Victor Solis Case Summary

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Thank you for your recent inquiry received March 31, 2017, concerning Victor Solis.

Please be advised that the material provided to you contains confidential patient information and confidential information proprietary to Blue Cross and Blue Shield of Texas (BCBSTX). The release of this information to any other party is restricted by the applicable regulations under the federal Health Insurance Portability and Accountability Act (HIPAA) and Articles of the Texas Insurance Code and Chapter 159 of the Texas Occupations Code.

Victor Solis has coverage under the Blue Advantage Silver HMO 102 Individual Health insurance policy effective January 1, 2017. The policy is currently active and paid through April 30, 2017.

After a review of the concerns presented in Lucercia Solis’ inquiry to your
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Samuel Davila requesting prescription coverage for the non-preferred insulin Humalog Kwikpen, 100unit/mL solution pen-injector. The Medical Director at BCBSTX reviewed the initial request and determined Mr. Solis did not meet the requirements to receive benefits for the non-preferred insulin Humalog. In order to approve coverage of this request, program criteria must be met. Based on the information from Dr. Davila, Mr. Solis did not meet the criteria. The information we received shows Mr. Solis does not meet the criteria due to the reason(s) listed below:

1) have a physical or mental disability that would prevent you from using a preferred insulin product, 2) you are pregnant, 3) have a side effect, Food and Drug Administration (FDA) labeled contraindication or allergy to the preferred insulin products that is not expected to occur with the requested insulin, or 4) your insulin pump will not work with all the preferred insulin products. The preferred insulin products are Novolin and Novolog. A contraindication is a health condition or risk factor that may cause harm if you use a drug.
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PRI:

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