Bob Krasen – Ohio

I am a type 1 diabetic. Our Medicare Advantage Plan is an entity of a non-profit hospital conglomerate and supposed to be non-profit as well. However, I have caught them “upcoding my health care records”; with stuff that is extraneous. I told the doc which ones I wanted removed. They did, but I have to keep watching.

A few years ago, my insulin costs were sending me into the “donut hole.” In July I asked my ENDO about it, and she said, “You should be getting your insulin through Part B of Medicare because you have a pump.” At first the insurer customer services at CVS Caremark said they couldn’t do that, but I insisted and called the Pharmacy Manager at the Medicare Advantage office. He was able to help, and ever since, I have at least stayed out of the “doughnut hole,” even though I am paying about the same for insulin as before, about $57 per vial. Too bad Congress didn’t vote to support the insulin cap of $35 per month. I guess too few of them have kids who face a lifetime dependency on insulin. Medicare for All (M4A) would finally solve the problem by paying 100% of necessary drug costs. CMS (the Centers for Medicare and Medicaid Services) would be able to negotiate drug prices, as the VA (Veterans Administration) has done since 1930, so M4A would save money.

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