Follow
Share

I am 70, have type 2 diabetes. I can no longer take metformin. Because I am 70 I would have to pay full price no help from insurance. I will no longer get insurance after the first of the year. I will start Medicare. Is there a program to help with this?

This question has been closed for answers. Ask a New Question.

59 Answers

Most
Helpful Newest
First Oldest
First
1 2
Do you have a particular drug in mind? If so ask your doc for samples and if it agrees with you call the drug company and see if they have financial assistance (many companies do.)

It seems terrible that you can't change because of your age. Isn't that discrimination?
Helpful Answer (0)
Report
What??!! On the face of it that is absurd. Type 2 diabetes generally occurs in later adulthood and gets worse over time. How can there be an age limit on covering drugs that would help? Maybe there is a rational explanation somewhere, but it sure doesn't make sense to me. Or is it a age of not having any drug coverage at all, and age isn't really the issue?

But, assuming it is as the doctor says, does that mean you will be eligible in January, when you are covered by Medicare? That means you would only have two months to cover. Does the doctor have samples that could get you through? Did the doctor tell you how to contact the drug company? Some of them help out, and it would be worth trying that for a couple of months.

I wish you success with this issue, and I am glad that you will have drug coverage soon.
Helpful Answer (3)
Report
I have insurance, will be ending in Dec. He said that insurance won't cover any new drug. My AC1 was 4.5 but with metformin,which I can no longer tolerate. I don't know what Medicare will cover. I will be starting that next month.
Helpful Answer (1)
Report
I don't understand this at all. Is the doctor suggesting a new drug? I believe that you can find out what drugs the various Medicare Part D plans will cover, so if he has a specific drug in mind, he can give you samples and use them until your new coverage kicks in in January. Do you have a relative or friend you can take to the doctor with you? I often find that having another set of ears is a good thing in that situation.
Helpful Answer (3)
Report
Beware of Brain Dead Doctors

ADW gets diabetes meds thru Medicare/Medex/drug plan
Helpful Answer (2)
Report
It depends on what drug it is. There is a new drug for excreting glucose that I wouldn't prescribe for most people if I were a doctor. I particularly wouldn't prescribe it for people over 70-80 unless their glucose ran so high that it was dangerous. They advertise this drug on TV. It sounded like a terrible idea for a maintenance drug for most people. I thought of the damage it could do the kidneys and the UTIs that would increase many fold with all this glucose being dumped. I can already envision Sokolove with the class action lawsuits on down the road. Sometimes pharma loses good sense in its quest to make money. The drug to me seemed almost like bulimia being done at the kidney level. It is much safer to use diet restriction and insulin.
Helpful Answer (2)
Report
Here is a bit about the drug. I see they are going to have post-marketing studies of the effect on the body. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm345848.htm
Helpful Answer (0)
Report
Check with your pharmacy. Most pharmacies will help you find ways to pay for your medications if they are not covered by your other insurance. Unless there truly is truly a ban on Metformin for the over-70 crowd, they might be able to find you another way to pay for it.

When my Mom had her meds with her local Walgreens, they were VERY helpful, this way, but I suspect other will also this, too.
Helpful Answer (1)
Report
FranKay, since you can no longer tolerate Metformin, your prescription health insurance should be able to pay all or part of another *generic* insulin drug. I know I have to pay full price if I want a brand name of any type of drug.

Glad your body was telling you not to use Metformin... you have to go with your gut feeling about any drug you take.... from research I am seeing, Metformin looks like it could cause B12 deficiencies to which B12 supplements don't help... thus with B12 deficiencies it can cause a variety of different ailments. Have your doctor check you for low B12 just to be on the safe side... not everyone who used said pill will run into this situation. Get more info from your doctor.

As for Medicare, check to see if Medicare will cover your prescriptions, it depends on what *Parts* you have signed up for... I know for myself I am using AARP UnitedHealth for my prescriptions and the premiums are quite affordable.

Curious why you waited until you were 70 to get Medicare. My Mom waited until she was 69 and found out she had to pay a higher monthly premium because she delayed in signing up. I don't know if that is still the case as that was over 25 years ago. Hope not. The reason my Mom waited was because she was getting good health insurance through Dad's employer and Dad was 4 years younger than Mom.
Helpful Answer (2)
Report
Without being sure, I would guess that Jessie has gone to the heart of the matter and the doctor's primary concern is about side effects in older patients. But he's still got to come up with a better idea if you can't go on as you are. What does he suggest you should do?
Helpful Answer (2)
Report
When my mom with long-standing type II diabetes and mediocre management over the years was on just insulin, she was ravenously hungry ALL THE TIME, and stashed sugar packets to eat, and her glycemic control was awful. She had vascular complications that caused peripheral neuropathy, peripheral arterial disease, and contributed greatly to heart disease, stroke, and brain atrophy.

Invokana is new and heavily hyped, but it may or may not be a not be a great choice for you. My mom was tried on piaglitazone, at my request, which flopped because her heart could not handle the fluid retention; but then her doc tried her on Januvia instead and she did a lot better. YMMV with any drug. There are other things to try that will be covered for you. Wish it was easier, but you need a really good diabetes doc who will not settle for the status quo if the status quo stinks. It is worth the trouble to delay or prevent diabetic complications at any age. YOU are worth the trouble!! Don't settle.
Helpful Answer (1)
Report
I saw an advertisement for a drug called Farxiga yesterday on TV. It was the ad I was thinking about. It is is in the same class of drugs as the Invokana. I read that insurance companies will no longer cover Farxiga starting in January 2015. I don't know what the insurance status of Invokana is. If I were a doctor, I would stay away from this class of drug except in extreme situations when glucose hasn't come down using other methods, and I would be very reluctant to use them in seniors. I would be afraid of infections and falling.

Another concern I have about these medications is that many people with diabetes are not good at management. Some people eat what they want, then take some extra insulin or other medication trying to make up for it. This is a deadly game. Would the person who does this use this class of drug to excrete the extra they eat? Water and minerals are lost along with the glucose.

I really dislike that the Farxiga ad tagged on that it may help you to lose some weight. I REALLY dislike that pharma is allowed to advertise serious drugs to people who have no medical training. The companies want people to mention the drug to their doctors to encourage them to prescribe it. Of course, these drugs cost more because of advertising costs. And in the case of Farxiga, pay will soon be out of pocket only.
Helpful Answer (6)
Report
If you are covered by private insurance when you reach 65 they usually require that you sign up for Medicare which becomes your primary insurance with the private ins picking up what Medicare does not cover. While you continue to be covered by the private ins you should not need part D which is the prescription drug coverage.
Most insurance companies have their own formularies which is a list of drugs they are willing to cover in full or in part and the more expensive or new/unusual drugs may require special permisssion. Where possible generics are prefered and have the lowest co-pays. When you reach the donut hole and are using a non generic you will be required to pay a very high percentage of the cost which can run into hundreds of dollars. Many people offset this cost by obtaining their medications from Canada where the cost is much less or from Europe. In both area the standards for drugs are similar to those in the US and although it is frowned upon it is legal to do it. Overseas pharmacies will still require you to send a valid Dr's precription with your order. Beware of very cheap prices from some overseas suppliers. The drugs may or may not be actually harmful but could contain less of the active ingredient than expected. There is usually an older generic drug available for most conditions and because it has been in use for a long time there is less likely to be unexpected side effects. Many insurance companies may require you to try a tried and true generic before they will pay for a new drug. It is well known that greater care has to be taken when prescribing for older patients and 70 seems to be the cut off age because the liver and kidney functions of this population tends to decline and they may need lower doses or a different combination of meds. Older people also tends to have more than one disease being treated so it is important for the Dr to be careful when prescribing. This is why you are asked to take a list of current medications, vitamins and suppliments to every Dr appointment. it is also wise to have prescriptions filled at the same pharmacy so the pharmacist can look out for undesirable interactions. Adding illigal drugs and alcohol into the mix can also wreak havoc in a treatment plan. I agree some Drs can appear to be brain dead but on the other hand they are terrified of being sued or loosing their licenses.
I also think that it is a very bad idea that drug advertising is allowed to continue. like any other advertising it is aimed at making money rather than treating patients and many people feel they should be allowed to have what they percieve as the latest and best.
Helpful Answer (2)
Report
Have you been to http://www.medicare.gov/ to see if there are any drug plans you can afford to help pay for the drug you need? I know my mom's doctor writes a letter whenever she needs something they won't pay for.
Helpful Answer (0)
Report
Veronica91, I agree about the older drugs that are on the market, they are more tried and true.... I always ask my doctors how long a drug has been out, give me one that's been around for decades. If the doctor says well that drug makes you sleepy, I don't care as I can deal with sleepy :)
Helpful Answer (0)
Report
FranKay, If you stopped metformin due to a low GFR (kidney failure), then you can't take Invokana either. Start looking into Medicare Advantage plans with prescription coverage NOW.
Helpful Answer (2)
Report
You can thank the president and the Affordable Care Act. Starting next year there will be a lot of medical procedures, surgeries, and medications older seniors will no longer receive.
Helpful Answer (0)
Report
AmyGrace, curious what medical procedures won't be available?
Helpful Answer (0)
Report
Seniors are covered by Medicare and associated programs, which have nothing to do with the ACA. If we try really hard, though, we might find a way to blame the ACA for the two rocket explosions this week... you know, butterfly effect and a bit of imagination.
Helpful Answer (6)
Report
There are some changes that are being encouraged for lower-income seniors with chronic conditions that are on Advantage programs. This is causing friction with the states, because the federal government wants to route more of these individuals to the Medicaid programs administered through the states. There are other reductions that are coming. I imagine these changes will make many designer brand medicines unobtainable to people who can't afford a Part D supplement.

What I would like to see personally is for each person to be careful with their use of Medicare. Many, though not most, do go to the doctor too much and take drugs that aren't necessary. My mother was majorly guilty of doing this. Her feelings were that it was something she had paid for with her work and premiums. She didn't realize how much she was costing the system.

It is a complicated issue on how to cut costs and keep the quality of care up. The nation couldn't keep going the way it was. (Now if Washington would just stop having all those multi-million dollar parties for each dignitary that comes in.)
Helpful Answer (2)
Report
I just compared the cost of Invokana to Metformin. Metformin is $0-6 for a month's supply. Invokana is $324. EEK!
Helpful Answer (1)
Report
FIL was also taken off of Metformin for type 2 due to kidney problems at age 85. A drastic change in diet and exercise fixed the problem and his A1C tests have been quite good. I prepare all his meals and we make sure he is walking daily. He does like his sweets and that is a constant battle, but the doc told him if he was not compliant he would have to go to the insulin shots, scared him a bit.
Helpful Answer (1)
Report
I agree with CountryMouse. If the doctor is afraid that complications will be more of an issue because of your age, then he or she needs to give you some guidance about what to do.

I'm surprised that you aren't already on Medicare but maybe you had better drug coverage under your old insurance. Medicare D is improving but still has a long way to go. Still, it's better than nothing, so if your doctor says that the drug isn't bad for you then it's time to find which Medicare D program (it's done through private companies) is best for you. The research is time consuming but it would be well worth checking out several reputable providers.

I do hope that you can find something that helps you without doing you harm. Please keep us posted.

Carol
Helpful Answer (0)
Report
The AC act will limit people starting at age 70 from getting certain care that they would have gotten if they were just 69. As you age after 70 less and less services will be paid or covered by insurances. You will be offered end of life services and pain pills. Interesting if you work for Congress you are exempt from limitations from the Affordable Care Act. Cancer treatments are one of the treatments that older people will not get. Have friend who is up-set because he has read alot in the bill. Welcome to Login's Run. Check out movie in Google. We should all be very worried.
Helpful Answer (1)
Report
There are tough issues being faced. We face them as caregivers. With the cost of medicine being like it is, how much can we afford to do to increase the length of life? As caregivers we are faced with the decisions of how much of time we can afford to spend, often at our own financial sacrifice. These are hard choices, since the value of a life is infinite, but money and time are not. Perhaps we need to look to ourselves for answers and not depend so much on the government to care for us.

The simplest solution would be to reduce the cost of medical treatment, but the last 20 years has taught us that isn't going to happen. The way things are going now, more expensive things, like designer drugs, may become reserved for those that have the money to pay. The rest of us may have to settle for what insurance will cover.

I don't know how things will end up, but I do see how we got here.
Helpful Answer (1)
Report
126Cher, that is a myth that "if you work for Congress you are exempt from limitations from the Affordable Care Act", along with a ton of other myths, hearsays, misinformation, yada, yada, yada.

I cannot understand why some politicians would want to keep scaring their constituents, especially elders, in the name of gathering one more vote to keep them in office. Same with many of the political talking heads who are just paid *entertainers* making multi-millions in salary.
Helpful Answer (0)
Report
Freqflyer: from what I have researched, and from what doctors are saying certain surgeries such as neurosurgery will eventually be off the table for people over the age of 75, as they are in the UK and many other socialized medicine countries. (This is phased in and hasn't happened yet) To jessebelle: this is because to fund the ACA, over $500 billion was re-directed from Medicare (reduction in doctor and hospital payments, and through reduction of the fed supplementing AdvantageCare and many other things. This can still change if the Congress and Senate do something about it. The changes are planned to take place after this upcoming election, and then after the 2016 presidential election. The one big change that has affected seniors already is Medicare no longer paying for seniors who doctors want to admit for observation. That has been a big topic of discussion in NY in the congressional races. Basically, it stands to reason that when there becomes a shortage of doctors (many already taking early retirement, closing single doctor offices and fewer entering medical school) and more and more people in the system eventually decisions have to be made, not by the doctor, but by the government as to who gets treatment. It hasn't happened yet, but if you read the whole ACA as we have, you will see it.
Helpful Answer (0)
Report
126Cher: yes, you are right, this is going to sneak up on us, little by little. There is a reason each phase occurs the January after a federal election year. I don't know about anyone else, but the measly 1.7% increase in social security (about $20 a month) doesn't even begin to cover my AdvantageCare premium increase and the increase in co-pays and annual out of pocket cap (which went up about $1500), or the increase in the %limit of tax deduction for medical expenses (going from 7% of total income to 10%) So far, they haven't notified seniors on how much the medicare deducted from our social security checks is going to be for 2015. Too much of a coincidence we won't know until after the election.
Helpful Answer (0)
Report
FranKay, Establish yourself in a Medicare program first, Parts A, B and D. Then,
address the drug issues with your physician. Good Luck.
Helpful Answer (0)
Report
AmyGrace, all what you are reading and hearing via political candidates are scare tactics to get your vote.

The ACA was developed to help people get affordable health insurance. The ACA has forced *junk health insurance* off the market, thus the cry from some that they could no longer keep their health insurance.... what good is junk health insurance?.... especially if you go into the hospital or the ER and find after the fact that your so called health insurance only covered $100 of the cost, and you have to pay the rest. I've read many articles about people who for the first time ever now have health insurance and they can finally visit a doctor to help with their medical issues.

Shortage of doctors? I've heard that myth for the past couple of years. There won't be a shortage unless all the medical schools worldwide close their doors.

As for extensive testing for the elderly, it doesn't make sense to put an elder through complex extensive testing if the person isn't a good candidate for major surgery or could even survive the treatment. Example, my Mom insists on getting mammograms yearly and she is 97... she very frail, thus if she had to have breast cancer surgery she would probably die on the table thus shortening her life by a year or two. Forget about chemo. So why put Mom through that very painful mammogram which takes 2 technicians to help her with the x-ray. If someone told me I didn't need mammograms any more I would shouting from the rooftops in delight.

Both my parents are in their mid-90's, and they are still getting outstanding care, plus Dad has been in the hospital several times from falls, again outstanding care... nothing has been eliminated.
Helpful Answer (1)
Report
1 2
This question has been closed for answers. Ask a New Question.

Recent Questions


Popular Questions


Related Questions

Ask a Question
Subscribe to
Our Newsletter