Pain meds not covered by my insurance anymore, aughhhhhhhhhhhhhhh!

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BigLucy
Regular Member


Date Joined Mar 2007
Total Posts : 413
   Posted 4/5/2008 3:10 PM (GMT -7)   
Got a message from Kaiser yesterday that the manufacturer that produces generic oxy is stopping production because of litigation. If I want to continue oxy, which i do b/c it works for me, i have to pay full price for the brand name b/c Kaiser doesn't pay for the brand label. What the ?????????? And who knows how much that will be?

TexasJen
Veteran Member


Date Joined Dec 2006
Total Posts : 649
   Posted 4/5/2008 3:22 PM (GMT -7)   
Don't take NO for an answer from Kaiser. My husband's insurer told him the basically same thing about his GERD meds. "We won't cover aciphex because you can take Prilosec OTC now." No, he can't. It doesn't work. They made him go through a month of trying meds they were prepared to cover to prove they didn't work. His doctor had to make phone calls and write letters and all that fun stuff, but he eventually got his aciphex covered. Give Kaiser a call, and work your way up the food chain. Don't take the "customer service rep's" word for it. There's always a way through, you just have to take the time to find the right person. It also helps to get a copy of the full policy under which you're covered - not the quick reference guide that most of use. The devil is in the details, so search through the legalese in the policy to determine exactly how to challenge coverage of meds that aren't on their formulary. And document everything in writing. Even if you have a satisfactory phone conversation, back it up with letter declaring your understanding of the situation. Yeah, it's a royal pain, but if you can pull it off it won't be as big of a pain had you not tried. :-)
Living in the Republic of Texas minus a gallbladder, a couple of cervical discs, appendix, uterus, and 18" of colon; but still alive and living with my husband, 2 dogs, 1 cockatiel, 1 quaker parrot and 2 gold fish. 


J_Rene
Regular Member


Date Joined Oct 2005
Total Posts : 279
   Posted 4/6/2008 9:56 AM (GMT -7)   
I got a letter from my insurance stating that the generic would no longer be avaliable due to law suits etc... blah blah.... So when I got mine I had to get name brade and it was double my co-pay. The upside to it is, I've noticed its been working better and I get longer relief.
 
I hope everything works out for you. I know what a strain this is. I just went thru something simular last week, with a prior authorization with the ins. company.
 
I know that its very costly without insurance. I'd talk to your Dr. about switching to something else with the same relief.
 
Good luck!
 

Major car accident 07/02

On going back and leg problems

DX with fibromyalgia 10/05

Goal in life:

To go bra less as much as I can!


sjkly
Veteran Member


Date Joined Dec 2007
Total Posts : 2113
   Posted 4/6/2008 1:17 PM (GMT -7)   
My insurance company reorganized its preferred med list to put the brand name back on when the generic was discontinued. It is still more of a copay then the generic but much less then paying full price would be. Call your insurance company and push them to do the same.
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