submitted by Cherise Shockley
I’ve been using a GLP-1 and insulin to treat my diabetes for the past two years. My PBM informed me in a letter that the GLP-1 is not preferred but that Ozempic and Trulicity are. I phoned Dr. P (endo) and requested the Ozempic script. A few days later, I received a refusal letter because I do not have type 2 diabetes. I froze.
I’m ready to pay the non-preferred price for the GLP-1 I’m now taking, so I requested my endocrinologist to retry ordering it. Unfortunately, the pharmacy benefit manager declined my request since I do not have type 2 diabetes. The concern I have with the refusal is that the PBM has paid for GLP-1 for the past two years without issue, and now, all of a sudden, it has been refused.
For the first time in a very long time, I cried about diabetes. I have adult-onset latent autoimmune diabetes and struggle to battle insulin resistance. The GLP-1 was useful. It helped significantly.
I want to cry as I write this. I’m angry. INCREDIBLY furious!
I am prepared to fight.
If you’ve had this issue with your PBM and were successful in overturning the denial, I’d like to know what steps you took. I refuse to let this go.
Cherise has been called the Khaleesi of Twitter. She is an enthusiastic moviegoer, book nerd, lover of tea and sneakerhead. In 2004, diabetes infiltrated her body and damaged a few beta cells, yet she refuses to let the condition steal her joy. She lives in Indiana with her lovely husband, daughter and three fur dogs.