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Stephanie S · 05-20-2011, 11:50 PM

Hello, me again, asking for my son. His insurance won't pay for insulin and the ADA and drug companies won't assist if you're HMO. How on earth do diabetics afford to live? And what will happen when he stops the insulin? This is crazy!
Also, he is not eligible for MediCal, yet doesn't make nearly enough to be able to buy insulin, not even close.

JJ · 05-21-2011, 06:28 AM

Never heard of any insurance company not paying for insulin..your right, it's nuts. He needs it to survive!! Obviously if he stops his sugar will get out of control. You or he need to raise some kind of stink to get someones attention about this even if it is some local politician.

Wishing you the best and keep us posted..JJ...

pupcake · 05-21-2011, 08:58 AM

The doctors office should be able to fill out a request for the insurance to pay for the insulin. A prior autherization.

Does the HMO pay for any medications?

Pup

SamQKitty · 05-22-2011, 01:33 PM

Yes, this doesn't sound quite right. If your son has drug coverage at all, they would definitely pay for insulin. It's possible that the insurance won't pay for the particular insulin his doctor prescribed, but they may pay for a different one in the same category. For example, if he's been prescribed a rapid-acting insulin, they may pay for humalog but not novolog; or they may pay for the basal insulin Lantus but not for Levemir. They may have contracts with particular drug companies which makes it more cost-effective for them to cover one, but not the other.

Ruth

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