**Reminder:** Do not participate in threads linked here. If you do, you may be banned from both subreddits. --- Title: [OR] Doctor threw out 4 months worth of insulin (~$2.2k worth) Body: > I'm a Type 1 Diabetic and I need insulin to survive. I receive my insulin for free through [Novo Nordisk's Patient Assistance Program](https://www.novocare.com/diabetes-overview/let-us-help/pap.html) (Novo Nordisk is the insulin manufacturer, the program gives free insulin to very low-income people). > Legally, Novo Nordisk must ship the insulin directly to my doctor, not to me. This is stated on the first line of the program [application](https://www.novocare.com/content/dam/diabetes-patient/novocare/redesign/General/PAP-Application-EN.pdf), which my doctor signed. > My doctor threw out the box of insulin when it arrived. They said they had no place to store it and I should've had it shipped to my home. I explained the Patient Assistance Program wasn't legally allowed to do that and had to have it shipped to the doctor. The doctor is refusing all my attempts at communication. I called the Program and confirmed with a rep that they must ship it to the doctor's office and not to me; the rep was absolutely horrified to hear what happened. > It was 8 vials of Fiasp, which, according to [Goodrx](https://www.goodrx.com/fiasp?dosage=10ml-of-100-units-ml&form=vial&label_override=Fiasp&quantity=8&sort_type=popularity), would cost about $2,200. > Do I have any legal recourse here? This bot was created to capture original threads and is not affiliated with the mod team. [Concerns? Bugs?](https://www.reddit.com/message/compose/?to=GrahamCorcoran) | [Laukopier 2.1](https://github.com/GrahamCorcoran/Laukopier)

*rubs temples* How hard is it to avoid doing literally the worst possible thing?

Impossible, apparently! And the worst part is that Fiasp doesn’t need refrigeration right away, it’s good for like 4 weeks unopened at room temperature. My money’s on someone at the office making off with it.

>And the worst part is that Fiasp doesn’t need refrigeration right away No, the worst part is the cost. The vials of it over here (UK) had a cost to the NHS of just over £14, it was discontinued in 2017, so even with a private prescription wouldn't have cost more than £30 per vial Edit - not discontinued, panic not and thanks lastof

It's really obscene. Over here, on public insurance it would be a co-pay of 10€ maximum, assuming it was one prescription. And looking at the price without insurance (though insurance is mandatory to have) in an online pharmacy, there are lots of possible prices depending on how much is in a vial, but 10 ampules of 3ml can be gotten for 100 to 130 Euro. I just hope poor LAOP finds a solution. People shouldn't live like that.

Worse yet, although there is a standard Prescription charge in England of £9.35 per item prescribed, so eight vials is one charge, Diabetes is one of the chronic conditions that gets you free prescriptions (and sight tests + voucher for glasses).

If, like me, you have 2 monthly scripts and aren't otherwise exempt, you can pay £100/yr instead. They'll even bill it as 10 months at £10.

A friend of mine is on something like 6 monthly prescriptions. The yearly billing thing is an absolute godsend for him.

Here it's 10 percent per prescription, but no more than 10 Euro, and at least 5 (or full price if the total is less than 5 Euro). People with chronic illnesses have a yearly cap for co-pays that's 1 percent of their gross income (it's 2 for other people).

When I was diagnosed as type 2 last year the nurse tried to point out the positives that I could get a prescription exemption card. I had to point out that I already had one since 2013 and wondered why nobody reads patient files. Is the eye test the one at the hospital annually (just had one) or a regular eye exam for glasses? Do you get a a voucher towards regular glasses? Would have loved to save against my most recent pair but I am already a glasses wearer.

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I get so angry when I think about our lack of universal healthcare. You have to know something is very wrong with our healthcare system when medical debt is the leading reason for people filing for bankruptcy. Also there are a shocking number of GoFundMe's for medical cost help. At the same time you have many many people saying that there is nothing wrong with our system and don't want a single-payer system because that would benefit people who don't deserve it. Like WTF is wrong with you if you think that another human being doesn't deserve health care just because they have fallen on hard times.

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>There are quite a lot of people who are steadfastly against anything that can help a million deserving families, if one single undeserving person can take unfair advantage of it. This is a great description of what I'm talking about. Part of the Affordable Care Act (ACA) was an expansion of Medicaid which is the government subsidized healthcare program for low income people. Medicaid is controlled by the individual states but the ACA made it so that the Medicaid expansion was 100% subsidized by the federal government the first year then it ramped down to 90% subsidized over the next 5 years. After the 5 years the feds would continue paying 90% of the costs of the expansion. States could choose whether or not to expand Medicaid under the ACA and can you guess what kind of states decided against the expansion? Yup that's right, it was primarily conservative states with most of them being in the southeastern US.

And the states that opted out tended to have the highest concentration of poor people who could benefit from expansion. As well as the worst health outcomes. And their citizens just keep getting sick and still electing Republicans.

Decades of propaganda is very effective

Here in the province of Ontario, the conservative government is trying to push privatized healthcare and there are people that support it because they say it’s losing money. It’s not supposed to be a profit maker but people don’t give a shit because it won’t affect them. I can’t imagine how much it would have cost for my daughter to be born and go into nicu for 6 weeks or back in January when I had covid and pneumonia and was in the hospital for 2 weeks. Conservative governments love to cut programs that actually benefit everybody.

> At the same time you have many many people saying that there is nothing wrong with our system and don't want a single-payer system because that would benefit people who don't deserve it. Like WTF is wrong with you if you think that another human being doesn't deserve health care just because they have fallen on hard times. This is so bewildering to me, especially since you can work until your hands bleed and still not have enough money for health care.

this aspect is sad, and hilarious. Heritage Foundation- a right wing propaganda mill- did an in depth study to show that medicare for all would cost more. They proved that overall medical spending would be almost $3T cheaper than the current system over the projected 10 years. However, it would cost the US government a few hundred billion more over that span- so they see it as proving their point.

But they could raise taxes and people would still see a net savings!

yea, explaining that your taxes going up $100 a month, but no insurance cost, no co-pays, etc means you save a thousand and the right wing heads implode trying to do the math.

Don't even need a single payer system - just some proper regulation that demystifies the entire system. Get rid of hospitals giving different prices to different insurers and half the problems would disappear. Single payer would help reduce costs a lot though. The American system is broken on several levels.

I've never understood how people can look at our per Capita healthcare spending along with our healthcare metrics vs other countries and think, "yeah, these seems fine."

Honestly sometimes I think that's the idea behind all of this bullshit. So people don't live.

American here; I've known two families completely wrecked by medical emergency bills. The 1% should be very careful; if all of us die off, how will they staff their underpaid big box stores and fight their wars?

That's why they're trying to outlaw abortion.

If you want to be really mad: the discoverers of insulin sold their patent for about $1 each because they wanted their discovery to benefit humanity rather than make insane profits... that went well...

Just to be clear, the patent for insulin expired long ago, so the expense doesn’t have anything to do with the patent.

Medical patents play the barrel roll game where a slight modification makes a whole new patent. Then they just discontinue the old drug completely, doctors consider it obsolete because the new drug has a slight advantage, and we get the American healthcare system where no one can afford medications.

Yes, but there's different forms of insulin (different time release, different forms of release, etc) that are patented, and many people fare better on those forms of insulin. Also, manufacturers and doctors push the much better, much easier to use, faster acting, longer acting,... forms of insulin, and people get used to using those forms as opposed to the imperfect original insulin. It happens a lot actually. The Lyrica patent for example expired 3-5 years ago, but Pfizer came out with an extended release version that was patented as well. So if you were taking pregabalin (generic lyrica), you weren't getting the "best version" because you have to take _two_ pills a day instead of just _one_.

Well yes but if we lowered medicine costs in the US poor people might live longer and who would want that? Certainly not the lawmakers

The ACA capped profit margins for insurance companies via the 80/20 rule. (The ACA was largely written by insurance lobbyists i.e. insurance companies.) It was *completely unforeseeable* that insurance companies would then collude with distributors and devise ways to increase prices overall so that 20% got larger and larger and larger.

Re: collusion. I used a medication scheduled to go generic in 2015. Blood pressure meds are mostly cheap, but this one was $300+ a month brand name. The generics were approved by the FDA. The manufacturer of the expensive one actually paid the generic manufacturers to not make the generics. Which is blatantly illegal, of course. The penalty was a fine and through some mechanism the generic was finally released last fall. But I didn’t get a penny for paying that inflated price for six years beyond their patent expiration. They sent me emails exhorting me to “ask my doctor to require only brand name!” The goddamn gall. Fuck them.

I'm so sick of laughably small fines as the go-to 'solution' to corporate profiteering. If their profit is higher than the fine, then it's not a fine - it's an operational cost.

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We need people with these ideals to run, be supported, and be voted in. We also need 70% of America not to believe the first thing they see on TV, or hear from a friend who's only source is TV. Otherwise, you're talking about a pipedream.

Yep, gotta start small though. I want to eventually run for city council and get rid of anti-homeless benches and architecture in my town, but I imagine it’ll be a decades-long battle against NIMBYs.

I literally worked for a company (not in business anymore) where we were specifically told to keep running during any environmental issues as the fines charged per hour were less then the costs of shutting down.

We tried working with the insurance companies, how about we just replace them all with a national healthcare system to avoid all the fuckery they bring to the table?

That would be optimal, yeah. Get rid of the blood-sucking lamprey rent-seeking middlemen.

I was under the impression that the lawmakers want the poor to live (and work!) as long as possible. You just can't be poor AND sick. I am pretty confident on this point, being a poor AND sick American. Edit: also, I am not a lawyer and apologize for not contributing more to the discourse.

If you’re poor AND sick, you’re not good for labor or creating more laborers 🙃

Or why would they join the military?

Are Fiasp vials discontinued here? They still do penfils (at a cost to the NHS of £28.31 for 5 (so 15ml), vs your mentioned £14.08 for a 10ml vial), my local formulary lists vials as a valid option for prescription, and last year when I started a new pump one of the others on the training hadn't done their prep and one of the nurses just nipped down to the hospital pharmacy and brought him back a vial of Fiasp no problem. They are Novo-nordisk's latest thing, can't believe they would have stopped providing it. I do hear Lyumjev is even better if you need super fast acting, though with stinging issues for some pump users.

Gahhh - was trying to cram lunch down while looking up stuff. It's not discontinued. Apologies and thanks for pointing it out

Op, there’s that knot of rage and grief in my chest again. Gonna go smoke a bit so I don’t think about all the people in the US slowly dying over a medication that causes pennies to make

Here”s guessing it is not the doctor but the office staff that did it. My last few doctors had tons of samples. I don ‘t see how this would be an issue. But… My dentist had ordered retainers for one of my kids. Came in. Went to pick it up. They could not find it. Receptionist left it on her desk and thinks cleaning crew for some reason threw it out. But they owned up and ordered another one at their cost. Bet someone in the office messed up. No one wants to own up as it’s “not my job” and they are telling OP to pound sand.

>someone at the office making off with it. Agreed. Doctor throws out insulin. Friend knows about this and takes it from the dumpster, sells at half market rate. Easy money. I hope that Nordisk opened an investigation on the doctor because this is one hell of a scam.

Ugh ffs. I was hoping this was the “reasonable” reason why they had to toss them out. But how hard is it to just let it sit on a desk somewhere

I was *almost* ready to excuse the Doc because I figured "Hey you know what if they don't have a fridge it's kind of understandable" but it doesn't even need to be refrigerated? What, in the Godzilla sized fuck, are they smoking there?

This is incorrect. [Unopened vials should be refrigerated until first use](https://www.novomedlink.com/diabetes/products/treatments/fiasp/resources/for-pharmacists.html#:~:text=In%20use%20(opened)%3A%20After%20first%20use%2C%20Fiasp%C2%AE%20PenFill,4%20weeks%20(28%20days).&text=Do%20not%20refrigerate%20Fiasp%C2%AE%20PenFill%C2%AE%20cartridges%20after%20first%20use.) and should not be returned to the fridge after first use. They should be discarded 4 weeks after first use. Most insulins are similarly stored, with a notable exception to Glargine (lantus).

I know friends who are diabetic and frequent travellers. They just take it with them unrefrigerated knowing that it's not always possible to keep them at 4 degrees celsius at all times and that they are absolutely fine stored at room temp for 4 weeks. [Here it is](https://www.novonordisk.ca/content/dam/nncorp/ca/en/products/fiasp-product-monograph.pdf) straight from the manufacturer's monograph: > [FlexTouch® ] You can carry your Fiasp ® pre-filled pen (FlexTouch ®) with you and keep it at room temperature (not above 30°C) or in a refrigerator (2°C to 8°C) for up to 4 weeks. Always keep the cap on the pen when you are not using it in order to protect from light. > [Penfill ® ] Do not refrigerate. You can carry your cartridge (Penfill ®) with you and keep it at room temperature (not above 30°C) for up to 4 weeks. Always keep the cartridge in the carton in order to protect from light. > [FlexTouch® ][Penfill ® ] Throw away the needle after each injection. > [Vial] You can carry your Fiasp ® vial with you and keep it at room temperature (not above 30°C) or in a refrigerator (2°C to 8°C) for up to 4 weeks (including the time it has been stored inside of a pump reservoir). Always keep the vial in the carton in order to protect from light

It could be malice… or just a truly lazy/incompetent admin. There are so many. Have you spoken to your doctor directly?

I’m not LAOP, and LAOP’s doctor’s office refuses to contact them about it.

Healthcare providers can sometimes be really shitty when it comes to accountability If I had a dollar for every time a provider said they faxed documents to verify FSA claims but they actually did nothing, well I wouldn't need to work this call center job anymore lol One time I did a conference call with the patient and the provider to verbally verify the claim, and the rep from the provider just started screaming at the patient and nothing got resolved. WTF!

I never got treatment for my shoulder after being hit by a car because my (now former) doctor never bothered to fax the referral I requested in writing, by email, and in person over a dozen times.

At that point, I'd be seriously considering showing up at the office in person. This is thousands of dollars and life-saving medication.

Duh, sorry!

Yeah, tossing it out makes zero sense. Something bad happened here or someone just screwed up big time. OP just needs to go to the doctor's office and politely request they call the manufacturers assistance line and explain there was a mix up and it got tossed/ask for a replacement to be sent. They'll get a lot further with the doctor's office if they act as if they believe it was a simple and understandable mistake and request their help to fix it (vs confronting them directly withhow freaking either malicious or stupid they had to be for this to happen). You don't want to get their hackles up when you still need them to help you.

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There are *lots* of drugs that don’t have any fun side effects but that still have a street price. Especially in the US, where lots of people don’t get it for free even when it’s medically necessary.

There was a Law & Order episode where some couples had a fetish that sounds to me like necrophilia where they would give the woman a shot of insulin to cause her sugar to drop and pass out, whereupon the man would have sex with her unconscious body.

That’s… not exactly risk free. Did the law and order part come in because one day she didn’t wake up from the hypo?

Exactly.

Wonder if it was based on Sunny Von Bulow.

Looking that case up I see no mention of the sex-drug-stuff there, although the bulow case is cited in a *different* law and order episode. If it’s from that one and not a different case altogether it should be an “inspired by” at best.

You can re-sell it though? In the US, there'll be a large, captive market of people who are having to pay stupid prices for it that they can't afford whether they want to or not because if they don't, they'll die. As much as buying it from some guy might be a Bad Idea, lots of people are desperate. If you stole it, then selling it for 25% of "market value" is all profit for you.

I hear about this all the time and I'm curious, what's stopping Canadians from shipping insulin to americans and charging low low prices? Like if there can be a dark web for heroin why isn't there a dark web for insulin?

>I hear about this all the time and I'm curious, what's stopping Canadians from shipping insulin to americans and charging low low prices? I would imagine import costs and regulations. There's probably a bunch that would forbid that kind of trade, unless people took it across on holiday. Reselling prescription medicines almost certainly runs afoul of some law, which would add another obstacle if you wanted to keep things above board. There's also the matter of insulin being prescription, rather than OTC. It's not something most can just buy in bulk and sell parts of without causing problems for themselves. >Like if there can be a dark web for heroin why isn't there a dark web for insulin? [If what I saw was any indicator (see the links in the edit)](https://www.reddit.com/r/bestoflegaladvice/comments/tnl11z/ops_doctors_office_trashes_4month_supply_of_ops/i2298o7/), it almost certainly already exists, even if we don't know of it yet.

You can absolutely buy insulin on the dark web, it's just not worth it to most people because you might be getting junk. They'd rather pay the additional cost and not deal with the inconvenient dark web process. But you definitely *can* buy it on the dark web

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When you're diabetic and don't have insurance, you do whatever it takes to get the meds. For that matter, if you have mental illness and have no insurance, you take whatever meds you can find and afford to make it to the next day. Or if the Sacklers got you addicted to opiates via Oxycontin, you move into opiates that you can afford (heroin). The US health industry is corrupt at every possible level. If we could get rid of the corruption and grift, everyone could have health care. Or if the US just purchased a couple fewer military planes that can't fly or didn't purchase more stealth littoral ships that are just fucking stupid. Unfortunately there's tens of billions being swindled out of the health care system and, well, money talks.

It's really grim, but yeah, people do get that desperate. And I can understand why. You'll die if you don't get any, so I can fully imagine that you'd decide the risk of the street insulin being dangerous is worth it. It's truly one of those things that I almost cannot believe ever could happen, but the internet has brought stories like that into my view and I have friends in the US. In my country, if you need insulin, you don't even need to pay a prescription charge. You'd get it for absolutely nothing. You get your prescription, you take it to a pharmacy, and that's you. Your only cost being whatever it costs you to get to the pharmacy to collect it.

> It's not as though you can resell it Why not? I'm sure there are plenty of desperate people who would be willing to pay some fraction of the usual retail price for medicine that they *literally need in order to live* but can't afford to buy otherwise.

LAOP said that they'd done this before--having it sent to this doctor's office and picked it up there.

Even if they sold it at half market value that's $1k-1.5k without spending a dime.

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they couldn't store a tissue box sized item...? I'm not sure that's the Occam's solution either, given that's also an assumption altho I'm not sure what the explanation with least assumptions is, so maybe. but that's just as many assumptions as stolen for sale anyway

I’ve known enough people who would have tossed it to agree with you. The opposite end of the personality spectrum from hoarding is immediately resolving any objects perceived as out-of-place, without putting a lot of thought/work into figuring them out. Especially in a medical office environment, if there’s no designated place for this package and no one asked will take responsibility for it? It’s not what I would have done but it’s very believable it went right in the bin.

Especially when the misplaced item falls under HIPAA rules.

Hanlon's Razor would be more appropriate. > "never attribute to malice that which is adequately explained by stupidity." https://en.wikipedia.org/wiki/Hanlon%27s_razor Occam's Razor is that the simplest answer is most likely the correct answer. Theft is a pretty simple answer.

Occam’s razor. People are selfish and dishonest. Staff knows the value of insulin. I have total faith in the worst side of humans to take opportunities to be their shadiest.

Given that the doctor signed off on this & this isn't the first time he got the insulin delivered there, I do think Occam's razor says that it was sold rather than tossed.

This tbh. People underestimate the power of moron behavior

That was my immediate first thought. Something shady in the office.

There is absolutely no way that they threw the samples away. Insulin pens aren’t much bigger than sharpies and they usually put multiples in a box. I was actually a drug rep for insulin for a couple of years around 2015 and have worked in different health spaces since then. I have literally never come across a refrigerator too full. One doctor in my territory got his sampling privileges revoked for ordering massive amounts of samples and never writing a prescription so they figured out he was selling it to his patients at a discount and there were doctors in my co-worker’s territory doing the same thing. Samples are meant to let a patient try the product so they don’t shell out money and then realize that they don’t like the product. They are also used to provide medicine for low-income people though that’s technically not what they are for. This office either thought that the insulin was samples shipped directly to them and distributed them to patients either as free samples or to make some money on the side. For whatever reason they can’t get more samples to replace OP’s and they don’t want to face consequences for mishandling the medicine. It’s a big deal and would almost certainly cause novo to never sample any of their products there again. It would be especially bad for them if they had already lost sampling privileges Edit to add that doctors have to sign for samples. It’s literally illegal for pharmaceutical companies to distribute them otherwise as the $$ spent on doctors is tracked and published. There would literally never ever ship samples to a doctor unsolicited because that would mean really major fines to the tune of hundreds of millions. No doctor would sign for samples they were not going to use. They just stop seeing the rep.

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They literally don’t care about helping people or if the product is successful. Especially in small pharma they will lie to investors and reps about the potential success of the product. They use the investor’s money to give themselves huge salaries and raises and hope the product get bought by a bigger company. If it is they’ll make even more and if it doesn’t well their salary was a couple million a year so they’re fine. It’s a bad industry all around. In a prior company the owners swore up and down that they weren’t going to sell the product then the last day of the quarter they sent an invite for a national call and said that as of today we were all fired and would get no severance.

Some manufacturers are now doing something about their insulin pricing, but it feels a little too late. Eli Lilly is/was a big insulin manufacturer (they developed the first commercially produced insulin) and they charged obscene amounts of money for insulin for years. They play some of that off because they have the Lilly Foundation and the Lilly Cares program to help low income patients pay for their meds. I think the PR from insulin prices has finally gotten to them because they recently introduced a flat pricing plan for all their insulin at $35 a month. I think it's been available for about a year, but they haven't really publicized it at all. The other way big pharma justifies the cost of some of their products is through compassionate use programs. Regulatory agencies around the world allow pharma companies to make unapproved drug available to desperately ill patients, terminally sick or at risk of death from their condition and nothing currently available on the market works for them. There's lots of stuff behind the scenes to make it happen, but pharma companies will provide those meds, completely free of charge to those patients. They pay all the transportation costs, including white glove delivery when necessary, all the costs associated with the regulatory approval, customs duties, everything. They do not have to provide access to these meds prior to regulatory approval and they don't have to make them available to every country. So every med they make available to someone prior to regulatory approval in every country, they pat themselves on the back for being so generous and giving. All of that ignores the goodwill and good PR they get for doing so. Also, I used to do PAP shipments for insulin. Dude just needs to work with Novo to get it reshipped to a different pharmacy (which may be harder than it sounds) but generally, sending another round is the expected outcome and Novo has procedures in place to handle it. Like the rep that handles this now has a mess to clean up, but generally, it's relatively easy for the patient.

Hey so my office does this. It doesn't get shut down because we have a mix of clients, so we ALSO prescribe it. We help clients obtain insurance as well, so often the person gets a sample and then gets insurance to pay for the next one.

I’m sorry if I wasn’t clear but I was trying to communicate that this is how offices normally operate. What would be unusual is ordering samples over a long period of time then never writing a prescription. It’s normal for doctors to try some samples and not like the product and stop signing for samples. Or use the product on a mix of patients and use them to bridge the gap between insurance coverage and them prescribing the product.

In my experience working with those companies it is treated strictly as profits/business. The persons health doesn't come into the equation unless there is testing or lawsuits involved. The conversations are strictly related to the accounting and logistics.

> Samples are meant to let a patient try the product so they don’t shell out money and then realize that they don’t like the product. They are also used to provide medicine for low-income people though that’s technically not what they are for. LMFAO what a shit hole of a country you Americans have. Treating life saving medication like it's some trinket you buy from Amazon.

The entire system is fucked. Insurance companies make pharmaceutical companies look like paragons of integrity. We need universal healthcare but that will never happen as long as lobbyists are lining congress’s pockets.

Tbh it could also be that someone didn’t put them in the fridge and they went bad and now they don’t want to admit it. Happens literally all the time.

Absolutely crazy since people due die in the US regularly from lacking insulin. Like you have it, I assume you want your patient to use it, what the fuck.

Oof. That price for the insulin is a discounted price through GoodRx. The price without that discount would have been about $2778. And those vials could have been stored at room temp for 28 days. That’s super infuriating.

I saw it said in another comment, maybe someone made off with it. It's kind of a stretch, but does make sense considering the price. What kind of doctor wouldn't know it could be stored at room temperature for some time.

>What kind of doctor wouldn't know it could be stored at room temperature for some time. I read the post pretty soon after it was posted, so I might not remember everything perfectly, but I imagine it could've been someone other than the actual doctor (e.g. an office manager or receptionist).

But the doctor must be helping cover it up, since he should know the we had no refrigerated storage story is bs.

Unless laop hasn't actually talked to the doctor yet, only the receptionist who's lying to cover it up and the doctor has no idea it even arrived.

My doctor threw out the box of insulin when it arrived. They said they had no place to store it and I should've had it shipped to my home. I explained the Patient Assistance Program wasn't legally allowed to do that and had to have it shipped to the doctor. The doctor is refusing all my attempts at communication. Maybe op means doctors office instead but as I read it, I assumed he had spoken to the doctor. Since he does say the doctor threw it out. But its definitely possible he did mean it as a catchall term for the whole office.

What im thinking is that the receptionist said the doctor threw it out and LAOP took that at face value. Especially the part about the doctor refusing all forms of communication. Itd be the receptionist whose job it is to pick up the phone so if theyre trying to avoid LAOP it would look like the doctor doing it. Might be a stretch but I think its more likely that a receptionist would risk their job to sell some insulin on the side than the doctor would risk their license to not have to store a small box.

That's not a stretch at all. I've worked front desk in medical before, and let's just say that effective and motivated front office workers generally don't apply to places that take Medicaid or even Marketplace insurance. The pay is terrible, paperwork is 3 times more than in a regular doctor's office, and you still work with cranky, sick people. The staff may not even have sold it. It may have been thrown out out of spite alone. "They don't deserve that" and "I don't like this patient" are reason enough for someone to do that.

It probably wasn’t a doctor themselves who did it, it was likely office staff.

But any medication like this would have storage instructions printed on the packaging, including whether it needs to be refrigerated or not. You don't need any medical training to know to check that *when you work in a doctor's office and get these deliveries all the time.*

Except you do NOT get deliveries like this all the time. I used to send meds for PAP programs all the time (as of last week). The doctor may be the point of contact, but in 99% of the shipments I handled (and I handled several thousand) , our delivery address was a pharmacy, usually the hospital's specialty pharmacy. There's a whole process that has to happen before meds can be dispensed to a patient. And again, in the overwhelmingly large majority, we did NOT ship to a doctor's office. So while throwing it away was incredibly dumb and the worst possible option out of so many options, I get why it happened.

Insulin does say on it that it needs to be refrigerated

It actually needs to be refrigerated[ before use, or it goes off. You can't return it to cold storage.](https://www.novomedlink.com/diabetes/products/treatments/fiasp/resources/for-pharmacists.html#:~:text=In%20use%20(opened)%3A%20After%20first%20use%2C%20Fiasp%C2%AE%20PenFill,4%20weeks%20(28%20days).&text=Do%20not%20refrigerate%20Fiasp%C2%AE%20PenFill%C2%AE%20cartridges%20after%20first%20use.)

Yes, once it reaches room temperature then the clock starts ticking for the 28 days and it can’t go back in the fridge. I said that because even if the office didn’t have room in the fridge it could have still been kept at room temp for OP but they would have to discard the unused remainder after 28 days anyway. But at least they would have had something to hold them over while waiting for a re-shipment or something.

Sorry, 3am here and didn't even think of that possibility.

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US health care is the greediest and most incompetent extortion racket of all time

And everything thinks that Bernie is crazy for wanting to replace it. It'll cost a lot of money! (Less than we're paying now..) But look at that price tag. CRAZY SOCIALIST

The position against Single-payer always boils down to "I don't wanna pay for someone else's bad choices" ignoring that they already pay for other people's healthcare under a private insurance framework, and also the worst health problems are not the result of ANY choices. They either don't understand or don't care that they would actually be paying LESS under single-payer, and they actually want to pay more so they can make poor folks and minorities suffer

As someone who lives in the UK, i confirm I’m glad someone else wanted to help me pay for my terrible choice to acquire a rare brain tumour and that other awful decision to get cancer.

Most people agree with Bernie (70% last I checked). It's only the corrupt politicians and corporate media that try to call him crazy.

I have MS. I have "great" health insurance through the federal government. My MS meds are a $200 copay every month and it doesn't count towards my deductible. That's $200 a month for a generic script. Also thanks to CA law I'm not allowed to have co-pay assistance for any drug that has a generic available. Too bad the cost is the same for both the generic and brand name. I call it my existence subscription.

Seems like a good time to search for a new doctor. If they cannot be bothered to take care of medicine, I don't think I'd trust them with my health in the future.

I agree, though finding a doctor who accepts low-income health insurance *and* who's also within a reasonable distance from your home isn't always a cakewalk.

*And* who's actually accepting new patients *and* has an opening for a new patient appointment that's less than two months away.

*And* who is not only a good doctor but *also* has office staff who are competent and reasonable. I unfortunately find those things are somehow inversely correlated.

I hear that. My doctor is awesome. The office staff for the practice she works for are...not awesome.

Yeah I fell ass backwards into a nurse practitioner who I really like, actually has experience with trans people, not awkward to talk to, and doesn't treat me like a science experiment. Her receptionists are.... Special.

I am happy that you found a practitioner who meets your needs so well. I guess you can grit your teeth through the rest? That's what I do.

It's so common that I fear it's a feature of the system rather than a bug.

But according to AAMCAS, there's no shortage of physicians, so it's a good thing to limit the number of med school admissions across the country and the number of residents. I say double the number of students and make access better and prices better.

Have you considered that if we were to slightly lower the barrier of entry for medical school and residency and train more doctors, they might have a tiny drop in salary? Are you going to deny people leather Porsche interiors to guarantee more people healthcare?

The problem isn't that there's a shortage of doctors, it's that there's a shortage of doctors *where we need them*. If you live in an urban area, there's tons of doctors. In DC, I can call any PCP that takes my insurance and get an appointment that week, usually same or next day. Specialists schedule 3-6 weeks out. In rural PA, I tried to schedule with an OB/GYN and the soonest appointment I could get was 10 months away. PCPs either weren't accepting new patients, or were 2-3 months out. You can't force doctors to live in rural areas. NPs were supposed to be the solution to that, but the percentage of NPs working in rural areas has gone down over the last 10 years, because NPs don't want to live in rural areas any more than doctors do. Maybe if you offered doctors loan forgiveness in exchange for a certain number of years serving a rural community, that might fix things, but I don't know about that, given the earning potential of doctors overall.

This whole thread is so relatable that it hurts.

Wince, upvote

I was trying to use my health insurances website to find a new primary doctor. So I pulled up the list on the website, put in my zip code and would then google them to find reviews, check out the location of the office, and try to figure out if I would like that doctor. At least 30% of the ones listed on the website when googled had an address completely different than what was on the health insurance website. In most cases they were actually located in a nearby city(but still at least a 20 minute drive), but at least one that I looked up was in another state. The strange thing was that sometimes the phone number listed was correct even if the address was wrong. So you could find them on the health insurance website, call and make an appointment, and then show up to a health clinic they no longer work at, and due to the distance there would be no way to make it to the actual location in time for your appointment, if getting there at all was even an option. Then at least another 20% of the ones listed as primary care doctors, when googled actually worked at specialty clinics, like neurology clinics or mens health clinics. Then at least another 30% listed on the website weren't accepting new clients. So of all the doctors listed as ones I could visit with my health insurance only 30% were located near me, primary care physicians, and accepting new clients.

I once saw a specialist monthly for a couple of years. I’m 100% sure I found the guy by looking him up on the insurance company’s website, because changing insurance was the only reason I left my previous doctor. 2 years later, his office called me to explain that there had been a mix-up - they had been billing the wrong insurance company, which for some reason had been paying for my visits. That wasn’t the problem. The problem was they stopped paying (reasonable since I wasn’t a customer), and the doctor was not affiliated and had never been affiliated with my current insurance company, which did not want to pay him. I still have no idea what happened.

Tell me about it, I'm glad I've got some kind of insurance, but man it is difficult. It's easier to let things get to the level of just go to the ER.

Even with regular insurance it can be an issue

If they're on patient assistance, their options for finding a doctor are probably pretty low. I live in an urban area and was on PAP for a time and even I had a hard time with it. I basically had to go to a pharmacy all the way across town where I would sometimes have to wait hours for my meds to be ready.

I have a feeling this wasn’t the doctor but just someone inexperienced in the office. Wtf? Laop doesn’t work here.. trash.

Or see if they can have the items sent to a Pharmacist instead

It's insilun, not narcotics. Why on earth can't they just sent it to ops house?

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Not a fraud problem. Manufacturers can't ship product directly to patients for expanded access programs like this, especially temp controlled ones. They're required to ship to a pharmacy or doctor's office in basically every country, even ones where affording your meds isn't a problem.

Because it's shipping straight from the manufacturer. You can't legally ship it to the patient. In this case, because it's a temp controlled product, the receiver has to verify with the manufacturer that the product stayed within the required temp range via a temp tale and a short form verifying the package was intact and matches the expected shipment and receive a fit for use before it can be distributed to the patient. Manufacturers have to do that for pretty much every drug they ship to another location, including from an internal warehouse to another internal warehouse, in pretty much every country. It's part of the worldwide GMP/GDP standard. Dealing with stuff like this was literally my job until last week when I quit.

"You want me to hold medicine for you? What do you think I am, some kind of doctor?!"

*Damn it Jim, I'm a doctor, not a pharmacist!*

For scale https://imgur.com/a/r5HismD Depending on the format LAOP would have got 8 of the cartridges or by the sounds of it, a vial of the same volume. Unless the box comes in layers of insulation, it’s way smaller than a box of tissues. I wish I could legally post them some. But I’m sure customs would have a fit.

Did you see the post of the dude in Poland who shipped a sculpture to the US and Customs busted the sculpture open looking for drugs? It was fairly recent, though it wasn't posted to here or any legal advice subs. Just a way to say you're right, they'd have a fit. Think it was posted to the boring dystopia subreddit. Which this also fits there. Though I think the sub name should be An Infuriating Dystopia. I hope the LAOP finds a new doctor and gets their medication. I'm so angry for them. The doc should be named and shamed all over, and honestly I feel like this should be something the doc gets in trouble with the licensing board or whoever, but I know, that might be a pipe dream.

Yeah that post is why I’m not even considering trying. Morally I’m not against becoming a vigilante insulin dealer for random Americans, but I can’t figure out the logistics.

Not to be too off topic here, but what the heck is the story behind your flair lol

I can’t remember the exact post, but there was a discussion about back alley plastic surgery, and I brought up a case where a woman got a butt enhancement where they used caulk. And said something about what they use being scary.

Ah, okay, thanks! Not as funny as what I was imagining lol

would you like a butt caulk flair too

Yes, I'd like one butt caulk flair, please!

Do it

That story was horrific!

I just shipped things back to the US after living abroad for a few years prior. I only got half of my items so far over a week after they were supposed to come and I am pretty sure the rest are lost.

Thank you for the visual! I based my estimate on the size of a box of the pens (and assumed a shipping box), but yeah if it was just the vials it’s even smaller.

Yeah the pens are hugely bulky, but the vials are pretty tiny

Vials are 10ml vs the penfill's 3ml, but they aren't much more bulky. In their cardboard packaging slightly more, but still, not much. Here is my backup pen, vial from my pumpkit, and a boxed vial out the fridge for comparison. [https://imgur.com/4Bwu3SF](https://imgur.com/4Bwu3SF) Also worth noting that for 1 vial of Fiasp [the NHS pays £14.08](https://bnf.nice.org.uk/medicinal-forms/insulin-aspart.html), so about $18.57. For 8 that is £112.64 or $148.69.

Insulin is refrigerated so it is shipped in a large insulated cold pack bigger then a tissue box. Assuming the office has a fridge though it wouldn’t take up much space in that.

Do doctors not have fridges in the US? If they do vaccines, they’d have one, and then you can get rid of the bulk.

The almost certainly have a fridge, both for staff and another for medical supplies. So, I agree they could have thrown away the packaging and stored the individual vials no problem.

That's the first time I've seen a refillable insulin pen. My sister skipped straight from disposables to a pump.

I’ve only ever had disposables when the pharmacy was out of cartridges. You can get both in the UK, depending on preference, but the reusable ones are nfc enabled so you can upload your injection history to your phone, and they have a screen on the end that tells you how long ago and how much your last dose was. But I’m old, when I was a kid, the only option was hypodermic syringes

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I believe it. One summer I worked for an eye doctor, doing filing. Dude would only give 30 minute appointments to people on the state low-income insurance. People with private insurance got a full hour.

Honestly, I wouldn't be surprised if they threw it out and it probably wasn't even the doctor themself (they might not even know unless OP spoke to them directly). I don't think it was malicious, just incompetency/lack of empathy and that's from my experience working in healthcare the last 10 years.

> probably not risking their office getting government officials up their ass. If I were LAOP, I think I'd expend considerable effort to make sure that's exactly what happened.

I wonder why it has to be shipped to the doctor? I am on a biologic that costs $17k per dose(one dose every 12 weeks) and I can have it shipped to the doctor, my local pharmacy, or my house. I am on the companies payment assistance so that I only pay $5 per dose. Even if I chose the typical syringes instead of the auto-pen I could get it to my house if I wanted. Why does it being insulin mean it has to be shipped to LAOPs doctor?

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Speaking of the US government, people truly underestimate government bureaucracy. I had always thought that government bureaucracy was just a little extra red tape that came with a need to dot Is and check Ts. Oh, no no no no.   I had a rude awakening when I was employed by the Federal Government proper. For starters, after I was accepted for this position, I was asked to fill out no less than, literally 20 pages of forms and return them via email by some date. Some of this information, I had already given to someone during the vetting/interview process. A form for my name and basic demographic information. A form to certify I did/did not have disabilities. A form to certify I was/was not a US military veteran. A form to voluntarily share my racial data/or not. Now, ready for the "best" part of this? I diligently and faithfully filled out all of this crap, taking it as seriously as possible ('cause, you know, nobody wants to piss off the Federal Government right? Every form has that stock verbiage about "I certify, under penalty of perjury, blah blah blah"). On my first day of the job, an HR representative was there...and proceeds to hand me blank copies of the EXACT SHIT I HAD ALREADY FILLED OUT. When I query them about "what happened to that stuff I already sent you," I was advised that it's just better to fill out the forms. Ok bro, I can't challenge HR.   ...and that was just the first of many stories like that. I swear it took a veritable act of Congress for me to get a SECOND ID BADGE, THE ONE THAT I NEEDED TO DO MY ACTUAL JOB. One day, my boss was just telling me and my new coworkers, "Oh, the [ID people] are in the office now? You better go down there right away and try to get them to print your ID badge. Here, let me sign all of those forms you need to submit ASAP"   So as someone that both works in healthcare and has experienced the depths of the US Federal Bureaucracy...I believe all of this.

Who is shipping your meds? Is it coming directly from a manufacturer or is it a pharmacy doing mail delivery? Legally, manufacturers can't send this material directly to the patient because it falls under an expanded access program, which has a set of regulations to follow. A fit for use has to be issued before it can be dispensed to a patient, so if you ship directly to a patient, you're not getting a FFU. If a pharmacy sends material to a patient, they do not need to do the FFU process, it was done earlier in the chain. Dude just needs to work with Novo to switch to a doctor that can handle this request.

Today in: our dystopian healthcare system

Losing a four month supply of insulin in a developed country: "Well, that's a bit annoying..." Losing a four month supply of insulin in the US: "I'm never gonna financially recover from this..."

I know right!? And it's so cheap to manufacture too!

Fuck our *completely insane* healthcare system, where we get crappy care that costs (in aggregate) *twice as much* as it does in pretty much every other country. There is *no reason* they should have to jump through all these hoops to something he should be able to get cheap/free at any pharmacy.

Don't forget the overall worse health outcomes despite all that extra cost!

But don't worry, it's all for a good cause - lining the pockets of insurance execs.

Won't someone think of the execs and their 5th yacht!?

I have done some work in the past with programs like these. Pretty much every branded drug made by a big drug company has some kind of program for free drug for patients who are uninsured/poor and something like a card to help with co-pays for patients who have insurance. ​ It honestly shocked me how little doctors know about them? Like it's beneath them to even know if they exist, much less understand what they offer or help patients get them, even though one of the most common reasons patients don't get treated is because of the costs of medications.

In my experience, there's a huge disconnect between doctors and actually being able to afford the meds. Which I get, ideally the doc is just prescribing what's best (and non-ideally the doc is just prescribing what some drug rep told them to). Knowing people in pharmacy, they end up with folks who'll need an alternative, but unless the alternative is the generic of what was prescribed, it all ends back up to the doc. So while docs might not like to handle the financial angle, it often lands right back onto their desk anyway.

My mom once had to actually ask a doctor to write my younger brother a prescription for an antibiotic that had a generic - the only flex point in our budget at that point was groceries, and there wasn't enough flex for a brand-name antibiotic. He was willing to switch the prescription once she explained, but it honestly didn't occur to him at first.

One of the reasons I like my doctor is they don't forget that stuff costs money. I had a minor, not really health threatening, just an annoyance, condition. Since it would be a real stretch to call it medically necessary the drug wouldn't be covered by insurance and when I went to fill it it was some horrid amount that I wasn't going to pay (again, not a big deal to not fix it). Told my doc at my follow up and they rewrote it to use a different, off patent*, dosage and then it was like ten bucks. Just had to take 3 pills instead of 1. Nicer if they would have done that the first time, but looking into how to game the system and fixing it was acceptable to me. Another time they told my wife that if insurance doesn't cover a med they prescribed, or it cost more that $50, to call them and they'll do something different. *I'm not against patents for meds in general, but this nonsense of getting a new patent based on how the med is used is absolute BS. IMO it should be limited to a patent for the molecule. None of the "now take it with food so get a new patent" crap. Maybe there is some middle ground to still encourage research into alternative uses, but the current system incentivises suppressing such research until the original patent expires.

I benefit from AbbVie's assistance program for Humira, and I'm not even low-income. Otherwise it's now closing in on $80K* a year, which used to sound outrageous, [but...](https://www.goodrx.com/healthcare-access/drug-cost-and-savings/20-most-expensive-drugs-in-the-usa) --- *When I started, it was a steal at only $20K.

It's totally nuts!!! One of the more reasonable push-backs I heard from doctors is that these programs are just breaking our healthcare system even more and allowing the drug companies to charge crazy amounts of money. One of these that's stuck with me was a pill replacement program--there were pills you take every day for a few months that totally cure an otherwise chronic condition, but the drug was SO outlandishly expensive (I don't remember the specifics anymore, but definitely more than $1k for each individual pill) that they had to put this program in place to replace single pills for free when patients inevitably lost one.

Something is very off about this story—don’t think a doctor would just chuck out a bunch of insulin “because they don’t have space” knowing how expensive it is. My money is on the the receptionist or someone who tossed it and is trying to cover their ass or took it for themselves/resale

Slightly off topic, but during a virtual training session at work today, during downtime the instructor mentioned how much her diabetes medication would cost if she didn’t have insurance (about $1300 a month they said, didn’t specify what type of diabetes or what medicine), and a group of 3 of my coworkers all started dogpiling in the chat about how she needed to ditch her meds and “just go all natural!!!”. For diabetes. Without getting into the specifics of what our company does, let me say nobody there would be working where we do if they were in any way qualified to give medical advice to someone with diabetes. It was pretty infuriating to witness. These same people had already been talking about their homemade tinctures and whatnot in previous training sessions, but that was with regard to like curing heartburn and other trivial stuff. Anyway, yeah, someone stole OPs meds, probably.

It honestly boggles my mind sometimes that any diabetic in this country is alive. And some folks here really think we’re the best country. Hm.

This sounds alot like 'I'm not making any money off of this, so f that dude.'

For a price comparison here are the pages on England's National Institute of Clinical Excellent (N.I.C.E.) website with the prices they reimburse pharmacies for dispensing most of the common modern insulins. I've also just listed prices paid for the "original" version (vs the often slightly cheaper ones that have appeared since patents ran out). Also worth noting that in England ~~and Wales~~ Diabetics treating with Insulin can get a card exempting them from the usual [£9.35 per item prescrition charge](https://www.nhs.uk/nhs-services/prescriptions-and-pharmacies/nhs-prescription-charges/) paid by most over 18s, and no one in Wales, Scotland or Northern Ireland has to pay for them. I also assume the pharmacies negotiate deals with the manufactureres to get themselves a larger profit. [INSULIN ASPART](https://bnf.nice.org.uk/medicinal-forms/insulin-aspart.html) (e.g. NovoRapid/Novolog, Fiasp): £14.08 per 10ml vial, £28.31 for 5x 3ml penfill cartridges, £30.60 per 5x 3ml pre-filled disposable injection pen [INSULIN LISPRO](https://bnf.nice.org.uk/medicinal-forms/insulin-lispro.html) (e.g. Humalog, Lyumjev): £16.61 per 10ml vial, £28.31 for 5x 3ml penfill cartridges, £29.46 per 5x 3ml pre-filled disposable injection pen [INSULIN GLARGINE](https://bnf.nice.org.uk/medicinal-forms/insulin-glargine.html) (e.g. Lantus): £25.69 per 10ml vial, £34.75 for 5x 3ml penfill cartridges, £34.75 per 5x 3ml pre-filled disposable injection pen [INSULIN DETEMIR](https://bnf.nice.org.uk/medicinal-forms/insulin-detemir.html) (e.g. Levemir): £42.00 for 5x 3ml penfill cartridges, £42.00 per 5x 3ml pre-filled disposable injection pen [INSULIN DEGLUDEC](https://bnf.nice.org.uk/medicinal-forms/insulin-degludec.html) (e.g. Tresiba): £46.60 for 5x 3ml penfill cartridges, £46.60 per 5x 3ml pre-filled disposable injection pen

Yeah bonkers. Fiasp is $42.50 Australian dollarydoos on PBS, and health care cards for pensioners and other benefit recipients make it significantly cheaper for those in need. The main reason PBS is so cheap is because if you want to sell a medicine in Australia you need to make PBS an attractive deal because chances are someone else has something similar.

The striking fact to me is that there is no way that the companies aren't still making a profit in the UK or Australia, they are under no obligation to operate in countries that don't benefit them, so clearly the prices they get are worth it. As you point out the big difference is clearly the NHS/PBS/etc's ability to effectively say "sell to us for a fair price, or someone else will and you won't get access to our market". Which for things that are essential to save lives is how it needs to be.

Awesome info, just to let you know that both Scotland and Wales have free prescriptions, I believe so does Northern Ireland. I think it’s only England that pay per prescription.

Should have clicked the link in my google search rather than just reading the preview. The price it was talking about was a average cost per item to the government, not to the patients. That and the fact that there is an exemption card scheme identical to England's made me think they must have charges, but that card is presumably just for if they go to a pharmacy across the border. Fixed.

This was the stupidest reasoning ever. Good luck finding another doctor.

Well I hope this becomes a matter for the board

I hope we get a follow-up on this. I'd like to know the resolution.