Dear John: I have had Type 1 diabetes and been on insulin since 1968.
I have been a New York state employee with the Tax Department since 1997 and have had Empire Plan insurance since then.
As of Jan. 1, 2014, the Empire Plan switched pharmacies from Medco to CVS/Caremark. They also changed their “formulary list” of approved drugs.
On Jan. 6, I tried to order my two insulins, Lantus (long-lasting) and Apidra (fast-acting). There was no Apidra prescription listed, so I called CVS/Caremark and was told to have my doctor send a new prescription. He did.
I was informed a week or so later that Apidra was not on the new, approved list. I was told the only fast-acting insulins were Novolog and Novolin. I informed them I have had a severe allergic reaction to these insulins.
They told me to have the doctor file an appeal with an explanation. He did, twice, and both times the request was denied, with the only reason given being that the drug is not on the “approved list.”
I spent more than 200 hours on the phone with CVS/Caremark, which told me to file an external appeal.
My doctor and I filled out the paperwork and faxed it in for an expedited appeal. One hour later, I received a call from the NY state Dept. of Financial Services stating it does not review formulary appeals.
I called civil service on May 2 and was told that I wasted time filing the appeals, since CVS/Caremark cannot review drugs not on the list.
I was also told there was no way to get this changed, as the list was supposed to be made up with possible alternatives.
Although there is an obvious mistake here, I was told there is nothing I can do.
I now have about two weeks of insulin left. I have put myself on a starvation diet as to minimize the amount of insulin needed. Once the insulin runs out, I will:
1. Not take insulin, go into hyperglycemia and ketoacidosis, then a diabetic coma, and eventually die. The hospital costs will be in the tens of thousands to hundreds of thousands of dollars.
2. Or take the insulin I am allergic to, go into anaphalactic shock, lose total control of my sugar levels, go into hyperglycemia and ketoacidosis, then a diabetic coma, and eventually die. The hospital costs here, too, will be in the tens of thousands to hundreds of thousands of dollars.
3. Or continue to starve myself (as diabetics did prior to 1921, when insulin was discovered) and still go into hyperglycemia and ketoacidosis, then a diabetic coma, and eventually die. The hospital costs will still be in the tens of thousands to hundreds of thousands of dollars.
Apidra is made by Sanofi-aventis. I can also take Humalog, made by Eli Lilly, but the state only allows the drugs made by Novo Nordisk.
All the persons I talk to say it’s terrible, a mistake, shouldn’t be, but give no way to take care of it. L.H.
Dear L.H.: You contacted me on a Friday night, May 2, when all state offices were obviously closed. And I kept my promise to you that I would see if this matter could be resolved pronto.
I got in touch with the Tax Department the following Monday morning, and by noon that Wednesday, your drug was approved by CVS.
You should thank the state Tax Department for working quickly and taking this so seriously.
I’m glad I could help.
Feel better.
Dear John: I am a college graduate with a bachelor of fine arts degree in graphic design.
I became disabled because of a severe auto accident, leading me to [file for] Social Security Disability (SSD) benefits. After a fully favorable decision, I was given an award-letter appointment at the Social Security office and was told I qualified for disability and regular Social Security benefits.
After [I was] told this, the interviewer [at the Social Security office] decided to add $20 a month to my SSD benefits but said that was all I was entitled to.
I find it strange that after being informed I was entitled to both benefits that this would be all I would receive.
I have attempted on several occasions to investigate this matter, but to no avail.
Social Security representatives were very vague and unwilling to assist me. [Their attitude was that] I should be satisfied with what I receive, and that’s that.
I am strongly hoping that you may be able to help me. M.B.
Dear M.B.: I was able to get an answer, but it’s not one that you will like.
The Social Security office in New York City — which is always nice to me — says that the problem is simple: There’s a cap of $808 a month on what you can receive from both programs. That extra $20, I’m afraid, put you at that cap.
Wish I could give you better news.