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Post by compound26 on Dec 9, 2015 16:55:59 GMT -5
update from the same member on tudiabetes.org: www.tudiabetes.org/forum/t/insurance-company-denied-afrezza/49313/3We have mentioned the hypos and can prove them on the download of the meter. We will pay out of pocket, and I know they have a $150 knocked off the script but is that a one time thing only? I also know their discount is in effect only until next year. We are not new at this and have been at this for ten years. We have successfully appealed for Apidra, had continual appeals for sufficient testing strips, appealed for Dexcom successfully twice (now she won't wear it). We have one more appeal after this one. Problem is the endo who prescribed the scripts seems to have a very busy practice. We have switched endos before who have refused to fight for adequate strips. I hope the endo will follow through with us to the end of the appeal process. Her receptionist told us we can't appeal as the insurance is demanding visual impairment as one of their grounds. Naturally the endo cannot lie. Hoping for the best, and it won't end here. We will appeal at a governmental or State Insurance Board, whatever we can think of we will do. Once Sanofi stops the discount this could get very expensive. She seems to be using quite a bit of Afrezza... the dosing is not equivalent. But, no, not going back to Novolog, Humalog or Apidra. Been there. Done that. There is no comparison. update from the same member on tudiabetes.org:
www.tudiabetes.org/forum/t/insurance-company-denied-afrezza/49313/8There is a second appeal. We know from past experience that they often will deny the claim and even the first appeal Then you go back with documentation and we did get her Dexcom on the second appeal. We also got her Apidra approved I think on the first appeal. We have had to fight for adequate testing strips countless times. For the next year we are okay because, although expensive, we can cut back elsewhere. She just picked up her first month's script (and she may need more, I'm not sure yet). Sanofi takes $150 off each box I think. She got two boxes of the 8 unit cartridge and one box of the four unit cartridge for $350. I think it may be even less expensive at Costco or Sams; we used Rite Aid. After next year if they don't renew the discount, it would cost upwards of $700. I think she will need another box of the 4 units per month at least. Diabetics and their parents friends, in fact most people with health issues should start a movement, much like Act Up, to get their medical needs covered. We know the drill. I think we will win in the end on the second appeal. Or time to go job hunting for better insurance coverage. That's one way.
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Post by peppy on Dec 10, 2015 11:28:53 GMT -5
update from the same member on tudiabetes.org: www.tudiabetes.org/forum/t/insurance-company-denied-afrezza/49313/3We have mentioned the hypos and can prove them on the download of the meter. We will pay out of pocket, and I know they have a $150 knocked off the script but is that a one time thing only? I also know their discount is in effect only until next year. We are not new at this and have been at this for ten years. We have successfully appealed for Apidra, had continual appeals for sufficient testing strips, appealed for Dexcom successfully twice (now she won't wear it). We have one more appeal after this one. Problem is the endo who prescribed the scripts seems to have a very busy practice. We have switched endos before who have refused to fight for adequate strips. I hope the endo will follow through with us to the end of the appeal process. Her receptionist told us we can't appeal as the insurance is demanding visual impairment as one of their grounds. Naturally the endo cannot lie. Hoping for the best, and it won't end here. We will appeal at a governmental or State Insurance Board, whatever we can think of we will do. Once Sanofi stops the discount this could get very expensive. She seems to be using quite a bit of Afrezza... the dosing is not equivalent. But, no, not going back to Novolog, Humalog or Apidra. Been there. Done that. There is no comparison . quote: the insurance is demanding visual impairment as one of their grounds. reply: this chart regarding visual impairment was in dr. edelman's presentation, (in case it is of use in this situation) screencast.com/t/7FTSvdekyts "Finally found a doctor in New York to prescribe Afrezza for 18 year old daughter. She loves it. Her blood sugar was 312 after eating out in a restaurant. 4 unit dose of Afrezza brought her to 180 in half an hour 130 in an hour."
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Post by Deleted on Dec 10, 2015 12:06:10 GMT -5
update from the same member on tudiabetes.org: www.tudiabetes.org/forum/t/insurance-company-denied-afrezza/49313/3We have mentioned the hypos and can prove them on the download of the meter. We will pay out of pocket, and I know they have a $150 knocked off the script but is that a one time thing only? I also know their discount is in effect only until next year. We are not new at this and have been at this for ten years. We have successfully appealed for Apidra, had continual appeals for sufficient testing strips, appealed for Dexcom successfully twice (now she won't wear it). We have one more appeal after this one. Problem is the endo who prescribed the scripts seems to have a very busy practice. We have switched endos before who have refused to fight for adequate strips. I hope the endo will follow through with us to the end of the appeal process. Her receptionist told us we can't appeal as the insurance is demanding visual impairment as one of their grounds. Naturally the endo cannot lie. Hoping for the best, and it won't end here. We will appeal at a governmental or State Insurance Board, whatever we can think of we will do. Once Sanofi stops the discount this could get very expensive. She seems to be using quite a bit of Afrezza... the dosing is not equivalent. But, no, not going back to Novolog, Humalog or Apidra. Been there. Done that. There is no comparison . quote: the insurance is demanding visual impairment as one of their grounds. reply: this chart regarding visual impairment was in dr. edelman's presentation, (in case it is of use in this situation) screencast.com/t/7FTSvdekyts "Finally found a doctor in New York to prescribe Afrezza for 18 year old daughter. She loves it. Her blood sugar was 312 after eating out in a restaurant. 4 unit dose of Afrezza brought her to 180 in half an hour 130 in an hour."
lol ..visual impairment as in the patient is unable to inject the insulin and so needs afrezza... Thats what i think
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Post by stevil on Dec 10, 2015 12:17:21 GMT -5
Ya... How awesome is it that you have to suffer and lose permanent function of something before they'll over something that probably would have prevented that permanent loss from ever happening. It's sick.
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Post by mssciguy on Dec 10, 2015 12:21:20 GMT -5
Ya... How awesome is it that you have to suffer and lose permanent function of something before they'll over something that probably would have prevented that permanent loss from ever happening. It's sick. stevil If there were a "post of the day" award, yours would have my vote. I am totally for preventative care myself, but there is not much money for the big corporations in preventative care. They want to sell you double bacon burgers, sugary liquids, and worse. One day you will be in a position to change things. Study hard.
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Post by compound26 on Dec 10, 2015 22:44:24 GMT -5
Here is a thread in Tudiabetes.org on the issue of checking blood sugar in public: www.tudiabetes.org/forum/t/checking-blood-sugar-in-public/10731/73Question: Has anyone encountered any issues with checking their blood sugar or their kids blood sugar in public?There is a close family member who seems to take offence and says it bothers her and many others that I check my blood sugar with my glucometer and my son's blood sugar in public. She expects that we should go to the washroom to check our blood sugar except if we are low (of course, my son does not always know he is low unless he checks his sugar so how does that even make sense). When in a restaurant, I discreetly check my blood sugar on my lap under the table but with my son I put his meter on the table and he checks it himself. Personally, I will check my sugar whenever and wherever I want/need to despite whether or not it makes others uncomfortable. I find that in today's day and age this is unbelievable and this IS A FAMILY MEMBER on my husband's side of the family!!! Since my father, brother, myself and my son are all Type 1 diabetics no one in my family would even say such a thing. Just curious to other diabetics experiences. User Comment: I always avoided doing any of those things in front of just about everyone.... Since I got afrezza it's gotten a lot easier because I don't feel near as out-of-place taking a puff off an inhaler in front of others than I do making myself bleed or injecting, and frankly it works so well that I really don't even need to check my glucose levels, I can just decide on the large dose or the small dose and get on with my life-- maybe check a couple hours later to ensure I am not getting a delayed spike... Observation: this is consistent with other Afrezza users' experience: See more comments from Afrezza users on this subject at: www.afrezzajustbreathe.com/afrezza-injection-free/
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Post by compound26 on Dec 11, 2015 0:06:20 GMT -5
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Post by compound26 on Dec 27, 2015 13:34:19 GMT -5
update from the same member on tudiabetes.org: www.tudiabetes.org/forum/t/insurance-company-denied-afrezza/49313/3We have mentioned the hypos and can prove them on the download of the meter. We will pay out of pocket, and I know they have a $150 knocked off the script but is that a one time thing only? I also know their discount is in effect only until next year. We are not new at this and have been at this for ten years. We have successfully appealed for Apidra, had continual appeals for sufficient testing strips, appealed for Dexcom successfully twice (now she won't wear it). We have one more appeal after this one. Problem is the endo who prescribed the scripts seems to have a very busy practice. We have switched endos before who have refused to fight for adequate strips. I hope the endo will follow through with us to the end of the appeal process. Her receptionist told us we can't appeal as the insurance is demanding visual impairment as one of their grounds. Naturally the endo cannot lie. Hoping for the best, and it won't end here. We will appeal at a governmental or State Insurance Board, whatever we can think of we will do. Once Sanofi stops the discount this could get very expensive. She seems to be using quite a bit of Afrezza... the dosing is not equivalent. But, no, not going back to Novolog, Humalog or Apidra. Been there. Done that. There is no comparison. update from the same member on tudiabetes.org:
www.tudiabetes.org/forum/t/insurance-company-denied-afrezza/49313/8There is a second appeal. We know from past experience that they often will deny the claim and even the first appeal Then you go back with documentation and we did get her Dexcom on the second appeal. We also got her Apidra approved I think on the first appeal. We have had to fight for adequate testing strips countless times. For the next year we are okay because, although expensive, we can cut back elsewhere. She just picked up her first month's script (and she may need more, I'm not sure yet). Sanofi takes $150 off each box I think. She got two boxes of the 8 unit cartridge and one box of the four unit cartridge for $350. I think it may be even less expensive at Costco or Sams; we used Rite Aid. After next year if they don't renew the discount, it would cost upwards of $700. I think she will need another box of the 4 units per month at least. Diabetics and their parents friends, in fact most people with health issues should start a movement, much like Act Up, to get their medical needs covered. We know the drill. I think we will win in the end on the second appeal. Or time to go job hunting for better insurance coverage. That's one way. update from the same member on tudiabetes.org: www.tudiabetes.org/forum/t/what-do-you-think-about-afrezza/47626/77?u=charles5We are not covered by insurance yet and our DD has not been using it long, but I would literally take food off the table to pay for this insulin. And if insurance does not kick in, it may be rice and beans for the adults, LOL. However, she is using quite a bit more Afrezza than she would have used Apidra. 30 grams and under she uses a 4 unit cartridge, 40 and over 8 units. We are giving it ten to fifteen minutes into a meal, and I am beginning to think our timing is off and we should give it immediately after. Regardless of the meal, almost always she will be 170 one hour after eating and we then give a four unit cartridge. It seems to require two doses, either four and four or eight and four, depending on size of meal. Very surprised that at 200 and even 170 one four unit cartridge for correction is not too much, but she is also on a new basal insulin and we are trouble-shooting that as well. For now, the four unit does work for a blood sugar of 170. To give you an idea of the dosing, a correction dose for 170 on Apidra is 1:70 or just one unit. We are probably going to need more than what they initially give for one month. But it is fast, very fast. It is easy to use. She loves it.
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Post by compound26 on Jan 3, 2016 10:45:59 GMT -5
www.tudiabetes.org/forum/t/how-do-you-handle-high-post-prandial-readings/50061/45?u=charles5M_K_Type 1 Hello! I love my healthy breakfast: instant oatmeal (20g) mixed with greek yogurt (9g) and 1/2 banana (15g) with cinnamon = around 40-44g CHO. I wake up at 100 (7am), two hours after my breakfast I am at 250 (10am). But at lunch time (12pm), I am back at 120. I was not aware of that spike until I wore a CGM for a week and noticed that. How do you handle that? If I take more insulin, I will have a low at noon... Should I change what I eat or should I talk to my doctor to change to a more fast acting insulin? I'm type 1, use Novolog and Levemir (Basal). Gus1 Short answer: I mostly don't have any of those anymore, since I started using Afrezza back in April 2015. I eat what I want when I want it, and have mostly non-diabetic T1D numbers (A1C of 5.5, ~90% in range 60-140) and life. Long answer: Before Afrezza I did all the heroic and incredibly complex things described in this thread, because there was no other choice. I used a pump. I did a very low carb diet during the day, as carbs where my enemy. I only took a moderately large amounts of carbs immediately after training (run, bike or swim). And I tried to keep my life as monotonous as possible, because change was my enemy as well. So, specifically for breakfast, I only had one with carbs on Saturday as I had time to deal with the IOB mess later. It required planning, pre bolus, waiting, eating, and then based on what happened during those long 4 IOB hours, correct as needed. With Afrezza, this is what breakfast looked like today: I woke up with around 110 (although pre eating sugar does not matter, I just have more Afrezza). I prepared my granola with milk and banana (probably around 100gch, carbo loading for the mid-morning swim :smile: ) . Had my mid size Afrezza dose (its the 8U cartridge, but Afrezza units have nothing to do with injected insulin). And started eating. My BG stayed mostly flat for around 90min. Then Afrezza is gone, and because I eat complex carbs I either give a small dose of follow up Afrezza (4U), or exercise to burn the remaining glucose. That's it. No IOB mess, no severe lows. Really freaking amazing if you ask me. PS: I ditched the pump 3 weeks after starting with Afrezza, as I discovered in awe that most of the super custom basals I was using where to compensate the IOB mess. Now I use Toujeo, once a day. Pump free! M_K_Type 1 Okay, you just turned my world upside down. lol --- Thank you so much for sharing, I am researching right now about MDI, Afrezza, Toujeou... I don't know what any of those things are, so thank you for introducing me to new options that could be a possibility. I am not an athlete like you, but I identified myself with a lot of the things you described. I am writing it down to talk to my endo on my next appt. Thank you!!!
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Post by compound26 on Jan 3, 2016 16:59:36 GMT -5
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Post by compound26 on Jan 5, 2016 15:15:39 GMT -5
To me apparently Sanofi did not use reasonable efforts to promote Afrezza. Sanofi terminated the license agreement 11 months after a very soft launch. Pfizer pulled off Exubera after 16 months into launch and after Exubera has already obtained approval from both US and EU. Pfizer also spent $370 million promoting Exubera in 2007, including TV ads. Here is another user's comment on this: Jim2 www.tudiabetes.org/forum/t/sanofi-ending-its-afrezza-partnership-with-mannkind/50253/6?u=charles5I had never heard of it until I got my CGM a couple of months ago and returned to this board after a hiatus of several years. I have since gotten some samples and a prescription, and it really is a different animal from injectable insulin that holds great promise. My fear is that it will be viewed as a failure like Exubera and no company will be willing to pick up the ball and take a chance with it. Unfortunately, just having a great medication doesn't mean much if you don't have the means to manufacture, distribute and promote it and survive a sea of red ink until it gains traction.
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Post by biffn on Jan 5, 2016 15:31:22 GMT -5
This was SNY playing hardball with Al. Anything they did was the bare legal minimum their attorneys told them they could get away with. They wanted it all for next to nothing. Either that or they used this deal to try to kill Afrezza on the competitive market. Either way, here we are. SNY is guilty of gross ethics violation as regards the diabetic community and their corporate responsibility to patients and families.
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Post by docfrezza on Jan 5, 2016 15:44:28 GMT -5
Sanofi rep just told me that they had a company teleconference with their reps today, actually 2 teleconferences with the content of both teleconferences being the same. According to that teleconference Sanofi will continue to provide representatives in the field and sampling of Afrezza until April 4. Sanofi will completely turn Afrezza back to Mannkind as of July 4. Not sure exactly what happens between April 4 - July 4. According to the representative they were told during the teleconference that it was Sanofi that terminated the agreement with Mannkind. For many of us that have prescribed Afrezza the biggest concern is whether or not Afrezza will continue to be available for our patients in the coming months.
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Post by Deleted on Jan 5, 2016 15:47:32 GMT -5
Sanofi rep just told me that they had a company teleconference with their reps today, actually 2 teleconferences with the content of both teleconferences being the same. According to that teleconference Sanofi will continue to provide representatives in the field and sampling of Afrezza until April 4. Sanofi will completely turn Afrezza back to Mannkind as of July 4. Not sure exactly what happens between April 4 - July 4. According to the representative they were told during the teleconference that it was Sanofi that terminated the agreement with Mannkind. For many of us that have prescribed Afrezza the biggest concern is whether or not Afrezza will continue to be available for our patients in the coming months. This is what I was afraid of. We are hostage until July
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Post by biffn on Jan 5, 2016 15:57:18 GMT -5
So it looks like the 6 months is going forward. If there is a new Afrezza partner, SNY will probably use this period to hinder market entry. This may be very dirty pool, though contracts should be written with the worst case in mind and with the intent on either party to break the contract on terms they can each live with. This seems to be what SNY has done, just hoping MNKD can handle the result.
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