. Just a straight no.
Trulicity is noted to work by making your own insulin production more efficient. It's my understanding that it amplifies the signal from your body to produce insulin in response to sugar. This is pretty oversimplified, but the gist of it is it helps push insulin production hopefully without overdoing it. It's supplied as 4 pens in a box, each pen delivering a single dose. It couldn't be easier to use, also. Remove the cap, twist the lock, pinch some fat, press the pen on it, push the button, wait for it to do its thing, and done. No measuring, no guessing. I only ever fucked it up once (funny story for another time).
Trulicity replaced Victoza. Taking Victoza was exhausting, though I am back to doing a daily injection anyway (Basaglar). It was among the drugs that helped bring my HbA1C down before even getting to the insulin. Only UHC's meddling really caused problems. I have 2 doctors that agreed upon my regimen, and for it to include Trulicity. We had a small celebration when we finally saw my HbA1C below 7.
And I have taken my last dose.
Aetna is not helping find an alternative. From what I understand, their reply is just a no. I was suppose to be sent some information, but no one can tell me where it was sent.
I have no idea what happens next. Higher Basaglar dose? Switch to Bydureon? There appears to be a new one called Ozempic? Unfortunately it appears we can't know until we submit the claims to Aetna and check their response since their formulary can't be trusted anymore.