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» LymeNet Flash » Questions and Discussion » General Support » Started Zith and having ins. problems

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Author Topic: Started Zith and having ins. problems
sapphire101
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Member # 6638

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I just wondered if this is a common practice for ins. companies. My prescription was for 60 zithromax but when I picked it up I only had 6 pills. Now I have to pay a $30 copay every 3 days.

I am so mad. How can they do this? Is there something else that I can take besides zith that would do just as good?

I'm not really worried about me affording it but my daughter will be taking it next and there is no way she can afford this. She has the same ins. co. that I have.

Is there anything we can do? I am so mad that I can't see straight. Hubby is going to call them tomorrow but I doubt it will do any good.

Anyone else had this problem?

Take care,
Sapphire


Posts: 495 | From KY USA | Registered: Dec 2004  |  IP: Logged | Report this post to a Moderator
notime2work
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Almost the same thing happened to me. My insurance co-pay is $25, and the standard dose is 5 days, so I had to go back every 5 days to get my 10 pills for $25!
Posts: 142 | From Flyover Country | Registered: Aug 2004  |  IP: Logged | Report this post to a Moderator
trailsgrl
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Me too! I have been on the phone up to 2 hours at a time about this zithro stuff! But they will cover the mepron at $10 bottle! That is insane! Talk about VOOODOOOO math? Even the people I talk to at my scipts 1-800 number dont understand. The last one I talked to said she has NEVER seen a case like this and has worked there for " a very long time." I have to pay 50 bucks every 10 days for my zithro but I have UNLIMITED refills. The story is actually along one, but I am sort of relieved to hear that others are struggling, coz I thought I was the only one. I posted to another site and no one else had this problem.
I did look into getting it online and thru mexico, you may want to do that. It is cheaper that way, but I just dont know how reliable. I have never done that, maybe others here have? good luck!
trails

Posts: 196 | From Mesilla, NM USA | Registered: May 2005  |  IP: Logged | Report this post to a Moderator
hwlatin
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I think insurance comapnies use dart boards when it comes to what they cover or don't. MEDCO the largest perscription drug plan is partnered with Merck, can you say conflict of interest. MEDCO has already had more than a few lawsuits in the past couple of years.

The problem is actually with the formulary tables that are created on a yearly basis. These tables use common dossages supplied by the manufacturer for all meds for both children and adults. The problem now though is there are alot of off lablel uses for alot of these meds.

I had the problem with Zithromax in the beginning as well, but the doctor called the insurance company and we were able to get it setup to cover 60 pills on one copay, for all of us.

The point I want to make is don't stop with the first person you speak to at the insurance company. Keep going up the ladder until you feel you have the response that you are looking for.

If all else fails go directly to the office of the president of the insurance company. In most cases the team that works for that office can get alot of things accomplished. Always make sure you keep good notes when calling recording all of the people who you have talked too.

Zithromax is due to come off patent this year.

[This message has been edited by hwlatin (edited 09 May 2005).]


Posts: 533 | From Las Vegas, NV | Registered: Jun 2003  |  IP: Logged | Report this post to a Moderator
JillF
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I had the same problem.

6 pills for one copay.

So I had to go back every 3 days for my medication. I had to pay the copay every 3 days. It starts to really add up.

Not only is it financially a pain in the butt but time-wise it is a pain in the butt. Who can go to the pharmacist every three days?

There was nothing they would do or my doctor could do.

Ended up changing insurance companies when my husband changed jobs and had no problems getting 30 day supply of Zith with the new health insurance company.


Posts: 1485 | From USA | Registered: Apr 2004  |  IP: Logged | Report this post to a Moderator
pippy
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sapphire,
you must have the same insurance co. I have. BC/BS (emphasis on the BS part!!)
yeah, they only pay for 10 days per month. zith is a GREAT antibiotic, at least it was for me.

My husband is on it now too because he can't tolerate tetracycline class. He may not stay on it though.

I get mine from Canada for about 15% less than retail in the US. Most of the pharmacies are good that I looked up when I was looking to Canada for Zith.

On a good note, the pharmacist at Costco was yelling so loud at the guy from BC/BS on the phone about how they are denying treatment to lyme patients! It made my day!
One more reason why Costco goes the extra mile for the consumer....unlike the insurance co.'s.

Pfizer may have a program to let you get the med cheaper. You may have to have your doctor help you apply for coverage from Pfizer. It is good that their patent is expiring!
That will help bring the cost down. There must be something similar you could take that does not cost so much...I hope someone has the answer to that.


Posts: 446 | From California | Registered: Jul 2004  |  IP: Logged | Report this post to a Moderator
Stumble Bee
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Another unhappy insurance co-payer... I'm on Zith right now. Also, I'm on Cipro for a co-infection. $40 co-pay for 14 pills! I'm going to be living in a cardboard box soon if this keeps up!
Posts: 8 | From Chicago Suburbs | Registered: May 2005  |  IP: Logged | Report this post to a Moderator
sapphire101
LymeNet Contributor
Member # 6638

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I'm sorry others are having the same problems. I've already spent $60 for 6 days and that is ridiculous.

Hubby called our ins. co. (BC/BS) today and they gave him a number to have our dr call and maybe he could get it approved for longer than 3 days.

Will let you know the outcome. I sure hope he can convince them that it is medically necessary. That's what they said he needed to do.

Thanks to you all for letting me know I'm not alone in this.

Take care,
Sapphire


Posts: 495 | From KY USA | Registered: Dec 2004  |  IP: Logged | Report this post to a Moderator
   

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