Understanding prescription renewal for diabetes supplies

Have you ever thought about demystifying diabetes prescription renewal to make your life with diabetes a little easier? When your health depends on continuous access to prescription items like insulin, continuous glucose monitors, and insulin pumps, it makes sense that you would want to know exactly how you're going to access these things month after month. Learning more about the process and the rules that govern it are an important part of navigating this aspect of diabetes management.

Why do we have to renew prescriptions for insulin?

With the knowledge that type 1 diabetes (t1d) is a chronic condition with no cure and a singular life-sustaining treatment, it can be challenging to have to jump through hoops to get the medication and supplies needed to manage it. One common obstacle is having to renew prescriptions (and receive prior authorizations, etc.) for insulin.

Although it may feel frustrating to have to go through the diabetes prescription renewal process, it's the law. Non-controlled substances may have a prescription duration of up to 12 months. However, some states have begun to extend the time window beyond one year. As of January 2020, there are at least six states that have laws or regulations that allow for longer duration, including Idaho, Illinois, Iowa, Maine, South Carolina, and Wyoming. If you live in one of these states, you can ask your prescribing physician about a longer interval.

While there are pros and cons to this approach, the American Medical Association states that some benefits of a longer prescription duration include improvement to the patient-physician relationship, increased commitment to the treatment plan by the patient, less stress for patients, and less work for the medical office over time.

What is the prescription renewal process?

While the prescription renewal process can vary depending on a number of factors—such as type of prescription, prescribing provider, insurance coverage, and the pharmacy where you fill your prescriptions—the typical process looks like this:

1. The doctor prescribes medications and/or supplies and sends the prescription to your preferred pharmacy or durable medical equipment (DME) distributor. If the prescription is for an item that has been prescribed previously, this is a prescription renewal instead of a new prescription. The prescription specifies the item, quantity, number of refills available between now and the next prescription (if applicable), and directions for use.

2. Once received, the pharmacy, pharmacy benefits manager, or DME company then processes the prescription using the insurance and billing information attached to the patient profile. The prescription is billed accordingly. If there are any additional steps required by the insurance, like a prior authorization or step therapy, that would happen around this step.

3. When all of the involved parties are on the same page and ready to proceed, the patient is presented with their cost, which may be a co-pay, coinsurance, the cash price, or the price with patient assistance applied.

4. If the patient accepts the price, the payment is processed, and the patient either picks up the prescription at a physical location or receives it through mail order or courier service. If this is a new prescription item, the patient can receive counseling from the pharmacist to ensure that they understand how to safely and effectively make use of the medication or supplies.

How can you make the process of receiving new or renewed prescriptions easier?

There can be a lot that is outside your control as a patient when it comes to diabetes prescription renewals. However, controlling what you can is one way to stay in the driver's seat of the situation and take ownership of your diabetes across another aspect of disease management.

Here are a few things you can control in filling new or renewed prescriptions:

• Have an awareness of your formulary (the list of allowed drugs and prescription items from your insurance). This can change on an annual basis, and it's helpful to know which diabetes medication and device manufacturers are listed so you can have an idea of your financial responsibility for these fills throughout the year.

• Work with your pharmacy to see if they can help get your prescriptions on a regular schedule. If you have multiple items that you expect to fill on a monthly basis, it can be a timesaver to be able to do all refills at once. It might take some time to maneuver everything onto the same fill date, but it's usually something that can be done with the help of the pharmacy team.

• Set a reminder for the auto-ship or auto-refill dates for upcoming prescription refills. If something happens that delays the fill, you'll be able to inquire about it before it becomes a potentially scary situation when you're at risk of going without your medications or supplies.
  
  

Record keeping is king

Now that you have a more thorough understanding of diabetes prescription renewal, you'll be able to interact more effectively with everyone involved, from your doctor to your pharmacist. With things like insurance and mail delivery outside of your control, record-keeping around fill dates and upcoming renewal requirements can help you stay organized and give peace of mind that your most important items will be there when you need them.

Did you know that your diabetes supplies may be covered under medical benefits, pharmacy benefits, or both? Learn the answers to some commonly asked benefit questions on the Edgepark Health Insights blog.