$1,000/mth ypoallergenic baby formula rejected for drug coverage
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|Mon, 10-01-2012 - 12:37pm|
An Edmonton couple says they may be forced to sell their home to pay for a special formula they must feed their allergy-afflicted infant because the product was rejected for drug coverage.
In the eight weeks since his birth, Isaac Caskenette has been hospitalized twice and undergone abdominal surgery after his parents Lisa and Ira found blood in his stool.
He was diagnosed with necrotizing enterocolitis (NEC) and a cow’s milk protein allergy.
Doctors at the Stollery Children’s Hospital prescribed Neocate, a hypoallergenic, amino-acid based formula designed for babies with cow’s milk allergies who cannot digest milk or soy-based formula.
“The social worker sat down with me and said there is a down side to this: it is very expensive,” Lisa said Sunday.
Neocate, available by special order through select pharmacies, costs about $262 for a case of four 100-gram cans of powder, which is mixed with sterilized water for about 10 days supply.
The Caskenettes estimate it will cost at least $1,000 a month for the formula.
“I wasn’t too concerned because we have Blue Cross and I thought no problem. We have coverage. It will be OK.”
But despite the doctor’s prescription, Alberta Blue Cross rejected Neocate for coverage because it is not classified as a drug under the Caskenettes’ plan.
“Neocate Oral Infant Formula is considered a dietary supplement,” said a letter the Caskenettes received from the company.
“Unfortunately, this product is not a drug, nor is it covered under any category under the supplementary health benefits included in this plan.”
A spokesperson for Alberta Blue Cross could not be reached for comment.
“They’re categorizing it as if it were Ensure or Boost and they don’t see this as a necessity for him,” Lisa said.
She said she can’t breastfeed Isaac for fear of unknowingly passing along to Isaac any dairy proteins contained in a wide variety of foods she might eat, and it’s not known what other allergies he has.
“He can’t go through this much more. The next step is a colostomy bag.”
The Caskenettes say they have made requests to several organizations to help pay for the formula, including Alberta Health, social assistance (the family earns too much money), five charity foundations and the food bank.
All have been unsuccessful.
The family has also applied for assistance from the provincial government’s Family Supports for Children with Disabilities
“It’s in the process, but allergies are not viewed as a disability even though it’s debilitating for him,” Lisa said.
Ira, a labourer for the City of Edmonton, is applying for help from his union’s emergency fund for members, but it’s not certain how much money would be available or for how long.
Friends and family have also pitched in.
“It’s a big hardship,” Ira said. “It’s a thousand dollars out of your pocket every month.”
Lisa said the family may be forced to sell their home. “At the end of the day, there is no cost that’s worth your child’s health.”