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» LymeNet Flash » Questions and Discussion » General Support » Insurance won't pay for Zithromax

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Author Topic: Insurance won't pay for Zithromax
MamaMelvis
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I am so frustrated. I'm having to fight for meds and I'm sick and tired of it. My script was for 60 pills, 2 a day. They gave me 6 pills for my $10 co-pay. Told me to come back every 3 days with $10. Not possible!

Which brings me to the cost of this rx. My slip shows my co-pay of $10 and shows insurance paying...0. I called the pharmacy and asked how much it would be as a cash customer. $49.98 for 6 pills. This doesn't make sense to me!

The pharmacist told me to have my doctor (LLMD) cal the insurance company for a PA--to explain why I need more than the typical course. Then it's up to the insurance whether or not to approve the rx.

Does this happen frequently? Am I likely to get the meds or should I just move on? Flagyl is next on the list and I'm worried they won't cover that, either.

Something that's strange to me--they had no problems paying for 2 months of amoxy at 8 pills a day--which is obviously way over the normal dose. Ugh, insurance blows.

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~*Melvis*~

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Posts: 80 | From Midwest | Registered: Jul 2010  |  IP: Logged | Report this post to a Moderator
abigail
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I had the same problem with Zithromax. My insurance company has had no problems paying for expensive drugs like IM cefotaxime or IM penicillin but wanted to do the same thing to me with Zithromax. I also was expected to pay a 110 dollar copay on tindamax so you might watch for that. The pharmaceutical companies are so rich and greedy that it makes me sick...literally!

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Dying is easy. Living is harder.

Posts: 257 | From owensboro kentucky | Registered: Mar 2008  |  IP: Logged | Report this post to a Moderator
MamaMelvis
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So did you end up taking the Zith or did your LLMD switch it to something else?

So far, Tindamax isn't on my list but I will definitely watch for that one. What about Flagyl? Any troubles with insurance on that one?

I totally agree with you regarding the pharmaceutical companies--so sad.

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~*Melvis*~

`

Posts: 80 | From Midwest | Registered: Jul 2010  |  IP: Logged | Report this post to a Moderator
Keebler
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They'll probably want you to take the generic for Flagyl.

If you get prescribed Diflucan, you may also have some restrictions. Although my doctor wanted me to take it every day, (many years ago) the pharmacist would only give me ONE per week. And just ONE at a time.
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Posts: 48021 | From Tree House | Registered: Jul 2007  |  IP: Logged | Report this post to a Moderator
LymeMom Kellye
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My insurance company wouldn't pay for zith as prescribed, so rather than asking for a PA for it, we switched meds to Biaxin. She switches between doxy and biaxin.

Biaxin works for her. We figured we would wait for the PA on the 'big guns'. We don't want to raise too many flags all at once, so are waiting to use the PA option until it's really vital that a specific drug/dosage be approved.

And yes, it sucks!

Posts: 333 | From Lyme Here Too | Registered: Mar 2010  |  IP: Logged | Report this post to a Moderator
sixgoofykids
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Yes, insurance might require prior authorization. You may get it, you may not. My daughter did, I didn't, same insurance policy!!!

Biaxin is easier to get because it generally doesn't require prior approval and is from the same family of meds.

Also, some have better luck getting zith prescribed if the pill is a different size than what comes in a z pack, so I hear.

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sixgoofykids.blogspot.com

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kam
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Same here. Insurance would not provide so went with biaxin and amoxy out of pocket.
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002  |  IP: Logged | Report this post to a Moderator
peacemama
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They wouldn't pay for 250 for more than 6 days, but they would pay for 500 mg, cut in half. HOWEVER, I don't suggest this. I have former student who makes drugs for a drug company and he said this is a very unreliable way to do it.

Ask the pharmacist for ideas. They have tricks.

Posts: 564 | From Tick Hell | Registered: Oct 2008  |  IP: Logged | Report this post to a Moderator
kellephant
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try going here and print off an ID card:
http://freeusadrugplan.com/

my insurance wouldn't cover enough for my zithromax... it was going to be over $300 for generic...

with this card it was only $81!!!

it helps pay for tooons of meds!

Posts: 220 | From Kansas | Registered: Mar 2010  |  IP: Logged | Report this post to a Moderator
MamaMelvis
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Hmmmm...can I just say that this all SUCKS?! Ok, I feel better now.

They gave me the generic for Zithromax and still won't cover it. Now I've got 6 pills here that my husband picked up for me and no clue what to do with them. I want my $10 back.

Keebler, My script says that generic Flagyl is allowed so I assume that's what I'll get! I haven't seen anything yet for Diflucan--that's for yeast, right? So far, I haven't had any troubles in that department. I started taking Nystatin about 1 month into treatment.

Peacemama, I've heard that pill cutting is unreliable. That said, I did it for awhile with my thyroid meds because the ignorant *** of a doc told me to. I've learned from that mistake!

Kam, Biaxin is on my list but not until after Flagyl. I wonder if my LLMD will switch stuff around. Is the Biaxin as cheap as amoxy?

kellephant, I'm going to check that out! Unfortunately, I can't afford the $81 at this point either but maybe in the future!

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~*Melvis*~

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momofthree
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Please check with hometech-rx.com
Posts: 303 | From green bay, wi | Registered: Mar 2009  |  IP: Logged | Report this post to a Moderator
MamaMelvis
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Will do, momofthree!

On another note, LLMD's office called back today and wants to call in a PA for the Zith. I had assumed he would just switch it to something else. Not sure if this is a good idea??? I'd hate to have insurance start questioning the other meds.

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~*Melvis*~

`

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JR
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I don't know if this will help at all, but we lost our medical insurance because of a lay off, and we were without any insurance for a while-very very scary.
My scripts were being filled by Giant Pharmacy(grocery store) and they had an insurance plan. They covered my scripts under their insurance plan until I was able to get my own insurance.
The cost for scripts was marginal compared to my out of pocket expense.

Posts: 365 | From Sylvania | Registered: Aug 2008  |  IP: Logged | Report this post to a Moderator
   

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