Bloody hell! My strips are going up.


Well, the lucky streak is over. After several years of fairly steady co-pays for my test strips, my copay for them will more than double in 2013. What's more, the insurer, who is new to us and who shall remain nameless, has deemed test strips as a tier 4 drug (I never knew there were more than 3 tiers on a drug formulary) and has also decided they don't qualify for any sort of 90-day supply price break. The only thing that has kept me from weeping is that the copays on three other scripts declined slightly, a small offset but hey, I'll take what I can get.

By the way, the insurer's definition of tier 4 is, I kid you not, "drugs that have not been included in Tier 1, Tier 2 or Tier 3." There is no explanation for why they aren't included in Tier 3 ("Tier 3 consists mostly of brand-name drugs without generic equivalents)" but I can guess it has to do with high cost/high utilization.

The insurer also requires a prior auth for the strips, which will be a new experience for me. I'll let you know how it goes.

All this reminds me of a conversation I had today with Tom Milam, who used to head up a mail order supplier, and still follows industry issues like competitive bidding very closely. You (the insurer, be it private or government) can do all you want to reign in costs and you can make providers and patients jump through hoops to get what they need, but you'll never erase the need for certain supplies or prescriptions. Furthermore, for some patients, (not me, fortunately) such obstacles mean less testing, which in turn leads to health care problems that cost a lot more in the long run.

When I hear people blame "Obamacare" for everything they think is wrong with the economy, I say, why not point your finger at runaway drug costs, lab tests and everything else. I'd also point a finger at insurers who keep dumping double-digit increases on employers. I don't know if Obamacare is going to make things better, or worse, but I do know this: The healthcare system as it has stood is broken.

For those of you dealing with the dreaded annual open enrollment process as you read this, I wish you luck and an employer who does their best to keep a lid on health care costs, painful though it may be.

Theresa Flaherty
Type 1, 13 years