August 6, 1999
Hypoglycemia, Social Issues: Insurance/Costs
Question from Pennsylvania, USA:
Is Glucagel as effective as a using injectable glucagon in the event of a child having a hypoglycemic seizure? My HMO has dropped Glucagon Emergency Kits from its formulary. My diabetic son is 9 and I am uncomfortable with the idea of not having a glucagon emergency kit in the event of a seizure. Our CDE says she has never heard of an HMO not covering glucagon and is trying to help me convince them to cover it for me, but what about the bigger policy issue for all their other insured children? Is this the start of a trend?
Answer:
It is medically dangerous to give a child who is having a hypoglycemic seizure anything by mouth. This could cause aspiration of the food and lead to serious illness. If your plan covers prescriptions in general, it should cover glucagon. I would suggest writing your HMO and threaten to report them to the state insurance fund, attorney general, and state medical society if they do not fill your prescription for glucagon immediately. You should report them for both medical malpractice and insurance fraud if they are recommending giving oral medication to someone who is having a seizure.
I would also contact the local chapters of both the American Diabetes Association and the Juvenile Diabetes Foundation for help. You could also write to your congressman, senator, and governor.
You should not allow them to get away with this dangerous practice.
TGL
Additional comments from Dr. Quick:
While it’s rare that Glucagon is needed, and it’s possible that Glucagel rubbed between the cheek and the gums might work in an unconscious child, anything placed into the mouth during any seizure is dangerous.
HMO’s are driven by cost, and Glucagon is expensive. This is not the first instance I’ve heard of where Glucagon is not on the HMO’s approved medication list (“the formulary”). A “Letter of Medical Necessity” from the CDE or the doctor, explaining the need for this “off-formulary” medication, should be sufficient to get the HMO to pay for any child’s Glucagon Emergency Kit. If not, my advice would be to buy it with out-of-pocket money, keep copies of the bill, and then fight for reimbursement as Dr. Lebinger suggests.
WWQ
