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Novolog is not 'medically necessary' or the letter that made my head almost come off my body

Happy New Year everyone!

Ok, now sit down. I mean it. Sit. Down.
Then read this:

Did your head almost come off your body? Steam from your ears? Or is your jaw still on the floor?

Yep, Grace's insurance, Keystone Mercy,  the flippin' Medicaid that the state put her on on December 1st, denied her Novolog and said that she needs to use the 'formulary' insulin. That is Humalog.
If I wanted her on Humalog, I would have had her on Humalog.
If her doctor wanted her on Humalog, she would have placed her on Humalog.
If her endo thought Humalog would do better by her, she would have prescribed it.
As it turns out, gee, she is on NOVOLOG - for TWO YEARS now!

And you know the sole reason that Keystone Mercy decided this???
You guessed it folks.


Money was the sole reason they made this decision. Novolog costs more than their formulary.

Not for one minute do I believe that they have Grace's best interests and healthcare at heart.
They didn't consult her endo.
They didn't consult her primary doctor.
They didn't call me.
They didn't read her files or ask for her history.
They didn't call her CDE.
They didn't look at how long and how successful she has been on Novolog.
They didn't look at her A1C or her blood sugars.
They didn't look at the difference reported between Novolog and Humalog.

They even go so far as to say that she has not tried 'formulary alternatives' which means she didn't try what they have rostered as the lowest-costing insulin they can get.
Oh, poor Keystone Mercy.

Monday morning - a complaint AND a grievance are being filed against Keystone Mercy.
Monday morning, the 'BitchSwitch' that my dear friend Kelly coined, is being flipped!
Monday morning, I am calling a lawyer at the PA Health Law Project.

It's so ON.

1-3-11 update:
* Complaint/grievance sent certified mail to KMHP
* Complaint/grievance filed over the phone
* Left case manager at KMHP left a scalding message on their voicemail
* Endo on board and sending letter in support of Novolog
* BitchSwitch flipped
* Head still on body, surprisingly

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