Martin Librarian

Dealing with Rx Coverage Changes

Open Enrollment is that magical time of year when you have a brief window of opportunity to make decisions about your retirement, savings, life insurance, health insurance, and whether or not you want to join the local granola grocery co-operative via payroll deduction. Okay, so maybe some parts of Open Enrollment are more important than others.

At my work, we have a health and wellness fair during Open Enrollment where all employees can show up and visit vendors, talk to various company representatives, have their blood pressure checked, get flu shots, and participate in testicular cancer screenings. It’s usually a complete madhouse, with way too many people, so I tend to avoid it if at all possible. This year, however, I went so that I could get some information on my health insurance options, and make the rounds taking advantage of free information and basic health services.

Wait…what do you mean nobody was supposed to be performing testicular cancer screenings? Dangit! Fooled again!

At the end of the week, I was clicking around doing research and exploring my options for 2014, and I stumbled across some panicked discussions of changes to prescription drug coverage. As I lurked, and got caught up on what was going on, I realized that the prescription drug insurance company that folks were talking about was the same as the one that I use to get those things that I can’t live without, like insulin and BG strips.

Don't Panic

Word has been getting around that Express Scripts is changing their coverage, or preferred coverage, or well, really it just depends on how you look at it and what your contract with Express Scripts says. But don’t take my word for it. The CMO of Express Scripts lays it out pretty clearly: It’s all about money. Shocker, right? (That’s sarcasm.)

For me and my diabetes, my biggest concern had to do with the coverage of Novolog shifting over to a questionable category in the Express Scripts 2014 Forumlary (PDF) called “Excluded Medications.” What does that even mean? Does it mean that Novolog is no longer covered at all? Because that is what I think when I see the word “excluded.”

Well, despite being on a list of “Excluded Medications,” I was able to confirm with my HR representatives and pharmaceutical reps that “excluded” really means that those drugs and products are no longer “preferred” medications, but are still covered as non-preferred medications, which means they fall under a higher copay, as well as possibly requiring the patient to pay the difference between the non-preferred brand name medication and the preferred alternative. As an alternative to Novolog and Apidra, Express Scripts is suggesting Humalog. When I talked to a physician friend of mine and he mentioned a recent visit by a Lilly rep (who manufactures Humalog) to his office, the word he used to describe the Lilly rep’s reaction to the Express Scripts formulary changes was “jubilation.”

But don’t worry folks, Viagra is still covered and preferred.

The shared reasoning behind so many drugs moving over to the non-preferred list at Express Scripts is because they do not believe that many newer, more expensive, more recently researched medications are as effective as their cheaper counterparts. They feel that patients already have enough options. Besides, patients are all the same, right? I mean, if you have diabetes, and I have diabetes, then we’re basically twins. Right? No.

I know what I need for my diabetes. My immediate healthcare team knows what I need for my diabetes. My A1C says that what I’m doing is working pretty well. This is MY diabetes. There are many sort of like it, but this one is MINE. Pharmacies and prescription drug insurance companies focus on how much I cost, and how much money they stand to make or lose from me, which is the biggest decider in the level of service that they provide. That is business, and as someone with a chronic condition who needs prescriptions on an ongoing basis, I’m not worth as much to them as a person who pays a monthly premium but never uses prescription benefits. To hedge their losses, they move prescriptions that are actually working better over to a non-preferred status so that they don’t have to lose as much money filling orders that are more expensive. To be honest, I’d probably do the same if it were my finances. The difference is that my personal financial savings decisions don’t usually require other people to make decisions about how they are going to live and survive. < /rant >

In some situations, where your physician feels that you need the brand name medication that is on the non-preferred list, there is a solution that may help. I was advised by my benefits group of the following:

If you request a preferred brand-name drug when a generic is available, you must pay the difference between the generic cost and the preferred brand-name cost, plus the appropriate copayment or coinsurance. If your physician writes on the prescription that the preferred brand-name drug is medically necessary or“dispense as written” and the reason, you pay only the appropriate copayment or coinsurance.

Maybe none of this information is helpful to you. Maybe you are covered at 100% and don’t have to worry about copays, preferred and non-preferred medications, or notes from your doctors that include the words “medically necessary.” Or maybe you’re wondering how you’re going to be able to afford insulin in 2014, along with BG strips, pump supplies, glucagon, doctor appointments, and other diabetes randomness. Whatever the case, DON’T PANIC. In most cases, you still have time to get an appointment with your healthcare team to talk about your needs and build a plan for what is next. With insurance, prescriptions, and even diabetes advancements, the only thing that is constant is change. Diabetes is a different beast every day, and we adapt to it constantly. This too, we will adapt to.

Diabetes In Boston

This week I’m at the Leadership Institute for Academic Librarians (LIAL) at the Harvard Graduate School of Education in Boston, Massachusetts. This is the 15th year of the LIAL, and the Class of 2013 is made up of roughly 100 librarians from all over the world. I can say “world” because the group is made up predominantly of librarians from the United States, but also Canada, China, Saudi Arabia, South Africa, and Trinidad and Tobago.

Welcome to Boston

The first thing I’m not supposed to do is tweet about LIAL. Or Facebook about LIAL. Or probably write this blog post about LIAL. So I won’t share all of the intimate specifics of LIAL, but I feel that I have an obligation to share some of what I am experiencing without necessarily divulging the deep, dark, sordid secrets of my fellow librarians.

Because diabetes is a part of every single thing that I do, I don’t feel shy about sharing some of the other sides of my life every once in awhile. How am I ever going to be able to sell that line about “I am more than just my diabetes” when I’m not willing to share more than just my diabetes? Besides, there have been some diabetes moments, so it’s not all librarian mumbo jumbo. Which is lucky for you, because that means you get to learn a little bit about Martin Librarian as well as the usual rants and raves about my living with diabetes. Consider it as entertaining as when someone farts in church while the preacher is taking a breath mid-hellfire and brimstone. I will be that fart of fresh air for you.

Like yesterday, when I was getting on my plane in Atlanta, a nice couple in the front row reached out to me and pointed out my Medtronic insulin pump that I had clipped to the outside of my jeans pocket. Turns out they work for Medtronic (or did, I’m not sure…boarding the plane was a little chaotic). There wasn’t much time for chatting, but they were very happy to see someone wearing a device that they are so proud to have been a part of developing. That made me happy. Not so much because they work for Medtronic, but just that MY diabetes made someone else’s day. Because, let’s face it, sometimes it’s a real dump in the pants.

(And that’s the 2nd fart joke I’ve made in one blog post. I should be ashamed of myself. I’m not. You’re welcome.)

Since I arrived in Boston, I’ve pretty much been going nonstop. So far I’m managed to break one iPhone case, one set of earbuds, discover that I didn’t bring enough socks, or any workout clothes, I didn’t complete near enough reading to feel prepared for class, and that the minibar is no substitute for a fridge in a hotel room. On the positive side, I won an argument versus a cab driver with a stereotypical Boston bad attitude, found an honor system book sale on the street, and saw socks in a store window tonight that have stripes made out of eff words on them. I’m sorry if you’re easily offended, but I WILL be going back to get me a pair tomorrow when they are open. You don’t let that kind of opportunity pass you by.

Several times so far this trip I’ve been asked about diabetes, which is awesome. Probably because I have it tattooed all over me. Yesterday, a nice woman that I was sitting next to on the plane from Atlanta to Boston asked me about the differences between multiple daily injections (MDI) versus using an insulin pump for people with Type 1 diabetes. Today, after getting off of the phone helping out a fellow T1D with a diabetes challenge, a librarian colleague and I had a conversation about Students With Diabetes and my passion for helping people with diabetes, and especially my unique perspective as a medical librarian with Type 1 diabetes. I absolutely love it when my diabetes world intersects with the real world in a positive way, and that I’m making progress integrating it with Martin Librarian world.

I also sat next to a nice librarian lady today (named Ripple, which may be the coolest name ever) who had a Mickey watch, same as mine. What are the odds? She’s the first person I’ve ever met in the wild with a Mickey watch like mine, and who isn’t six years old.

Mickey watches at LIAL 2013

I’m learning a lot this week, and will share more as I can. There is a TV inside the mirror in my bathroom, so I’m going to go watch SportsCenter now.

TV in mirror

(3rd fart joke. You didn’t even see that one coming!)

32 Things

Today is an important day in Martin World. A day that I look back and reflect on some of my accomplishments.

1. I passed Chemistry in high school. It was the hardest class for me. Tutoring helped. The tutor had a cute daughter. Those last two statements are mostly unrelated.

2. I graduated. Four times. Because once just wasn’t enough. (HS, AA, BS, MS…in case you were wondering.)

3. I was a DJ. On a Christian music radio station. Yeah, I don’t believe that either. But it’s true.

4. I found love. And lost it. And found it. And lost it. And found it again. I’m like a country song.

5. I’ve changed the world. Sort of. I stepped on an ant hill. “World” is relative.

6. I’ve been a President. It’s a lot harder than it looks.

7. I rode my bicycle over 100 miles in one day. Most people have enough sense not to do that.

8. I had dinner with Olivia Wilde. Kind of. She was two tables away from me. I’m still counting it. Can we be friends?

9. I was fired once. They called it a “lay off” because of the recession. Lipstick on a pig.

10. I’ve worked in two libraries so far in my career. I’ve been the token male in both. I’m like a trophy librarian.

11. I’ve been an Apple, an Android, and a PC. I prefer being an Apple.

12. I was voted Most Intelligent in middle school. It was nerdy at the time. Now it’s dead sexy.

13. I grew up on a farm. I delivered a calf. I about had a cow.

14. I had a dog named BJ when I was a kid. I lived on Fifth Street. I’m usually on top of that “What would be your name?” game.

15. I write with Sharpies. People with dry erase boards hate me when I get excited about flowcharts and to-do lists.

16. I worked in a 1-hour photo lab. I got paid to stick my nose in everybody else’s business.

17. I am Jack’s complete lack of surprise. According to the first rule, I can’t talk about this. I do love the movie though.

18. I wear a Mickey Mouse watch. It reminds me that great things start with small ideas.

19. I have jumped out of a perfectly good airplane.

20. I have a tattoo. I’d like to get another one. I just don’t know what yet.

21. I love video games. They are a way that I escape and decompress. I also want my own personal Navi, like in Zelda.

Navi_Hey_Listen

22. I always have more to do than I have time for. In related news, sleep is a nuisance.

23. I like to explore a new city on foot or bike. You see things that you didn’t realize were there. Like celebrities.

24. I love New York, DC, and Seattle.

25. I’ve tried escargot (snails). It’s not my thing.

26. I speak a little bit of Russian. I would like to learn how to speak Spanish. English would also be helpful, some days.

27. I can’t speak in coherent sentences before coffee in the morning.

28. I’ve read every book by Terry Goodkind, Barbara Kingsolver, Tobias Buckell, and John Steinbeck.

29. I have pets that are some of my favorite people. Two dogs and a cat. All spoiled rotten.

30. I have moved nine times in my life so far. Books are very heavy. Save your back, buy an e-reader. And get a library card for Pete’s sake.

31. I gravitate toward leadership roles. Which probably explains why my to-do list is so long.

32. Today is my 32nd diaversary. 32 years with Type 1 Diabetes. Making it this long is nothing short of a big deal. But, as you can see, there is a lot more to me than just diabetes.

Briar Patch

I’m not perfect. There, I said it.

The past few days have been a rollercoaster of educational opportunities and lessons learned for me. It’s as if I’m stuck in the Robert Frost poem about two trails diverging in the woods, and I’m constantly finding myself on the one that is less traveled.

Of course, the road less traveled is the one that is supposed to make all the difference. That whole “thrive through adversity” thing, I guess. If I’m being honest though, it’s exhausting always traveling that path. Sometimes I’d like to just travel the well worn option, where I can proceed without so much resistance.

I remember my mom telling me when I was growing up that when you’re stressed out and upset, you have to find your stressors, and get rid of them. That sounds so easy, but in reality, there are a lot of stressors that we have no control over. Sometimes, it doesn’t matter what you do, it’s never going to be perfect, right, or appropriate for everybody.

That is exactly where I’m at right now. From nasty emails that completely blow non-issues out of proportion, to trying to lead a group of people with shifting priorities in all directions, to dealing with supposed professionals behaving unprofessionally, I feel like I’m traveling down a path that more closely resembles a briar patch than it does a simple path less traveled.

It’s hard not to internalize times like these, especially when there are conflicting reports about whether or not you are doing a good job. It’s hard not to take it personal. Sometimes I just need someone to say, “Martin, I know this is hard, and I know you feel like the world is against you because of these few small things, but you’re good enough, you’re smart enough, and gosh darn it, people like you.” Preferably in the Stuart Smalley voice. Short of that, I’d settle for someone that knows just telling me that I’m doing the right thing, because sometimes I’m just doing the best I can and hoping that is good enough.

I guess this is the part that I could link to diabetes. Fortunately, and thankfully, it’s not my diabetes that is giving me the hardest time right now. I’m waiting on new test strips to get approved by my insurance company and arrive, sure. I need to order pump supplies, of course. But really, those things are just another day with the “D.”

I did get to Skype with some amazing Students With Diabetes from Tampa last night, and that was awesome! I love hanging out with people with diabetes (PWDs), even if it is virtually. They certainly reminded me that not all is awful in the world, and even if we get the diabetes blues, PWDs are resilient and forever hopeful.

SWD_02_06_2013

That is what I have to remember right now. There is hope. Better days are just around the corner. You can’t please everybody, and sometimes it really doesn’t matter what you do, some people have made up their minds from the start that they are going to proceed with their panties in a wad or their boxers in a bunch. I just have to be consistent, and stay positive, briar patch or not.

The advice I gave to the Students With Diabetes last night about diabetes blues is that if you can find a way to laugh about it, you can overcome it.

That said, who wants to get me one of these Lionel Richie cheese plates for my birthday on Saturday? Or you could just donate to my Tour de Cure and help me kick diabetes in the teeth. Either way, you da best, and I thank you from the bottom of my busted pancreas.

HelloBrieOR

ADATdC2013

 

How About No Bear

Social Media and Medicine

Today, October 1, 2012 is “No D Day.” Today is the annual day to take a step away from diabetes, to do something different, to share something new, and to not mention the “D” word that so many of us live with every single minute of every single day. For me, it’s even more special, because this is the first time that I’ve visited my blog to share with the world in over two months.

You can find all of the “No D Day” posts on Twitter by searching for the hashtag #noDday, or you can visit Ninjabetic.com for a list with links. I hope you enjoy this and all of the “No D-Day” posts today. As always, we will continue to work, and share, and push for a future where every day is a…

No D Day 2012

I’m a joker. No, not like the Steve Miller Band song (although, that is a great song…”I’m a joker, I’m a smok…” Nevermind.). What I mean is, I love a good laugh. Lately, I feel like I’ve been so busy that I haven’t had time to laugh as much. I haven’t had time to stop and appreciate the humor in things. I haven’t had time to stop and sniff the chihuahua eating venus fly traps. (What? Those TOTALLY exist.)

Most of my time lately has been spent working and traveling for work. In the past three weeks I have been up and down the state of Florida three times teaching physicians and medical students all about how social media and medicine collide. Basically, this is what happens during the Social Media and Medicine workshop.

First, my colleague and I get a bunch of physicians and lock them in a classroom. Then we start to mention social media, Facebook, Twitter, and the fact that people are sharing information online, and they go all…

How About No Bear

Then they spend two hours being exposed to all the various social media vehicles, why social media is important, how patients and physicians are actually using social media for good, and they start to get all…

Finally, by the end of the workshop, we reach the point of…

Dammit Jim LOLcat

That’s when we know that our work is done, and we move on to the next workshop in another city. Nothing makes me happier than a health professional embracing LOLcats. Okay, LOLcats and social media. I love being a medical librarian! And soon, I hope to slow down enough to share more of my world with everyone again.

(Also, this was my very first blog post using a MacBook Air that a friend let me test drive for a week. TOTALLY different than the PC that I’m most familiar with and accustomed to, but I have to say…I kind of love it. Dear Santa Claus, I’ve been really good (mostly) this year…)

SWD - Sara & Martin - May 2012

Bullets: Rat-a-tat Tat

I’ve been traveling a lot lately. And working. And traveling some more. If my counting is correct, this past weekend was my 8th trip somewhere out of town in the last two months, after weeks of prepping for said travel, and I still have one more trip to go.

8 Fingers

I’ve forgotten what weekends at home are, but if those mythical creatures still exist, I’m certainly looking forward to one someday soon. I’ve got a lot of catching up to do, and so much that I want to share with all of you that still read my blog and haven’t given up on me while I’ve been M.I.A. the past few months.

Overall, the past several months have been a success, made up of both work and diabetes, and including a lot of reading, thinking, meetings, planning, traveling, juggling, tightrope walking, backward and forward somersaults, and as much fun as there has been time for in the three ring circus that is my life these days. Here are just a few highlights:

  • I took a trip to Seattle, Washington for the Medical Library Association conference. I had never been that far west or north before, and it was a mind-boggling and delightful experience. Jet lag sucks though.
  • I attended the inaugural Students With Diabetes National Conference in May, and it was one of the most incredible three days with diabetes that I’ve had in my entire life. Ever. I’m still processing my thoughts on it, but what is being done with Students With Diabetes and Bringing Science Home is nothing less than life altering.
  • After working every day (and night) since the end of February to plan a statewide meeting of medical librarians, I was elected President of the Florida Health Sciences Library Association. I’m extremely proud of and excited to lead this group to some grand things for medical libraries in Florida over the next year.
  • I’ve finally decided that I’m all in for D-Ink. I just have to find someone who has the skill to draw what I want. Will share my thoughts on that process, which may appeal to some of you who are also considering D-Ink.
  • New diabetes technology is out and about, and I’m drooling over it. However, with every new invention to improve the lives of people with diabetes, there comes a list of challenges.
  • Traveling and eating out so much has left me still struggling with my weight…again. It’s a recurring theme, really. I wanted to be lean by Friends For Life this year, but alas, that’s next week, and I don’t see myself losing the equivalent of a toddler between now and then. I’m exploring some options of what to do about it, and trying to figure out how I can get into a routine that isn’t so detrimental to my bottom line, so to speak.
  • Through everything, I’m still working to stay on top of my world with diabetes. 60% of the time it works every time. Wearing my Continuous Glucose Monitor (CGM) on a constant basis is still probably my biggest diabetes challenge, for a host of different reasons.
  • Also, I’ve spent some time recently shepherding someone near and dear to me who is newly diagnosed with Type 1 diabetes. It has left me with a lot of thoughts about how we, both as patients and parents of children with diabetes, react to change and the news that our transmission has decided that it wants to be a “stick shift” rather than an “automatic.”

More to come on all of this, but I’m just excited to get back to writing and sharing and communicating with everyone again.

Here’s a picture of me and Sara at the Students With Diabetes National Conference. See also: Poster children for Type 1 diabetes. (You read it here first.)

SWD - Sara & Martin - May 2012

I Break For Coffee

Hangry

It’s hard to describe, and even differentiate sometimes, the difference between having a low blood sugar and just running on pure empty from not eating all day.

All week, since Daylight Savings Time kicked in, I have been trying to outrun the clock and get to work on time. I love DST, don’t get me wrong, but it’s really hard to get up in the morning when it’s still dark outside.

Okay, who am I kidding? It’s hard for me to get up in the morning whether it’s dark outside or not.

Yesterday morning was no different. Running late, I brushed my teeth, grabbed my work gear, made certain that I wasn’t walking out of the house with flip flops and pajama pants on, and hit the road.

I realized when I grabbed my messenger bag out of my car that it was lighter than usual. Turns out I had left my lunch (leftover white bean chicken chili from dinner the night before) at home. It happens, right?

This wouldn’t normally be a problem, but I have a habit (a good habit, if you’re viewing things from my employer’s perspective) of getting to work and throwing myself into things and not stopping. I’m notorious for working through lunch, skipping breaks, and looking at the clock to surprisingly discover that it’s mid-afternoon and I haven’t seen the outside of my office all day. The only thing that I will consistently break for is coffee.

I Break For Coffee

After my second cup of coffee…okay, third cup…maybe fourth cup…I realized that I was pretty much plowing through my day of meetings, emails, phone calls, and one-armed library dragon training. Once I was done, and those dragons were tamed well enough to stamp due dates in library books like they were born with that one lonely arm to do just that instead of burn villages and terrorize innocent monks (Trogdor!!!), I called it a day and headed home.

Now, I knew I had been moderately low all day. I’m back to wearing my Continuous Glucose Monitor (CGM) again, after a slight hiatus from all the beeping and bonking and wee-ooo-wee-ooo-wee-ooo alarms waking me up in the middle of the night, and it had warned me off and on all day that I was hovering around 75 mg/dl. Still, I didn’t stop to treat it or deal with it. I just kept working.

When I got home, A-Flizzle and our pal EriCAH were there, so I started preparing dinner. Yay, food!

I kept noticing that I was agitated with everything, but I didn’t have the sense to question why. Cutting the chicken and vegetables, I was seething. Trying to figure out how to make the chicken stock thicker, I was fuming. When I realized that we only had a single serving of rice, I was mulling over what it would be like to throw the refrigerator off a cliff. It was so ridiculous that I was getting on my own nerves. I must have been driving A-Flizzle and EriCAH crazy.

That was when I realized I had reached my limit. I was low. I was hungry. I was angry. I was HANGRY! And I was making dinner and the food was too raw to eat immediately. Oh, the agony! The horribleness! The tragedy!

Eventually dinner finished, and we all got to experience my chicken thai curry science project of a meal, but it was a great example of how normal for some people isn’t normal for those of us with diabetes. There are times that we absolutely MUST stop and eat. Going all day long without eating is dangerous, and in hindsight, I’m probably lucky that I didn’t have a sneaky low that left me sitting in my office in a pile of sweaty, shaky, confused nonsense with a co-worker telling me, “Drink your juice Shelby!”

I’ll probably do it again though. Because I’m stubborn like that.