CVS Caremark — Hates Diabetics, Hates America

I hope that shocking title will grab everyone’s attention, or at least the attention of diabetic Americans. I’ve only been on Caremark since January and am already extremely dissatisfied with them for two reasons:

1) They will only cover Novolog insulin. I have nothing against Novo Nordisk or against Denmark. But, please understand that I am a U.S. citizen living in the U.S. with a U.S. based health insurance company. And, that company will not allow me to buy my insulin from a U.S. company, Ely Lilly. Instead, they require me to buy from a Danish company, Novo Nordisk. They should cover all brands of insulin as different people get different results from the minor differences in the insulin analogs we use today. Especially in difficult economic times for the U.S., U.S. based companies should not be explicitly disallowing patronage of U.S. companies for the few things we still actually do manufacture in the U.S.

2) I was just denied coverage for my continuous glucose monitoring (CGM) sensors. For anyone who is not a diabetic or does not use CGM, this technology allows for testing glucose levels every 5 minutes throughout the day. While there are a lot of issues with the current level of this technology, it has quite possibly saved my life several times. Low blood sugar, in particular, can be immediately dangerous. Diabetics can go into insulin shock and die. These sensors have alerted me to very low blood sugar before I felt the affects several times in the last 4+ years since I’ve been using them. Far more often, they alert me to high blood sugar. While high blood sugar is generally not immediately dangerous, the long term affects of high blood sugar are both devastating and costly. They include at a minimum blindness, loss of limb, kidney failure, heart disease, neurological damage and severe constant pain, and impotence.

So, while the sensors may not technically be life-sustaining, they actually can prevent death and severe diabetic complications.

If you are a diabetic and have any choice in prescription drug plans, do not choose CVS Caremark.

Medco was far better. They all suck. But, Caremark is the worst I’ve encountered. If you are not a diabetic, I would still recommend against Caremark partially just to make the statement to them that if they want to remain in business, they should provide rather than deny health care. Also, since it’s probably impossible to really find out what will be covered in advance, I would suggest that it’s a good bet that if they treat diabetics so poorly, they probably aren’t singling us out. They probably treat all of their patients poorly.

I do plan to appeal this. However, I will be off of Caremark soon. So, really we’re talking about 3 orders. Still, at $420 per order, this is not an insignificant sum.

I should have moved to a civilized country years ago.

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15 Responses to CVS Caremark — Hates Diabetics, Hates America

  1. Nancy May says:

    I am sorry to hear of your plight, but I’d suggest it is not the fault of CVS/Caremark, it is more likely the benefit plan your employer selected when they contracted Caremark to administer their pharmacy benefits. I have been with Caremark for several years. They are fine for my prescriptions. You might pursue obtaining your CGM sensors via your DME (durable medical equipment) benefit. Have your physician write a letter of need, too, and submit through your insurance carrier; you may find that your health plan has a third party supplier designated for your T1 supplies – insulin, strips, lancettes, reservoirs, skin prep, infusion sets. I had a hell of a time with Medco when they were my Rx provider.

    Your best defense is to know what your state mandates as far as diabetic care and what your health insurance will and will not cover. It takes several phone calls and lengthy conversations with multiple people at both the health insurance carrier and at the pharmacy benefit company. The real pisser is no one can answer the sticky questions during the enrollment period, you have to wait for the plan year to begin in order to find out what is and isn’t covered.

    I spend a good 2 months the beginning of the year going through this exercise, and it never gets easier.

    • Nancy May,

      Sorry, I’m having a really hard time imagining my employer sitting down with Caremark and saying “I don’t want to cover continuous glucose monitoring” and “I will only pay for Novolog insulin”.

      Whatever plan they chose, it was a plan offered by Caremark. The details of what it covers were decided on by Caremark. The fact that my employer likely chose the cheapest plan does not change the fact that Caremark had such a plan to choose.

      As for why no one can answer the sticky questions during the enrollment period, I’ve been fighting with that for years. It’s because of our for-profit, denial of health care insurance companies.

      Face it, by being for-profit companies, they are legally mandated to maximize shareholder profit, period. The best way to do this is to charge an arm and a leg and to deny deny deny coverage at every possible opportunity. It’s their legal obligation. And, they’re all very good at it.

      This is why we need medicare for all.

      I will say thought that I have had Medco for years and now Caremark for just a few months. I’ve had problems with Medco raising my cost on prescriptions. I’ve had them reclassify drugs to be in higher copay categories. But, I have never once had them deny something outright or tell me that they simply didn’t like my brand of insulin.

      Insulin!! Are you fucking kidding me?

      They’re not all the same. Different people respond differently to each of the analogs, especially with respect to absorption rate.

      Sorry, Caremark is just evil, and more so than others.

      You say you work for them. I understand. Jobs are few and far between these days. But, do you really like the company? Or, is your job public relations? Don’t answer if it would compromise your position.

  2. SteveZ says:

    CVS Caremark is the Prescription portion of my health plan. I have had them for years. I have never (knock on wood) had a problem with them denying any of my diabetic supplies. I am not forced to get the Novolog insulin. I have been getting Eli Lilly right along through them. I just got some this past week. That may be a decision of your health insurance. I get my blood test strips through Caremark as well, and recently my Health ins provider made the decision to only cover Bayer glucose meters and strips and because of that that is all I can order through Caremark. This could explain what is happening to you. I don’t know, just a guess because I am not having your issues with them and the insulin. I get my sensors from Edgepark Medical. They bill my health ins directly and they are covered through the durable medical equipment portion of my health insurance. NEVER had a problem with Edgepark.

  3. SteveZ,

    I’m glad to hear you’re satisfied with your insurance. I received a letter in the mail last month with the Novolog only information.

    The issue you have with only Bayer meters would drive me insane. I would need to see the specs on the meter. But, I’m very particular. The Freestyle Flash that I have is the only one of which I’m aware that works in the temperature range that it does. When skiing, other meters sometimes require 30 minutes to warm up, even if they’ve been kept in an inside pocket and even if I pop out the batteries and warm them separately. The Freestyle works immediately.

    For some reason, my pump supplies are DME on my plan. But the sensors are under the drug plan.

    Oh well.

    I’ll have new insurance beginning May 1 when I buy an individual plan. I no longer work, so no longer have access to any group plan.

    Whatever I get next will be guaranteed to cost more and cover less and just generally be worse in every possible way. Bad to worse is all that’s in my near future. And, it’s probably what’s in store for the long term for all of us as long as we don’t have medicare for all.

  4. bobbo, the pragmatic existential evangelical anti-theist says:

    Hello All — I’m thinking (Hoping?) I don’t have diabetes but given my overweight status and American Diet, lack of exercise and age I should develop Adult Onset any time now? Genetically, all the males in my family die from heart attacks–none have had diabetes. I think diabetes whenever I get any dizzy sensation momentarily in my waking moments.

    I was fascinated by “The Blood Sugar Solution” by Dr Mark Hyman as presented on PBS this weekend.

    He said doctors focus on the blood sugar level but the key is actually the insulin level as you can have low blood sugar and still get/have diabetes. Then he stated that a very high number (don’t quote me) like 90% of diabetic patients could be CURED by no drugs and only a change in diet. Now–I do think diet can play a key role for many people but 90%??? Given his bias as pushing his book and diet plan, it still probably makes sense to get on a low sugar, processed carbs type diet but I’m curious what you folks on the inside think of such claims? Been hearing them for years I assume?

    Maybe relevantly–do low glycemic diets “help” in anyway or if you get diabetes “must” you get on drugs no matter what?

    I guess I’m bound and determined to get diabetes as cooking and baking has become my new main hobby and I’m making ice cream now. Sure tastes good and it is a fun hobby. Been thinking about making sugar free ice cream but the good doctor said to avoid artificial sweeteners but he didn’t give the reason for that. I’d think whatever the associated risks of artificial sweeteners, I’m in the zone now where developing diabetes is the highest risk and I should go for aspartame? Think I saw where the fat free half and half was made with lots of sugar?

    Dr Mark Hyman also made a big point that High Fructose Corn Syrup was NOT the same as sugar but his reason disappointingly was that it was found in almost all processed food products. Some other doctor I think said HFCS was processed differently than sucrose but I forget what exactly.

    In this day and age, I think you can either have diabetes or be concerned you will get diabetes?

  5. Hi bobbo,

    Is it possible that the number was 80% instead of 90%? Last I heard, 80% of diabetics have type 2 diabetes. Type 2 is the type that is severely on the rise due to obesity. So, perhaps it is now 90%.

    I’m not sure that all cases of type 2 diabetes could be cured with diet and exercise. But, it is possible.

    Type 1 diabetes, sometimes called insulin dependent or juvenile diabetes, is an autoimmune disease where the body essentially rejects its own pancreas in the way that a transplant patient might. This is a little simplistic, but is a good way to think of it. Type 1 diabetics, after a honeymoon period ends, typically produce no insulin at all.

    Type 2 diabetes, sometimes called adult onset diabetes, is a disease caused by a lack of insulin sensitivity. Type 2 diabetics often produce vastly more insulin than non-diabetics as the body attempts to cope with the high blood sugar that results from being unable to use the insulin.

    Exercise is a huge factor in insulin sensitivity. Many years ago, when I joined a gym, my insulin intake dropped from about 70 units a day to about 25-30. I’m currently a bit higher than that at about 28-38 depending on food and exercise.

    So, a type 2 diabetic who took up a regular exercise program might actually improve his/her insulin sensitivity sufficiently to rid him/herself of the disease.

    Similarly, if one weighs more, one needs more insulin. So, dieting to reduce weight can also help a lot. Though, I don’t know if it would be enough.

    For me, weight matters, but not as much as exercise. I can tell because I need to take insulin no matter what I do. I’m a type 1 diabetic.

    Regarding HFCS, it is really bad. One of the problems with it is that unlike table sugar, HFCS does not trigger the production of insulin, or maybe does less to trigger it. I’m not positive.

    One of the effects of insulin is also to trigger the body to recognize that you are full. So, a 400 calorie liter of cocacola might have the caloric content of a meal. But, you’ll still be hungry after it.

    That will lead to further increased weight and higher risk of diabetes.

    Anyway, that’s my take on the subject. There are now a few (or one) doctors claiming HFCS is a poison. I don’t agree with that. Poisons kill faster than that and in smaller quantities. HFCS is still really bad news though. Avoid it like the plague whenever possible. At least, if you must drink cocacola, drive up to Canada to buy it. Theirs has sugar. Or, try a diet soda with stevia in it. Or, at the very least, try one of the smaller brands of cola that uses cane sugar.

  6. bobbo, the pragmatic existential evangelical anti-theist says:

    Scott – you read me wrong. Thank goodness we aren’t arguing? The claim by the doc is that 90% of people who HAVE diabetes can be cured by diet alone. He was talking about Type 2 (I think?).

    I’ve been looking at the Blood Sugar Solution. It is simply a reduced calorie balanced diet that avoids sugar, processed food, trans-fats, and artificial sweeteners. Its the “Zone Diet” with slightly higher percentage of carbs.

    First I have heard that HFCS does not spark an insulin response. I have heard that said about artificial sweeteners AND that they break down into toxic substances like formaldehyde.

    I’ll bet all these factors DO make a difference. Just not sure how much?

  7. Oh … 90% of type 2. That makes sense. I wouldn’t be at all surprised by that number. The zone diet might not be bad except for the zone thing. 🙂 The zone diet, AFAIK, is based on eating so few carbs that your body goes into “the zone”. Unfortunately that zone is called acidosis. Any physical state of your body that has a medical name is generally synonymous with “unhealthy”. But, add just enough carbs to avoid going into acidosis and it could be a good idea for type 2 diabetes.

    I’m sure there are a zillion (to be an obviously made up non-number) factors that DO make a difference. I’m sure the amounts of toxins in our bodies from living in the industrial world make a difference, even though most are in trace amounts. I’m sure the trace amounts of all of the medications we take that spill out in our urine and don’t break down in our sewage treatment plants, thus ending up in our water supply make a difference.

    Some doctors are beginning to use the term obesogens for chemicals that make us fat.

    http://en.wikipedia.org/wiki/Obesogen

    And, of course, many people are blaming an array of chemicals, especially from plastics, for lower fertility and a host of other health issues.

    The truth is that many of the trace chemicals in our bodies were never intended to get there in any quantity and are thus completely untested even in trace quantities. Who knows what the effects may be?

    The only thing that keeps me moderately sane about it, though others may not agree I’m moderately sane, is the knowledge that it won’t be my kids dealing with it. Sorry to any parents who may be reading this. I have no idea how you’re handling it. Hopefully through denial. There are few real and feasible solutions to the issue. Although, saline, as in tears, is always a solution.

  8. UPDATE UPDATE UPDATE! Caremark has actually paid for my sensors. It took a tremendous amount of fighting and submitting the paper claim twice, but it is finally paid.

    They do still cover only Novolog insulin. No Eli Lilly for you! (Or me.)

  9. lisa treese says:

    I was given this post to read by a friend. Our state insurance is making us use caremark. I was on the phone all day…..they want us to use novolog but my secondary insurance wants us to use humalog which we currently use. But somehow my pharmacy said they can use my secondary with no problems and continue getting humolog. I cant believe how each chooses a different insulin. I don’t have time for all this crap when my little one has been using humalog for five years! I’m ready to call caremark! I spent all afternoon on the phone between pharmacy and both insurances. On top of it all….our medical access cjenged without telling us and put us into a company that isn’t accepted at any of my kids doctors!

    • Sorry to hear you’re having such trouble too. I’ve been saying for a while that the only thing worse in our denial of health care industry than our health insurance is not having any. Let’s hope for a bit of help from the incremental improvements in Obamacare.

      And, let’s all shout at the tops of our lugs that we need a public option. Do I want health insurance run as well as the post office? Hell yes! The post office isn’t perfect. But, they do a pretty good job despite being hamstrung.

      If only our health insurance were as good as the post office!!

      Good luck getting care from the very competent individuals in our private insurance industry who are explicitly tasked with not providing you care. I hope you succeed.

      BTW, I’m now on Oxford. The rules suck. I have a gatekeeper. But, since it’s all about the money, there is something to know about the Oxford plans. They cover all diabetic supplies at the cost of a primary care physician visit for a one month supply.

      I actually don’t have a drug plan now. Some things, like insulin will have to be purchased out of pocket and then get reimbursed. I haven’t tried this yet. So, I have no idea how it works.

      Getting covered for pump supplies, including CGM sensors, has been easy as hell through Byram. They have dealt directly with Oxford and billed me only the copay. This was hard to figure out, but works beautifully.

      I’m now paying totally out of pocket for my health insurance. But, it’s not quite as bad as I expected. It’s just more hassle. And, of course, for non-diabetes related prescriptions, I have no coverage at all.

      All options suck at this time.

      I want Nixon’s plan. The icon of 1970s conservatism had a plan to allow people to buy into medicare on a sliding scale based on income. Imagine. By now, the denial of health care industry would be out of business!

      Who in their right mind would choose a competent corporate executive whose charter is to maximize profit, i.e. minimize your care, over even the most incompetent bureaucrat who is at least tasked with providing care? Which one will provide more care more of the time?

  10. Tony Pereira says:

    My son has type1 and we too have had issues with CVS Caremark(CVS Careless) they took away his Humalog and now supply us with novolog (thank to all the kick backs) and now they no longer cover the freestlye test strips which my son NEEDS for his Omni pod system. they said they would be happy to send us a new meter but have explained to them that his PDM which links to the POD on his body uses the freestyle strips! All they said was “sorry can I help you with anything else” great service!

    • Tony,

      That is really unconscionable on the part of CVS. I’m specifically referring to the test strip issue. All of us living with diabetes are well aware that test strips are one of our greatest expenses.

      If you can get through to anyone with half a brain, like a supervisor, you should try to ask the process for getting an exception to the rules. This could be a case where a doctor’s letter might help. There are sometimes ways around these rules.

      Alternately, do you have any choices in your insurance? Does your employer have other options? I assume Caremark is only your drug plan. You could also try contacting your medical insurance company.

      As a final suggestion, assuming this is through an employer, definitely involve your HR department. Companies often provide crappy health insurance while HR people with no health issues think it’s just fine. If you get HR involved in your battle, you have much better odds of winning and getting what you need.

      I doubt they can help much with the Novolog thing. It would be harder to make a case that there is a difference. I notice a slight difference between humalog and novalog, but can’t really quantify it. The absorption is only very slightly different.

      Anyway, it is possible that if you really involve HR, one effect might be that they ditch Careless for the next calendar year. If they’ve already made their final decisions about health care for 2013, it may have to wait ’til 2014 for them to fire Careless. However, they could still be in the decision process now.

  11. Steph says:

    Hi. Just found this article. I’m having a hell of a time with CVS Caremark as well particularly for the Dexcom CGMS. I can’t get sensors. They are just simply not covered. My employer doesn’t offer any other prescription plan. Why all of a sudden can these not be billed to my BCBS insurance as Durable Medical Equipment? When did that happen?

    The woman who I spoke to on the phone at CVS Caremark was the worst. She was rude, ignorant, and didn’t give a flying fig newton about my coverage. She said she had never even heard of Dexcom and that just because you have a prescription for something doesn’t mean it’s always covered. Yes, thank you, I understand what no coverage means, I was asking WHY you don’t cover it. What is the reasoning?

    This is ridiculous if you ask me. I was diagnosed at the age of 10, I’m 30 now. I take care of myself. I am not obese. I am active. The alarms and arrows on the Dexcom are crucial to my care. I can sleep soundly knowing that if my blood sugar drops for some unknown reason, the alarm will wake me. I’m trying to plan a pregnancy next year as well and have to make sure my blood sugars are in range while pregnant.

    The Dexcom prevents so many complications that could end up costing insurance companies much more than what it takes to cover my Dexcom. I don’t even care if it’s in a Tier where I have to pay a little more. But no coverage at all? You have to be kidding me. Get with the program, CVS.

  12. Hi Steph,

    I would really love to be able to feign surprise or shock at your experience with Caremark. However, my ability to perform deadpan humor has never been very good. Caremark is by far the worst prescription drug plan I’ve ever had. I can’t even feign surprise at how badly they are treating you.

    So, instead, I can really only say that I’m very sorry to hear about your experience with them.

    I can offer you this tidbit though. I now have Oxford as a medical plan and no prescription drug plan. You might ask how insane I must be to take a medical plan with no drug plan as a type 1 diabetic. But, here’s the kicker. Oxford, if you don’t have a drug plan, pays for all diabetic supplies at the cost of a primary care physician’s office visit for a one month supply.

    This means that I pay $35/month for each of my supplies, including test strips, minimed sensors, infusion sets, reservoirs, and insulin. For insulin, I must submit a claim. For all the others, I can purchase them through a DME supplier like Byram Healthcare.

    So, if Oxford is one of your choices, see if you can opt out of the prescription drug plan. The downside is that any other prescriptions you need will be paid completely out of pocket at whatever the shocking retail price is. The upside is that, at least for me, even though I need some very expensive eye drops and other prescription items, it is still less than the difference in cost between Oxford with a prescription plan and Oxford without.

    If your employer pays a portion of your insurance, that may not be true for you. But, I’m paying in full. So, for me, the difference in premiums is significantly more than the benefit of having a drug plan.

    You may also check what your available choices for health insurance do for diabetic supplies if you have no drug plan. Perhaps Oxford is not unique in this.

    Hope this helps. If not, you have my sympathy for your hassles.

    Remember though, if you’re lucky enough to be able to afford the costs, it’s not about quality of care, just about cost of care. If the cost is sufficient to drive you into worse care, then you really have my deepest sympathy for your situation.

    I still want medicare for all, or at least Tricky Dick Nixon’s public option, suggested by him in 1974.

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