Insurance company

[MamaBelle4]

I have morning sickness issues. Have with each kid. Have had hyperemesis each time. It isn't pretty or fun.

Dr gives me a sample pack of diclegis (only FDA approved morning sickness med). It works! I still feel sick almost constantly, but am able to keep most down. Hallelujah! !

So, I call the doctor to get a prescription. She calls me back. My insurance doesn't cover it and it can cost as much as $570/100 pills. She goes on a tangent all but cursing drug companies and insurance companies and everything. There's an option for preauthorization, but I need to prove I've tried other alternatives first and they still usually do not approve it. She told me to take unisom and Vitamin B6, as that is essentially the make up of diclegis. I intend to try that and hope it works.

I'm just so angry! I have ended up hospitalized multiple times in each pregnancy because of my severe morning sickness. And the insurance company had the cajones to say that a medicine that actually helps me isn't necessary.

Thanks for listening to my angry rant!

 

[prprincess]

I'm so sorry! And vent away--I remember how horrible it was for me! It's so hard to even functionally normally throughout the day because it's such a nasty feeling. Back when I was pregnant they wouldn't prescribe anything, so I had to rely on Prego Pops, ginger ale, essential oils, and Jolly Ranchers. Hang in there--I hope that you can get some relief and feel better soon!!

 

[piccolopat]

Did the insurance company say it is not necessary or that it is not covered? Each company develops its own formulary of what they will cover and what they won't. This is done to try and keep costs down. Too many new (and expensive) drugs are simply the old ones with a minor change in the chemical composition. If the old one works almost the same as the new one and is half the cost, that's what is covered. If the option your doctor gave you works and is less expensive, I don't see why that's a problem. The cost overruns in the health care system is what drives a good portion of the premiums up. Lower cost alternatives should always be considered first. You do have the appeal process with your insurance company. You can also ask the doctor to contact the manufacturer to see if they have an assistance program for people like you where the drug is not covered by your insurance. Congrats on the pregnancy and I hope you feel better soon.

 

[maxaroni]

Congrats on your pregnancy. I feel for you with the hyperemesis. My friends daughter also suffers from it with her pregnancies and has gotten IV's at home, walking around with the pole is not fun and being sick all the time. We have had this insurance issue with other things in our family, so can empathize on that aspect as well. Lots of luck with this and feel better.

 

[mom2rtk]

Congrats on the pregnancy!

I feel your pain. We have a high deductible plan, and all prescriptions are subject to the full deductible. So it's like they're not covered. It sucks.

 

[sonnyjane]

$570 for 100 pills would be worth it. My friend had horrible morning sickness with her pregnancy and her meds (zofran) were $700 for TWENTY PILLS.

 

[DaisyJ]

I have morning sickness issues. Have with each kid. Have had hyperemesis each time. It isn't pretty or fun.

Dr gives me a sample pack of diclegis (only FDA approved morning sickness med). It works! I still feel sick almost constantly, but am able to keep most down. Hallelujah! !

So, I call the doctor to get a prescription. She calls me back. My insurance doesn't cover it and it can cost as much as $570/100 pills. She goes on a tangent all but cursing drug companies and insurance companies and everything. There's an option for preauthorization, but I need to prove I've tried other alternatives first and they still usually do not approve it. She told me to take unisom and Vitamin B6, as that is essentially the make up of diclegis. I intend to try that and hope it works.

I'm just so angry! I have ended up hospitalized multiple times in each pregnancy because of my severe morning sickness. And the insurance company had the cajones to say that a medicine that actually helps me isn't necessary.

Thanks for listening to my angry rant!

I'm so sorry. We're going through something similar with issues DH is having and it makes me furious that insurance companies believe they are doctors.

I hope you find something that works!

 

[idkmyusername]

A lot of my meds have an outrageous co-pay, so I started googling each drug to see if they have a savings card of some sort. I googled diglegis for you and they do offer one.

https://www.diclegis.com/en/resources/save-on-diclegis

 

[piccolopat]

I'm so sorry. We're going through something similar with issues DH is having and it makes me furious that insurance companies believe they are doctors.

I hope you find something that works!

I think this is a big misunderstanding. Insurance companies don't think they are doctors. Insurance companies only determine what they will or will not cover under their policies. If a drug's not covered and your doctor thinks it is the only option, they can appeal the insurance company, look for manufacturer discounts or you can pay out of pocket. If you end up paying out of pocket, call around (don't forget Walmart) to see where you can get the best price. Prices can vary widely based on articles that I have read in the past.

 

[DaisyJ]

I think this is a big misunderstanding. Insurance companies don't think they are doctors. Insurance companies only determine what they will or will not cover under their policies. If a drug's not covered and your doctor thinks it is the only option, they can appeal the insurance company, look for manufacturer discounts or you can pay out of pocket. If you end up paying out of pocket, call around (don't forget Walmart) to see where you can get the best price. Prices can vary widely based on articles that I have read in the past.

In our case, it has nothing to do with meds. And yes, insurance companies do think they are doctors and they believe they know better than doctors what is best for a patient. My husband was straight up told by the insurance company "you don't need that, so we won't cover it".

 

[piccolopat]

In our case, it has nothing to do with meds. And yes, insurance companies do think they are doctors and they believe they know better than doctors what is best for a patient. My husband was straight up told by the insurance company "you don't need that, so we won't cover it".

Unless the insurance company rep was a physician, it sounds like someone was practicing medicine without a license. I would report this response to your state's insurance department.

 

[minushka72]

Check you prescription coverage to see if Zofran would be covered. It was covered as top tier for my first pregnancy (I think we paid $150.00 for a month supply), but was covered the 2nd time around at the lower tier co-pay ($25.00).

 

[mi*vida*loca]

.

 

[murmer]

Just an FYI my sis in law is doing the unison/b6 thing and it is actually working for her (severe issues with 1st very few now with 2nd unless she misses the med). So hopefully the combination will work for you.

 

[robinb]

I hope the doctor's suggestion works out for you.

 

[DisneyHardin]

I definitely sympathize with you. I just finished writing an appeal letter to Humana because they are refusing to pay for a medication that my DH really needs. His doctor has provided all the information they requested and they keep denying it. I thought maybe a heartfelt letter from the patient about much they he needs the medication might help, so I am going to mail it tomorrow.

 

[MamaBelle4]

Thank you everyone for the advice and congratulations.

A lot of my meds have an outrageous co-pay, so I started googling each drug to see if they have a savings card of some sort. I googled diglegis for you and they do offer one.

https://www.diclegis.com/en/resources/save-on-diclegis

That is awesome! I will have to save that link in case the unisom/b6 doesn't work.

Check you prescription coverage to see if Zofran would be covered.

Zofran was linked to cleft palate and other birth defects in 2015. I had actually JUST stopped taking it with that pregnancy when the reports came out. It did work though.

Just an FYI my sis in law is doing the unison/b6 thing and it is actually working for her

I have really high hopes that it will work for me. Just picked it up at the pharamacy.

Thank you all again for your advice and well wishes!

 

[Christine]

Yes, the Diclegis is a mix of an antihistamine and a derivative of B6. When I was pregnant they didn't have much and I was sick. So I got phenergan (antihistamine) suppositories and just half of one got me through the worst of it each day. So just the antihistamine itself worked without the B6. I took it via suppository because it absorbed better/faster and I didn't have all the fillers in the tablet. You might ask for that--it's dirt cheap.

 

[mnrose]

If your doctor is willing to write the script for it, you might consider getting the drug from a Canadian pharmacy. A quick look shows me that it's $167 for 100 pills....which is WAY better than what you were quoted. It does require a prescription, however.

It's the EXACT same drug you'd get in the US as there is only a single manufacturer, DUCHESNAY, and that's who makes the drug for the Canadian pharmacies too. It disgusts me that the price is SOOOOOOOOO much higher in the US. This should not be.

 

[manning]

Go to the insurance office and heave at the reception desk. Tell them you will be back tomorrow for same and until I get pills covered. Just being a smart butt.