I am a diabetic, and have been for two decades. I always knew that I would be, mostly because of my family medical history. My Father, his mother, and his father all had diabetes. It killed every one of them before they were 64 years old. I often joke that I lost the genetic lottery. My grandfather died when he was 47 years old. My grandmother, when she was 63- after having to live without legs for two years. My father died at 62. When I was diagnosed with diabetes, I lived in fear that I too would be dead before I could collect Social Security.
About 4 years ago, the diabetic medicines that I was on stopped being effective, and my A1C climbed to 10.0. This is a part of the disease- diabetes is a progressive disease. My doctor wanted to put me on Insulin, but knowing just how fragile diabetics become when they go on Insulin, I wanted other options. I see the story every day- insulin dependent diabetics inevitably go down the same road, ending in amputations, kidney failure, and death. Having to be on Insulin is a death sentence. I wasn’t going to do it.
That’s when the new class of diabetic medicines came along, and they were a miracle drug. Once I began taking Mounjaro, my A1C dropped to the mid 6’s, and my blood sugar is now well controlled. For the first time, I began thinking that I might actually make it to my 70’s. My last A1C was 6.2.
Since I could prove that I had been on Metformin and Actos for more than a decade, my insurance was willing to cover the $3,000 per month charge for the medicine. Insurance companies hate these new drugs- that’s why they got the Biden administration to go on a rampage to lower the cost of Insulin- they needed a cheaper alternative to the new medications.
Then two years ago, I got a new job. A new job means new insurance. The hospital that I work for, who is also my insurance company, requires you to get all of your medicine from the company’s pharmacy. That pharmacy has done everything that they can to force me to switch from the more expensive drug and take insulin. They delay filling my prescriptions, and say that they don’t have any, but if I would only switch to insulin, they have plenty of that available. I refused, and kept forcing them to pay for the drugs. As long as my doctor says that this drug is medically necessary, the insurance has to pay for it.
So this month, two months after the open enrollment period ended, my insurance company informed me that they will no longer pay for me to see any doctor who isn’t employed by the company that owns the hospital, and not coincidentally, the pharmacy. Not only that, but they are prohibiting me from paying out of pocket to see my current doctor. That was confirmed by my doctor this morning. They were threatened with legal action if they continued to see me for cash while I have active insurance. All of my future doctor’s appointments were cancelled. I offered to pay cash, and my doctor’s office told me that they can’t let me do that as long as I have active insurance. Now I am forced to see a company doctor, who will immediately place me on insulin.
I have a three month supply of medication left, and will be out of it by April 28. I can be added to my wife’s insurance during her open enrollment period, but that isn’t until July 1. It looks like they are going to force me to become Insulin dependent. I am sitting here thinking that my employer would rather kill me than pay for my medicine.
The only way to be added to my wife’s insurance earlier is to get a new job, and it has to be involuntary. I have to find a new job, then find a way to get fired, and I have to do it within the next three months. Maybe I can ask my boss to do me a favor and fire me.
My only other option is to try to convince a compounding pharmacy to sell me some generic, but you have to be obese for that to be legal, and I am not fat enough for that.
I am screwed.
30 Comments
Will · February 7, 2025 at 6:27 am
Are you Type 1? I am Type 2 and I have gotten my meds down to just Glipizide with diet and exercise. The diet is very strict but better than expensive meds and I am losing some weight. My last A1C was 5.9.
Divemedic · February 7, 2025 at 8:13 am
That works for awhile, until it doesn’t. My diabetes was controlled for 7 years with diet and exercise. Then my A1c climbed, so they added metformin. That worked for a couple of years, then we needed to add Actos. Then Trulicity. Now Mounjaro.
The Mounjaro has eliminated the Actos and Trulicity. Still, they will eventually have to up my dosage on it to keep it working. For now, it’s worked for the past 2 years.
Diabetes is a progressive disease. Once you have it, you always have it.
Will · February 7, 2025 at 1:27 pm
The cost of Trulicity was what encouraged me to get serious about diet and exercise. I had to pay for it out of pocket. Metformin was the first drug prescribed for me. It worked for several years and then started causing GI problems. I will be 77 next month and hope my current program will last me the rest of my life.
GreenCross4Safety · February 7, 2025 at 6:42 am
Damn, that royally sucks. I know if anybody can figure out a way forward, it will be you.
Boneman · February 7, 2025 at 7:10 am
That’s downright Communistic… Had a friend, utterly uninsured (self employed, curmudgeon, utterly mistrustful of Dr’s, etc.) that was in dire need of cataract surgery. As it happened, it was only during a frustrated in-office “conversation” with a receptionist about it that the doctor happened to overhear that HE (the PATIENT) was willing to pay CASH to have it done and “Man to Man” they worked out a deal. Otherwise, it was seemingly IMPOSSIBLE for him to get it done.
I wouldn’t doubt they may have broken a rule or two getting it done. This was after all in the People’s Republic of New Jersey even…
Doesn’t sound like that would be an “option” for you… and aside from literally buying your stuff on the street… if it were even available, I’m not sure how you could manage.
As to getting yourself involuntarily terminated, how about possibly bringing your situation to a couple of news outlets and EXPOSING these miscreants. That might get you shown the door.
Something alluding to “Saving MONEY not LIVES” would make a good bi-line for an Op Ed piece (you could almost copy and paste your posting here) to the local New “Paper”.
Just reading about this is infuriating ME… my Mom is diabetic and of course now insulin dependent a number of years. This has me thinking if that was even necessary. She is 84 and beginning to struggle.
Wishing you the best of luck in finding a solution and am truly feeling badly that you or anyone for that matter finds themselves in THIS kind of a situation.
Keep us posted.
Checkers · February 7, 2025 at 10:38 am
I rx here in Ohio to compounding pharmacy locally. A PhD pharmacist. Compounds in her office. She does ozempic or mounjaro. You should be able to find someone down there whom does this. I doubt your hospital cares as long as their insurance is not buying the expensive med.
Archie's Bunker · February 7, 2025 at 7:52 am
Down to a lean 200lbs. at just over six feet, off all insulin for five years.
High blood pressure will be what takes me out.
The diastolic number was 276 when I stroked out in December and it has roasted my kidneys.
Joe Blow · February 7, 2025 at 7:55 am
That sucks brother. You and I don’t always see eye to eye, but you have my sympathy here. I hope it turns out the best for you.
That being said, get a new job. I know, that’s an easy statement to make, hard to live with. My wife was faced w/ the choice over the clot shot. I told her quit, find a new job, new career, don’t care, it’s NOT WORTH IT. We’ll get by, we’ll figure it out, even if it means lowering our standard of living, we’ll figure it out. The clotshot is forever, money and status is temporary at best.
She ended up getting 2 phizer plugs, but none of the boosters, b/c she regretted taking the first ones. I have no doubt this will rear its head in the future, but so far God has been good to us.
You know better than me, once on, you will not come off insulin. Find another way around. There are always options, many unpalatable, agreed, but you are never forced to do something. You are presented choices from bad to worse. If you truly feel insulin will be the step that begins the spiral around the bowl, do not take it. It really is that simple. Find another way, anyway, somehow.
Businesses do not care about people, it’s anathema to their function (increase shareholder value). Your corporate employer doesn’t care if you live or die, you know that. They don’t care if you’re sick or healthy, you know that. They only care about their bottom line, you know that.
Deal with it. Sell your brand new house and find a new job if need be. Yeah, that would suck, I know. But so would having your legs amputated. That’s forever, the new house is temporary at best. You can buy a new brand-new house some day if thats what makes you happy. Can never go for a swim in the ocean again if you don’t have any legs. Think long-term here. You made sacrifices early in life so you could achieve your professional goals, same-same.
Best of luck to you Brother!
Anonymous · February 7, 2025 at 8:52 am
Have you tried going on a cruise and stocking up when visiting ports? That is how my friends get certain medicines they need.
Divemedic · February 7, 2025 at 8:59 am
Mounjaro isn’t available outside of the US that I can find.
Exile1981 · February 7, 2025 at 2:38 pm
Its available in Canada but hard to get.
Looks like one of the online indian ones sells it, but no idea if its legit or not
https://www.gnhindia.com/products/mounjaro-15-mg-tirzepatide/
JoAnn Tucker · February 7, 2025 at 4:55 pm
Divemedic, try going on the Lilly Mounjaro website and see if you’re eligible for one of their special programs. You may be able to get it at a greatly reduced cost. I would think you’re a prime candidate for one of these programs as you’re diabetic and not using it for weight loss. Worth a try!
SiG · February 7, 2025 at 9:14 am
That’s one of the most horrific stories I’ve ever read. Something like Boneman’s comment about taking it to a newspaper might help or get you fired which also might help.
There’s type 2 diabetes in my family but nowhere near as serious the way you describe it. No one had amputations, but I remember my grandfather on mom’s side injecting insulin to start his day on a visit to our house when I must have been 10. My mom had it and my brother has his in control with a keto diet and one medication. He was on insulin until he went keto and lost 50 or 60 pounds. I was “prediabetic” but have not progressed beyond that with the keto diet and exercise.
I’ve heard about some foods being found to have GLP-1 agonist properties that might bear looking into. The only one I can recall at the moment is a pentose called allulose that has become popular lately simply for its superior properties in cooking over the sugar alcohols pretty and much all of the common sugar replacements (sucralose, stevia, and so on). I’m not aware of amounts required, so eating some outrageous amount of allulose or some other food to get the effects might not be possible.
JimmyPX · February 7, 2025 at 10:15 am
Will the new insurance pay for Ozempic ?
It’s slightly different than Mounjaro but has a similar effect on glucose levels.
Anonymous · February 7, 2025 at 10:29 am
Obamacare raises its ugly head again. It is beyond time to set people free and let them handle their own health. Idiot at work, 150 pounds overweight, is bemoaning not having Canadian Healthcare because she has a $1200 copay at Kaiser for some tests on her knee. (She’s not dieting minding you. Those sweets get consumed daily). I said “Thank God we don’t. You’d be in a wheelchair before anyone got around to you”.
Is Mounjaro available in Mexico? Lots of folks in Kommiefornia and other places go there for meds. Say what you will about the Cartels, you can buy meds in Mexico cheaply and easily. One solution for you is to become a nurse with traveling nurses; like Nursa, ShiftMed, or AMN Healthcare. My friend’s daughter is a surgical tech specializing in limb surgeries. She works for one agency and makes a ton of money. Her condo is in Chico and she never goes farther than Redding. I’m pretty sure they are considered self employed, so she writes her own ticket. Your health is the most important thing you have. I believe this hospital is basically harassing and intimidating people so they can control them at all costs. Seems like a beautiful 6 o’clock news story.
You are right-know thy genetics. My family is pretty healthy and lives long, except for the high blood pressure. Look at me wrong, and my damned blood pressure starts climbing-even with meds. Good luck and think outside the box they want to stuff you into.
ScottTN · February 7, 2025 at 11:29 am
I was diagnosed with adult onset of juvenile diabetes in 1993, shortly after getting out of the Army. Been insulin dependent for over 30 years. Been using a dexcom since they came out. My last A1c was a 5.1, and I’ve been running an average in the high 5s for the last decade. I have some neuropathy, and related issues, but still booking on both legs and no amputations (yet). No history of diabetes in my family, but I watched it kill my FIL slowly, and it drove me to be VERY particular about taking care of myself.
Bad Dancer · February 7, 2025 at 11:33 am
and they wonder why most of the nation cheered when an insurance type got got in New York.
How is this any different than the company store that was largely outlawed or discouraged through social pressure?
I second taking this story to a news outlet along with the reciepts as it could force their hand or result in a termination.
Hate to hear this bud, you don’t deserve it.
Henry · February 7, 2025 at 11:41 am
I’m really sorry to hear that you’re facing such an ugly fork in the road. The options are all bad. One word of caution, should you be tempted to go public with the prediction that “Now I am forced to see a company doctor, who will immediately place me on insulin.” That sets up your employer’s insurance company to counter, saying that ‘of course we wouldn’t do such a thing unless our highly competent in-house physician does a thorough exam and determines that insulin is the best possible treatment’.
SoCoRuss · February 7, 2025 at 11:49 am
Dam, brother. I have a family history also but so far just below limits. Sounds to me that you may now have carte blanche with some of the problem folks at your job that you had to put up with. Oh you want me to cover for breast mom or put up with assault from patients, nope. Dam I have been having issues with my back and neck since the assault also so since You didn’t protect me maybe you should talk to my lawyer, Frank the Hammer. Maybe I should tell him about what your hospital is allowing and covering up and suggest some names for him to go see for class action lawsuit.
I agree with above about calling TV or news folks to raise a stink. That may give you bargaining chips for a amicable settlement and parting. What are they gonna do, fire you,LOL.
Daniel K Day · February 7, 2025 at 12:27 pm
I’m very sorry to hear that.
The bottom line, if you’ll excuse the expression, is that your employer is determined to get rid of you one way or the other. You have no choice but to be involuntarily terminated, and as soon as possible. I will send prayers for you to find a way through this.
John · February 7, 2025 at 1:20 pm
I’m pretty sure there’s a law that says your company can’t make you only see a company doctor, due to the obvious potential for abuse. Maybe it’s just in my state?
Michael · February 7, 2025 at 2:07 pm
https://renovohealthandbeauty.com/mounjaro-in-mexico/#:~:text=The%20cost%20of%20Mounjaro%20in%20Mexico%20is%20significantly,%24158.99%2C%20with%20costs%20scaling%20up%20for%20larger%20quantities.
Several weight loss online sell it far cheaper than Diabetic scrips in America.
Check reviews for best options. Yes, they do sell it in Mexico.
liberty · February 7, 2025 at 3:56 pm
Tough spot to be in. Our medical care system is so beyond broken. Perhaps this story inspires some creative problem solving: A friend of mine has been taking Ozempic for a while that he gets from a compounding pharmacy for $150/mo. instead of the usual $1,200/mo. If you went to a different dr. for the script and presented as a cash patient, not sure how the insurance co would find out, especially as it would only be for 3 months or so until you get on your wife’s insurance. For me, paying some out of pocket would beat going on insulin or doing wacky job maneuvers. YMMV.
Doug · February 7, 2025 at 4:20 pm
Look into want Dr Jason Fung and Barbara O’Neill have to say on the topic. I trust them over AMA folks.
lynn · February 7, 2025 at 4:59 pm
“So this month, two months after the open enrollment period ended, my insurance company informed me that they will no longer pay for me to see any doctor who isn’t employed by the company that owns the hospital, and not coincidentally, the pharmacy. Not only that, but they are prohibiting me from paying out of pocket to see my current doctor. That was confirmed by my doctor this morning. They were threatened with legal action if they continued to see me for cash while I have active insurance. All of my future doctor’s appointments were cancelled. I offered to pay cash, and my doctor’s office told me that they can’t let me do that as long as I have active insurance. Now I am forced to see a company doctor, who will immediately place me on insulin.”
Sue your employer and their insurance company may be one option that you have.
How far are you away from Medicare ? I turn 65 in June and am looking forward to going back on on school Medicare which is a PPO. I hate this Obamacare HMO that I am on now, it is obvious that they do not care about me.
Grumpy51 · February 7, 2025 at 5:58 pm
Double-check with your wife’s insurance. You might qualify under her insurance definition of change of life (or something similar) – these don’t require waiting for open enrollment period.
TRX · February 7, 2025 at 6:47 pm
> . They were threatened with legal action if they continued to see me for cash while I have active insurance. All of my future doctor’s appointments were cancelled. I offered to pay cash, and my doctor’s office told me that they can’t let me do that as long as I have active insurance.
—
I don’t know Florida law, but that would put them in serious trouble in my state.
Much as I dislike dealing with the practitioners of the legal profession, this sounds like a job for a lawyer.
Meanwhile, I’d start looking for a new employer.
shreck · February 7, 2025 at 7:42 pm
Damn, at which point does it become spiteful?
I am thankful that my insurance has always worked out. I had some of my internal plumbing bust and got a helicopter ride. I’ve had lots of helo rides and the delauded made it fun, just not $15,000 fun. One phone call and a nice lady told me not to worry about it and I never have. Today I had surgical excision of hidradenitis, I’ll see what the total is when I get the bill from everyone, but the actual surgery was $640 me thinks.
And to feel old, the anesthesia Dr was a lady, late 30’s. She stopped by to tell me what was going to happen with the drugs and she asked me if I was ready. I wanna feel sedated got me a blank stare.
If I am ever King I will have sexy nurses bring me warm blankets all day.
staci · February 7, 2025 at 8:35 pm
HIPAA gives you the right to not use your insurance and be self pay. no contract between your doctor and the insurance company can trump federal law. so you are absolutely free to continue seeing your same doctor if you’re willing to be self pay.
A in ocala · February 8, 2025 at 7:38 pm
Dang, Thank You for sharing your experience! A lot to follow here. I’m 62, and just retired. Took care of Dad in his last 15 years and it seemed that as long as he had dr appointments, he had tests, referrals, procedures and prescriptions, and had some various hoops to jump through… He did have a boat load of problems. But sometimes several months would slip by without a dr appointments and he wouldn’t notice, and he would feel better. I worked in vet medicine so kept good eye on his well being, and was licensed massage therapist and moderated his diet and if I could keep him on high protein, fat, low sugar, low/no carb the dr said he never believed we could heal the leg ulcers without their wound center help… btdt… but Dad loved his junk food and the home care help and my travels for work would bring the sores back. It was ultimately pneumonia took him at 81.
Seems some good advice in these comments. I retired early to grow more of my own food and be relieved of some of that stress. There will always be stress, deal with it wisely.
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