July 4, 2004
Insurance/Costs
Question from Decatur, Illinois, USA:
My son 14 year old son has had type 1 diabetes for four years. He uses Lantus and NovoLog and has done very well. When we were living in North Carolina, he was on Medicaid there and we had no problems getting any of his insulin. Now, we in Illinois and I was just told that Illinois Medicaid no longer covers Lantus. The pharmacist says I will either have to pay for it myself or the doctor will have to prescribe something else that Medicaid will pay for. We have a referral to a new endocrinologist, but are not scheduled to see him until July. I am very frustrated and do not want to change his current regimen but can’t afford to buy the Lantus myself. What other insulins would be options and how would they differ from the Lantus as far as scheduling, number of injections, etc.? He also has Down Syndrome and some behavioral issues so a pump is not an option for him.
Answer:
The Illinois Medicaid program uses a prescription drug formulary list of covered items. There is a process for providing access to non-formulary items if the physician certifies that the non-formulary drug is essential to treatment. You should contact the the Illinois Department of Public Aid for information.
DSH
Additional comments from Dr. Larry Deeb:
You are facing the reality of insurance companies. Medicaid is just one of them. Maybe the doctor could ask for an exception. Although it is trouble for the doctor and the pharmacy, it is option for you. Here in Florida, we can do this.
LD
