LIFE and Death situation but still do NOT want to fully cover NON Formulary Insulin

<p>The reason for my complaint- I am getting no help from Discovery Health- all i am asked to do is fill one form to the next- while Marks LIFE is played with by Discovery.</p> <p>(below is part of the letter that was sent to discovery- together with the necessary forms and reports)</p> <p>At the request of Discover about 4 months ago- (since they did not want to Fully covery – Levemar), we tried Basalgar. Before the switch we appealed to Discovery and warned them of the consequences of switching Marks medication. But the powers that be at Discovery decided to play with Marks LIFE instead. Since he was switched to Basalgar by Discovery a few months ago, he has had endless issues (listed below): The main in the past month (June – July2017) I (main member and his partner Elesha Mudaly) had to call the ambulance over in the wee hours of the morning as his Sugar dropped to below a reading. He was even unconscious. I have attached RHT Document from July 2017 – You can request the first one from Netcare 911, they did not give us a copy. He has been unable to work since the switch- his Glucose reading are so erratic – within a few hours can go from 2.4 to 20 without eating foods that spike his sugar.He has since had to resign from his job. All because Discovery did not want to cover his Levemir injection.</p> <p>Details of Failure:</p> <p> Erratic readings- his sugar can go from 2 to 20 in a space of an hour – without Sugar Spiking foods.<br />When he goes to bed his sugar is fine- after taking Basalgar his sugar drops below reading – it is not stabilising his sugar like it is meant to.<br />He sweats profusely. <br />Insomnia<br />In the past month I (Elesha Mudaly- his live in partner) had to call the ambulance in the wee hours of the morning to revive him as his sugar dropped to below zero- he was unconscious.<br />He has not been able to work in the hospitality industry that he works in due to him passing out. Ambulance report attached. <br />On one occasion he was on his way to work- he realised he was not feeling well- he went home and passed out as per his conversation with his partner Mr Leslie does not remember much of that day. When I Elesha Mudaly finally got a hold of him- I asked him to test his sugar at that point it was 2, on the phone she had to instruct Mr Leslie to take a Super C to spike his sugar- then she had to monitor him on the phone till his sugar reading increased. He was semi-conscious <br />Marks life is In danger now- being on Basalgar<br />Basalgar may work well for many people but it does not work for Mark Leslie, we have not ordered, Basalgar for this month, as he needs to be put back on Levemar. This is a life or death situation.</p> <p>The response from Discovery on the 18th July 2017 -</p> <p>"5 Levemir prefilled cartridge 3ml</p> <p>Type 1 diabetes mellitus without</p> <p>18 Jul 2017</p> <p>We have not approved this item as an</p> <p>exception for funding in full as there are other alternatives on the Medicine List</p> <p>As this medicine is not listed on themedicine list (formulary), we will cover it up to the monthly Chronic Drug Amount (CDA)of R460, up to the overall monthly limit ofR700 for Insulin."</p> <p>The total cost of Marks Insulin PM is Just under R1000 - Why should I pay the difference when Discovery already receives Just under R5000 pm from me in premium fees.</p> <p>I got on the phone with the Chronic department this AM : REF ********** 604 - which was quiet a frustrating call- the call centre agent had no valid reason in regards to the above decision all she could tell me was that a board of doctors made this decision and now we have to have tests and more information from our DR to have full cover- (this decision takes 3-5 working days) and that Discovery cannot take my word for it that I his partner am experiancing all these issues with Mark- because people say things somethings- what the heck does that even mean- that is not my issue, my issue is my Partners Life, all this is effecting his heart, liver, kidneys.</p> <p>He has NOT been working for a few months since the switch- erratic readings in the day.</p> <p>I got a call while at work yesterday- 19.07.2017 - he was unwell- he was dillarious - i had to call in the Paramedics leave my job in the middle of the day, sit in traffic to get home and tend to him , let the Paramedics in. He sugar reading was 2.4 at the time.</p> <p>I do not believe that Discovery reviews cases on an idividual bases and I feel that the aim is to frustrate, so much so that a memeber would say all this is taking too much of time- my loved ones life is more important and i will pay the difference out of pocket.\</p> <p> </p> <p>Disappointed in Discovery Health!!!!</p> <p> </p>