I hate posting my problems to Facebook and I also hate that it has come to this, but I don’t know what else to do and our endocrinologist has tried everything he possibly could.
Reed was diagnosed with Type 1 Diabetes on November 9, 2017. While in the hospital with Diabetic Ketoacidosis, he also had an allergic reaction to Novolog and had to have an epi pen with him all night. Because of that, our endocrinologist changed his prescription to Humalog, which has worked very well. He stated that the higher Reed’s insulin needs become, the worse the allergic reaction would become. Our Insurance doesn’t cover Humalog, therefore our endo and his diabetic educators have been battling our insurance nonstop since trying to help us get coverage. Almost a week ago we got this letter in the mail, telling us no and also telling us there is no chance to appeal. Our endo doesn’t know what else to do and has never experienced insurance rejecting to this point, so he said to go put our story out there as much as possible. That’s why I’m posting now.
I also want to point out that Humalog, the insulin we need, is $2.00 cheaper than Novolog. Insulin is incredibly expensive. Our not even 2 year old son has to have Humalog to survive. This is more severe than an “unfortunate medical circumstance” as BCBS stated. We will get Reed’s insulin no matter what and can, but we pay insurance for this reason, therefore we believe that in this specific case of an allergic reaction, they should cover it just as they do the more expensive medication.
why would a insurance company provide reimbursement for a single manufacturer’s medication and no EXCEPTIONS to get another brand… even if the pt is ALLERGIC to the preferred medication ?
BECAUSE… the insurance company gets the BIGGEST KICKBACK from that one company if the insurance company promised EXCLUSIVE use of the particular’s company’s product.
The pharma gets to sell more product… the insurance company gets to make more profits.. and the pt is left to deal with whatever QOL they get and/or ends up paying for the most appropriate product out of pocket. Since Insulin can be several HUNDRED DOLLARS a bottle.. the annual cost to the pt can be substantial.
Filed under: General Problems
[…] that shows just how bad therapeutic substitution can be in regards to the pt’s outcome Let’s not forget… healthcare is basically a FOR PROFIT BUSINESS when the profits of the insurance/PBM is the most important thing to the insurance […]
This something that is they made a appoinment with there state Representive they would get some help with this. As far as no appeal I would tell that if the patient condition gets worse or need to be hospitalized those cost would be even or if they got sued. The problem is people give up to easy and dont fight back and I cannot think of a better reason then this. They also need to contact there state insurance board. It is to bad Corparation have taken over our medical care and resist having unversial care. Even with all the complaint with the VA something like this would not happen. In fact when I had a staff infection they did a test on what antibiotic would work best. Well the one that was needed they did not have so they got the medication Unversity Medical hospital nearby. These companies make contracts with the Pharmaceutical companies so who offers the best deal goes but when someone has a allergy that was more than just an inconvenience and more life threatening then they should pay the cost. Hopefully this family will get the help they need or maybe they can reach out to the makers of Humalog and see if they have a patient assistance program. Most do.