LEADVILLE, CO — A local physician reportedly began questioning the linear nature of time this week after being informed that his patient’s long-acting insulin would need to be changed again, despite remaining the exact same molecule it was last Tuesday.
The trouble began when Insulin Glargine, helpfully labeled as “generic,” was deemed unacceptable by the patient’s insurance plan after being acceptable for nine days. The physician complied, switching the prescription to Basaglar, which the insurer confirmed was preferred, celebrated, and deeply cherished by the formulary committee.
Forty-eight hours later, Basaglar was declared a reckless choice.
The plan instead required Lantus, which is chemically indistinguishable, functionally identical, and delivered in a pen that looks the same until you read the logo under fluorescent lighting. The physician stared at the fax for a full minute, waiting for the punchline. None arrived.
He reopened the chart, retyped the same dose, resent the prescription, and wondered aloud whether the insurance company was running a behavioral study. The nurse asked if she should submit another prior authorization. He laughed, then stopped laughing.
The patient called to ask if insulin was still insulin. The physician confirmed it was. The patient asked why the pharmacy said it was different. The physician explained that it was not different, except in name, price negotiations, rebate agreements, and spiritual essence as recognized by the insurer.
Later that afternoon, a denial arrived stating that Lantus required documentation of failure on Basaglar. The physician attached the denial of Basaglar to the appeal for Lantus, creating what experts call a closed loop of administrative enlightenment.
Colleagues offered support. One suggested switching to another insulin entirely. Another recommended mindfulness. A third asked whether the physician had tried sacrificing a toner cartridge to the fax machine.
By Friday, the physician had memorized the National Drug Codes of all three products and could recite them faster than his children’s birthdays. He briefly considered opening a museum dedicated to identical insulins with different branding.
The patient eventually received insulin. No one was certain which one. Blood sugars improved. The physician did not.
At press time, the insurance plan announced an exciting mid-cycle formulary update and encouraged providers to “stay flexible.”
