I've had Type 1 for 20 years. I'm pretty sure my pancreas isn't going to start working next Tuesday.
And yet, every three months, I have to prove to my insurance company that I still need insulin.
Every six months, I need to see my endocrinologist to renew prescriptions for the exact same supplies I've been using for two decades.
Every time I start a new sensor or get a new insulin pump, there's a prior authorization form somewhere with my name on it, sitting in a queue, waiting for someone to decide whether my life-saving technology is "medically necessary."
It's not opioids. It's insulin. And CGM sensors. And test strips.
But the system treats chronic illness like it's temporary. Like maybe if they make me jump through enough hoops, I'll just get better and stop asking for refills.
Here's how it works in most insurance plans:
You can't just refill your insulin prescription. You need an active relationship with an endocrinologist. Which means you need to schedule an appointment every 3-6 months, take time off work, drive to the office, sit in a waiting room, and have a doctor confirm what you already know: yes, you still have Type 1 diabetes.
The appointment itself is usually fine. My endo is great. But the requirement is absurd.
I'm not going to suddenly not need insulin. My pancreas didn't partially recover since my last visit. Nothing about my diagnosis has changed. I know my ratios. I know my patterns. I've been doing this for 20 years.
But without that appointment, the prescription expires. And without a valid prescription, the pharmacy won't fill it. And without insulin, I have about three days before things get catastrophic.
So I schedule the appointment. I take the morning off. I sit in the waiting room scrolling my phone while perfectly healthy people with actual acute problems wait to see a specialist they actually need to see.
The weirdest part? The appointment isn't even where the hard decisions happen. My endo adjusts my prescriptions based on what I tell him I'm already doing. I'm the one troubleshooting. I'm the one experimenting with ratios and timing. He's just signing off on it.
Which is fine. That's how chronic illness works. You manage it daily. The doctor provides oversight and guidance.
But requiring an office visit every few months to rubber-stamp prescriptions I've been using successfully for years isn't oversight. It's bureaucracy disguised as care.
Then there's the prior authorization process.
Every time I get a new CGM or a new insulin pump, my doctor has to submit paperwork to my insurance company explaining why I need it. Someone at the insurance company reviews the request and decides whether to approve it.
For context: I need a CGM to know what my blood sugar is. I need an insulin pump to not die. These aren't elective. They're not cosmetic. They're the baseline technology required to manage Type 1 diabetes in 2026.
But insurance treats them like they're experimental or optional.
The prior auth process can take weeks. During that time, you're stuck using whatever you have left. If your current sensor is failing or your pump site is painful, too bad. You wait.
And here's the part that makes no sense: it's not like the insurance company ever says no. They always approve it eventually. Because of course they do. It's medically necessary. Everyone knows it's medically necessary.
So why the delay?
The only explanation is that the system is designed to be annoying enough that some percentage of people just give up or delay care. Which, for life-saving medical devices, is insane.
It's not opioids. It's not elective surgery. It's insulin delivery and glucose monitoring. The prior auth process doesn't protect anyone. It just adds friction.
Insurance companies keep diabetes supplies on a tight leash. Most plans limit how many CGM sensors or pump supplies you can get per month. If you need an extra sensor because one failed, too bad. You're over your limit.
This creates a specific kind of anxiety that's hard to explain to people who don't live with it.
Let's say you put on a new CGM sensor and it hurts. Maybe it hit a nerve. Maybe the adhesive is irritating your skin. Maybe it's just in a bad spot and you know from experience it's going to give inaccurate readings.
Normally, you'd just pull it off and replace it.
But with insurance-limited supplies, you can't. Because if you use that replacement sensor now, you won't have enough to last the month. So you leave the painful sensor on. You deal with the bad data. You wait it out.
The math is simple: if you get 3 sensors per month and each sensor is supposed to last 10 days, you have zero margin for error. One failed sensor and you're rationing.
I've left painful sensors on for days because I was scared I'd run out before my next shipment arrived. I've stretched sensors past their expiration trying to make the supply last. I've planned vacations around sensor shipment dates.
It's not because the sensors are expensive for the insurance company. It's because the system assumes people are trying to game it. That someone with Type 1 diabetes is going to hoard CGM sensors for fun.
The irony is that the tighter they make the limits, the more anxiety it creates. And stress spikes blood sugar. So their cost-saving measure actively makes diabetes harder to manage.
Here's the thing: none of these barriers stop you from getting what you need. They just make it harder.
You still get the insulin. You still get the CGM. You still see the endo.
But the cumulative effect is exhausting.
Every refill is a multi-step process. Every new device is a paperwork battle. Every supply shipment is a countdown timer you have to track.
And all of it is performative. The hoops don't improve care. They don't catch problems. They don't prevent fraud.
They just add friction to a process that's already mentally exhausting.
Managing Type 1 diabetes means making hundreds of micro-decisions every day. Tracking variables. Troubleshooting patterns. Adjusting on the fly.
The actual disease is hard enough.
The administrative layer on top of it shouldn't exist. At minimum, it shouldn't require this much energy.
If I could redesign the system, here's what I'd change:
Standing prescriptions that don't expire unless something changes. My insulin needs aren't going away. Neither is my need for CGM sensors or test strips. Let the prescription auto-renew unless my doctor specifically flags a concern.
Prior auth exemptions for established patients. If I've been using a CGM for 10 years, I shouldn't need approval every time I get a new one. First-time prior auth? Fine. But once it's approved, it should stay approved.
Supply buffers built into insurance limits. If the expected usage is 3 sensors per month, let people order 4. Sensors fail. Adhesives fail. Bodies are unpredictable. A 25% buffer would eliminate most of the supply anxiety without meaningfully increasing costs.
And honestly, just fewer appointments. I'm not saying eliminate endo visits. I'm saying make them as-needed instead of calendar-based. If my A1C is stable and I'm managing well, I shouldn't need an appointment every three months just to maintain my prescription.
Chronic illness isn't going away. The system should acknowledge that and reduce the overhead instead of treating every renewal like a new diagnosis.
None of this is going to change tomorrow. Insurance companies and healthcare systems move slowly.
But at minimum, it's worth naming the absurdity.
My pancreas didn't work 20 years ago. It still doesn't work today. It won't work next Tuesday.
That's not a guess. That's not a maybe. That's the reality of Type 1 diabetes.
The system should act like it.
