I had to jump through a lot of hoops for Viagra, that started with denial of coverage, and my ordering the medication through AllDayChemist instead. Then insurance changed to to "we'll only cover 8 pills a month" and finally they approved an exception for 90 pills per quarter as long as I need them. What convinced them was the letter of medical necessity from my surgeon, the head of the robotic unit at Ohio State's James Cancer Center. My regular urologist was impressed and asked for a copy of it so he could use it for other patients. Is there a way to post documents to emails here? Couldn't figure out a way--would be happy to share it if it helps others.
Incidentally, this was all fine last year when my surgery costs caused me to hit my deductible and out of pocket maximum limits, so the medication ended up being free. This year our deductible went up and our out of pocket max more than doubled, so even though insurance technically covers it, I went back to ordering from AllDayChemist. $100 for 120 pills through them vs. $1000 for 90 pills through insurance (which is offset considerably provided you hit the $2500 deductible).
Mountain Top High, Age 45
PSA 1.6 (2006), 1.9 (2007), 6.0 (6/2008), 3.9 (7/2008 after 30-day Cipro course)
8/08 biopsy--high grade PIN
11/08 biopsy--Dx (age 43), Gleason 7 (3+4), T1c
Da Vinci RP 2/9/09 (Dr. Abaza, Head of Robotic Uro, James Cancer Center @ Ohio State)
Path--PCa 9%, 39.5 grams, T2c, contained in capsule, margins & lymph nodes clear
Catheter 1 week, no nighttime incontinence
1-6 wks out: 4-5 male pads/day; 7-11 weeks 1-2 pads/day with regular ab/core exercises; 11-14 weeks out one mini-pad/day; since 14 weeks no incontinence
Complete ED, pump twice daily, fought with insurance for Viagra, ordered from alldaychemist instead, 4/23/09 started 100mg nightly, then insurance covered it. No success from Viagra and pump.
10/27/09 MUSE trial. No success and hurt like hell.
PSA at 3 & 6 mos post-op: 0