Dear fellow Kossacks,

Short diary. Wondering if someone can help me with the following:

Anyone familiar with California insurance law?

My mother was recently switched to a plan called Medicare 65+, managed under Blueshield of California. She has primary Medicare, then the Blueshield under my father's policy and also has her own PPO insurance.

She recently received a letter that her Januvia would no longer be covered under Blueshield.

She needs Januvia for her diabetes care and it is incredibly expensive. However, for the very brief period I had diabetes, before my weight loss, Blue Shield of Connecticut played games with me, saying I'd have to pay for my Januvia, $600 a bottle, myself, then get reimbursed. Then, after many phone calls, they suddenly remembered there was a state mandate to cover diabetes supplies in Connecticut. Suddenly, when I mentioned that, everything was great.

I know California has a similar such mandate:
Equipment, supplies (including prescriptions if prescription coverage is included), and self-management training for the management and treatment of diabetes.

My question is, can they get away with no longer covering her Januvia or can I refer to this mandate? As far as I know there is no generic for Januvia.

If they do not cooperate, what avenues should I pursue and to whom could I file a complaint in California?

Any thoughts or advice would be greatly, greatly appreciated!!

Originally posted to gladkov on Thu Feb 14, 2013 at 05:40 PM PST.

Also republished by Kossacks helping each other.

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