The Healthcare Headache_Part 1: The Stockpile

No matter your political affiliation, I think we can all agree the American Healthcare system is a cluster. I knew this but, I didn’t really know this until after my diagnosis. Diabetes does not just require a doctor, oh no, you get a team. This team consists of your health insurance, a primary care physician, an Endocrinologists, a Dietitian (yes, even as a Dietitian I have a Dietitian), a Certified Diabetes Educator, and a pharmacy/pharmacist. Generally, making a change in medication or acquiring additional supplies requires no less than 3 of the team members. Seeing as this sounds exhausting already I’ll split this healthcare mess into 2 parts. Part 1: Creating a stockpile of supplies and Part 2: finding, obtaining, and remaining insured while abroad.

Part 1: The Stockpile

Step 1 of creating a stockpile of supplies for your journey is to decide which method of insulin therapy best suits you. While this may seem like a no brainer, just continue on your current regimen, there are pro’s and con’s of both pump therapy and daily injection. At the time, and through to today, I used an insulin pump. Specifically, I use a Tandem t:slim G5 and, I LOVE TANDEM (but we’ll go more into why I’m a #fangirl later). First, some pro’s and con’s:

• Tandem pumps have so many parts! I would need a years supply of cartridges, syringes, needles, and infusion sets not to mention the alcohol wipes, skin prep and unsolved wipes, and skin barriers. This would all take up SO MUCH backpack space... goodbye pants there’s not room for you here. 
• I would only have to worry about having one type of insulin (Novolog) to manage. 
• I would be able to have the freedom of pump therapy, something I’ve really gotten used to  over the past 6 months. All T1 diabetics can speak for themselves on this one but, personally having to stab myself everytime I put a carb in my mouth makes me think Dante should reconsider the 3rd circle. 

• Pen injections would only require pens, pen tips, and alcohol wipes. Virtually no backpack space comparatively. Bring on all the pants. 
• I would need to carry, refrigerate, and manage Lantus (long acting) and Novolog (short acting) 
• Multiple daily injections...hello Circle 3...

After weighing the space in my backpack, daily life, and supplies I decided to stick with my Tandem pump. This presented another problem. Tandem is not international. I would need to either bring all my supplies with me, ship them to myself, or a combination of the two. Thus began the stockpile. 

Over the course of 5 months I ordered as much supplies as insurance would allow (usually only a 90 day supply). I was fortunate in that my employer at the time provided AWESOME coverage through Cigna which included a huge contribution to my HSA. Still, I won’t downplay that ordering the max supplies of Tandem and Dexcom costs $412.50 (Tandem) and $459.98 (Dexcom) with insurance for a whooping $872.48 every 90 days. Luckily it only took about 2 of these payments paired with a few checkups before I hit my deductible.

Step 2 of creating a stockpile is to get your doctors on board. I told my Endocrinologist about my plans early in August and he was all in for this trip. In fact, “he and his wife had recently been on vacation to New Zealand” and “...had I looked up Milford Sound yet?” In an effort to increase my growing supply collection he included in his prescription notes that I was changing my pumpsite every 2 days (instead of the standard 3) and that my insulin needs had increased. My supply of infusion sets was doubling and I was saving about 1 insulin vial for every one used. 

Step 3 of creating a stockpile is to call everyone. I wish I had thought to clock the hours I spent on the phone with Tandem, Solara (my Dexcom supplier) and Cigna. I was making daily calls asking everything. I asked for advances on my prescriptions for an upcoming trip. I was vague but included that I would be out of the country for up to a year. I asked what information was needed to get more insulin, and how long insulin would last. I had to call insurance and figure out what they needed to over supply my medication, then call my doctor and make sure the language in the prescription matched exactly to what the insurance provider was looking for. I asked how much everything would cost and how much insurance would cover. I asked if I should pick things up at a pharmacy or use the home delivery service (note: prices vary according to location). I asked if everything would count toward my deductible and fought till it was. 

Finally, after all the Tandem and Dexcom purchasing and frequent checkups to make sure my T1D was in control before leaving the country, I hit my deductible. It was time to go after the years supply of insulin. The request for a years supply was granted (because I had already talked to Cigna, my Endocrinologist, and my pharmacy at least 3 times each to ensure it would be). Picking up my 24 vials of insulin cost me $0 but, at the bottom of the receipt it showed what the cost would have been if I had not yet met my deductible $7,199.99. While I don’t remember my conversation with the pharmacist, I can remember running out of the pharmacy afraid that if I lingered they would realize it was a mistake and either charge me or take it back.

Stay tuned for Part 2: Am I Insured? Coverage While Away & Overpacked and Underweight- How to  transport a private pharmacy on your back through customs.