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Pharmacist helps save man's life, insurance company denies coverage

THURSDAY UPDATE: Highmark has agreed to pay for Dan Cook's EpiPen.

A local man had a dangerous, allergic reaction to bee stings.

With little time to spare, he rushed to his neighborhood pharmacy in New Castle.

He says he usually gets a generic EpiPen for about $6, but the shop was out, so in a rush he was given the name brand one at a cost of $600.

When he turned it into insurance, he got a letter saying it wouldn't be covered.

Now that he’s been forced to pay 100 times the cost for the prescription EpiPen, the customer and pharmacist both tell Channel 11 they're baffled, and can't understand why the insurance company won't budge.

"It was scary. It was very scary,” said customer Dan Cook.

"Dan Cook comes running into the pharmacy, 'Mike, I've been stung by bees. This is expired.  I need an EpiPen!’"

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Pharmacist Michael Fornataro and customer Dan Cook reflected on the experience that nearly claimed Dan's life almost one week ago.

"He was flushed red and was having trouble breathing," Fornataro said.

"I'm swelling up all over. My throat's starting to swell up. I got hives all over. I know I need the EpiPen," Cook said.

He was with his buddies, getting ready to go golfing at Sylvan Heights Golf Course when he was stung by 20 bees and he's allergic.

He reached for his EpiPen, but it was expired and not working, so he drove straight to East Side Pharmacy.

Without question, Fornataro handed Cook an EpiPen.

"He could have passed away,” Fornataro said.

"He saved my life. He definitely did," Cook said.

Hours later: "They said they'll only pay for the generic," Fornataro said.

Highmark said the name brand EpiPen is not covered under Cook's insurance and instead of paying $6, he would now have to pay $600.

"It's an emergency situation, it's not like I'm trying to gain anything,” Cook said.

Fornataro put in several calls to the insurance company to plead the case.

Cook showed us the letter, which states, “We are sorry to inform you that request for the coverage of this drug does not meet the criteria for approval and has been denied."

"It was an emergency situation. I wasn't worried about whether to grab the brand or generic. My whole concern was getting Dan the medication so he's alive today," Fornataro said.

Channel 11 reached out to the insurance company for answers, which told us, "Highmark is unable to comment at this time."

So what happens next?  They’re working to file an appeal with Highmark and Cook is even looking to take part in a peer-to-peer review to argue the claim.

 

Cox Media Group

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