Out of Zofran and my insurance company sucks. SO upset :(

MrsCrouch90

Well I stated in one of my posts that I was in the ER on Thursday (Thanksgiving) and diagnosed with hyperemesis. If I don't take the combination of Tagamet and Zofran every day 2x a day I throw up at least 10 times a day. My doctor has me prescribed to 4mg Zofran, and has me taking 2 tablets twice a day. Well he only prescribed 20 tablets and 3 refills. I called my insurance company because last time I went to refill they only gave me 10. My insurance company told me that they only allow 30 tablets in a month long period which doesn't help me because that's about a week and a half of medicine. I took my last one this morning hoping this would be sorted out today, only to find out that the form they are sending to my doctor will take a minimum or 3-7 days to be approved to pick up the last 20 pills. I am so upset. I would like to be able to spend time with my family not have my head in the toilet all day. I'm literally in tears right now and I have to go back to work. Nothing else helps either. I've tried ginger everything, hard candy, sour candy, emetrol, nauzene, etc etc. UGH

brooklynesque

Is it too expensive to pay out of pocket for some more? I have to do that for some of my meds that my ins co won't let me refill often enough.

singingirl96

That stuff is amazing.  pay full price if you need to... i would

MrsCrouch90

brooklynesque said:

Is it too expensive to pay out of pocket for some more? I have to do that for some of my meds that my ins co won't let me refill often enough.

 

I have no idea. I would pay out of pocket if they let me, they havent offered it so I didnt think about it. They just told me last time I called in the refill that they could only give me 10 instead of the 20 which lasted a whole 2.5 days.

alyssa719

If you have a prescription, you can always pay out of pocket.  Insurance just won't cover, or they'll maybe cover it later.

Natdubs

Order online from Canada...my sis in law is pregnant with twins and ran into the same issue.

MrsCrouch90

Lori_n_Lior said:

I think mine said on the box it would be about $100 without insurance for 30 4mg pills. I would probably pay out of pocket I am so miserable without them.

 

So am I. It is worth the 100$. Especially because I take 2 pills 2 times a day and I only had 1 pill left. So im already feeling like crap.

alyssa719

If your insurance company has a negotiated rate, I think you still get that rate, even if you're paying OOP (not positive though).  It can sometimes be a huge difference.

shannonhawkinson

I've heard of using vitamin B as well and this is supposed to work as well as Zolfran.....

Lola825

MrsCrouch90 said:

brooklynesque said:

Is it too expensive to pay out of pocket for some more? I have to do that for some of my meds that my ins co won't let me refill often enough.

 

I have no idea. I would pay out of pocket if they let me, they havent offered it so I didnt think about it. They just told me last time I called in the refill that they could only give me 10 instead of the 20 which lasted a whole 2.5 days.

I understand your frustration and would definitely pay out of pocket. I'm confused about the bolded though, why did 10 pills only last you 2.5 days if you are  taking two pills per day?

MrsCrouch90

Lola825 said:

MrsCrouch90 said:

brooklynesque said:

Is it too expensive to pay out of pocket for some more? I have to do that for some of my meds that my ins co won't let me refill often enough.

 

I have no idea. I would pay out of pocket if they let me, they havent offered it so I didnt think about it. They just told me last time I called in the refill that they could only give me 10 instead of the 20 which lasted a whole 2.5 days.

I understand your frustration and would definitely pay out of pocket. I'm confused about the bolded though, why did 10 pills only last you 2.5 days if you are  taking two pills per day?

 

I take 2 pills two times a day. So it totals 4 pills. His instructions were take 8mg of Zofran every 6 hours. I am prescribed to 4mg so I have to take two pills two times. So it only lasted about 2.5-3 days

MrsCrouch90

tundrabunny said:

Is there a higher dosage (like 8mg) so you can still get the 30 next time and then cut them in half?

 

 

There is an 8mg but for some reason my doctor has me prescribed to the 4mg but taking 8mg's of it two times a day. So im not sure why they wont just give me the 8mg so I only have to take 2 two times a day. I see my doctor next thursday so Im going to ask him about it then.

Lola825

MrsCrouch90 said:

Lola825 said:

MrsCrouch90 said:

brooklynesque said:

Is it too expensive to pay out of pocket for some more? I have to do that for some of my meds that my ins co won't let me refill often enough.

 

I have no idea. I would pay out of pocket if they let me, they havent offered it so I didnt think about it. They just told me last time I called in the refill that they could only give me 10 instead of the 20 which lasted a whole 2.5 days.

I understand your frustration and would definitely pay out of pocket. I'm confused about the bolded though, why did 10 pills only last you 2.5 days if you are  taking two pills per day?

 

I take 2 pills two times a day. So it totals 4 pills. His instructions were take 8mg of Zofran every 6 hours. I am prescribed to 4mg so I have to take two pills two times. So it only lasted about 2.5-3 days

Ahh ok, that makes more sense. The math just wasn't adding up to me. Either way, I would definitely see if you can pay out of pocket or just get prescribed 8mg so you can take less pills.

tealowl

You could pay OOP for this prescription, then when your insurance company okay's it, you can send in a reimbursement claim to them?

I had to do this when I went to CO one year and got a raging UTI. I left my insurance prescription card at home like a dumbass, so I paid up front and then called my insurance company when I got home and did a claim for it.

Have you tried Unisom at all? It might help for a bit. It's working well for me, BUT I just have nausea, not very much vomiting...

MrsCrouch90

tealowl said:

You could pay OOP for this prescription, then when your insurance company okay's it, you can send in a reimbursement claim to them?

I had to do this when I went to CO one year and got a raging UTI. I left my insurance prescription card at home like a dumbass, so I paid up front and then called my insurance company when I got home and did a claim for it.

Have you tried Unisom at all? It might help for a bit. It's working well for me, BUT I just have nausea, not very much vomiting...

I think I can do that where I pay OOP and send in a claim later on. Luckily I just spoke to my doctor and he said he would make it urgent so It only takes 72 hours (but still).

I havent tried unisom yet but im about to be desperate. Ive heard it works well at for nausea im just worried about the vomiting since that seems to be my main issue.

MrsCrouch90

Lori_n_Lior said:

I use the 4mg too and also am on a 8mg dose. My MW told me she did the 4mg specifically because the insurance companies tend to let that one through easier than the 8mg.

My last pregnancy they only gave me 30 a month and I was stuck cutting them in half so I could barely get through the day. Thankfully they haven't been giving me a hard time this time.

I hope you get it worked out

Yupp my company has the 30 a month limit. Which is probably why my doctor prescribed the 4mg but has me taking 8mg two times a day.

singingirl96

Natdubs said:

Order online from Canada...my sis in law is pregnant with twins and ran into the same issue.

you know, this is a great idea.   I have ordered domperidone from inhousepharmacy.biz several times before and they were great.  You can order 40 tablets of zofran through them for $52... here is the link: https://www.inhousepharmacy.biz/p-691-emeset-4-ondansetron-4mg.aspx

singingirl96

shannonhawkinson said:

I've heard of using vitamin B as well and this is supposed to work as well as Zolfran.....

for some people.  vitamin B6 / unisom combo worked great during my last pregnancy... this time around it did not work at all.

Zofran is now my best friend.

paxilchyk

I just went through this with my prescription. I went through my 20 pills in a week not knowing that was all that was covered for a month. Thankfully I get a generic and Target pharmacies offer discount cards if you pay without insurance. I paid $20 for 20 pills and I'm just trying to stretch them a little further. It is definitely worth the $20 for me to be able to feel human again.

MrsCrouch90

paxilchyk said:

I just went through this with my prescription. I went through my 20 pills in a week not knowing that was all that was covered for a month. Thankfully I get a generic and Target pharmacies offer discount cards if you pay without insurance. I paid $20 for 20 pills and I'm just trying to stretch them a little further. It is definitely worth the $20 for me to be able to feel human again.

Unfotunitely I go through Wal-Mart and I dont think they offer that. So I would be stuck paying the 100$

MrsCrouch90

singingirl96 said:

Natdubs said:

Order online from Canada...my sis in law is pregnant with twins and ran into the same issue.

you know, this is a great idea.   I have ordered domperidone from inhousepharmacy.biz several times before and they were great.  You can order 40 tablets of zofran through them for $52... here is the link: https://www.inhousepharmacy.biz/p-691-emeset-4-ondansetron-4mg.aspx

Thank you!! I will have to look into it!

pantherRN

The absolute last thing I would do in this case is buy prescription meds online. You have NO way of making sure that you are getting what you order.

If you have HG, go to the ED if the vomiting is that bad.

paxilchyk

I really think it could be worth the call or even switching pharmacies to see if they discount at all.

MrsCrouch90

pantherRN said:

The absolute last thing I would do in this case is buy prescription meds online. You have NO way of making sure that you are getting what you order. If you have HG, go to the ED if the vomiting is that bad.

Being a PA-C you would think I would know better, but I looked at Canadadrugs.com (BBB top rated) anyways and being that 30 tabs of the Ondansetron 4mg (which is what I take) is 90$ there really is no point in ordering them offline. It makes more sense to just pay OOP for the 20 tablets for $100 and make a claim for reimbursement to my insurance on Monday-Tuesday after it has been approved. If the vomiting gets that bad I will end up in the ED again just like last week, but im praying it doesnt get that far. I still have the bruise from the IV.

Edit:grammar 

singingirl96

pantherRN said:

The absolute last thing I would do in this case is buy prescription meds online. You have NO way of making sure that you are getting what you order. If you have HG, go to the ED if the vomiting is that bad.

Well... I would have thought the same thing once upon a time.... however when I was faced with a very low milk supply at least 2 reputable lactation consultants suggested this and I reluctantly ordered domperidone from inhousepharmacy.biz.  Its a medication that can't be ordered in the US without it being compounded and it is really expensive and insurance doesn't cover it.  I receive the meds and they worked extremely well.  So they're the real thing.  They had an expiration date on it and original packaging.   I ordered it several times, I know friends who have used them, and several women here on the bump have also used them, and everyone has been satisfied.  I have never ordered zofran from them, but based on my previous experience, I would say this is a good way to go if it is indeed cheaper. 
However the PP did say that she got 30 tabs from waltmart for $30, so that is a cheaper way to go if you can get the same price. 
I would say ordering online can be sketchy, but I can vouch for this specific pharmacy because I have used them successfully before.
Good luck.  I hope you get your meds!

michellexm

Try an independent pharmacy. Tell the pharmacist what's up. No guarantees it will work, but they may be able to be more flexible with pricing than your local CVS or Walmart.

You might also try pricing online with GoodRx.

beccaxrad

My Dr. Said vitamin B6 and unisom are great OTC solutions for nausea. You might want to call yours and see if that would be a good option for you!

michellexm

Another thought: is your doctor prescribing the orally disintegrating tablets (ODT)? If so, they're more expensive than the regular tablets. They'd probably work better for you as you are throwing up so much, but consider asking your OB to prescribe regular tablets. Or ask your doctor to contact your insurance directly. S/he shouldn't need to wait on a form; those are faxed ASAP if needed.

I know everybody on here is so well meaning with the B6 and Unisom recommendation, but that doesn't really work in hyperemesis.

Best of luck!

MrsCrouch90

michellexm said:

Another thought: is your doctor prescribing the orally disintegrating tablets (ODT)? If so, they're more expensive than the regular tablets. They'd probably work better for you as you are throwing up so much, but consider asking your OB to prescribe regular tablets. Or ask your doctor to contact your insurance directly. S/he shouldn't need to wait on a form; those are faxed ASAP if needed. I know everybody on here is so well meaning with the B6 and Unisom recommendation, but that doesn't really work in hyperemesis. Best of luck!

My doctor prescribes the normal tablets not the ODT. Apparently he filled out the form today and marked it urgent so I can get them hopefully by Tuesday (it was faxed to him and back to the insurance). I've tried the B6 and dramamine combination with no luck, so im hesitent with the unisom, I know it may help for nausea and I know everyone means well with the suggestions, but you're right. Hyperemesis is horrible and usually without the medicine I have trouble keeping down even water so im not sure trying to keep down unisom and B6 is a good idea. Though its worth a try I suppose.

Rmbaker2012

Do the same for zofran have your doctor up the mg and split it into forths, my aunt gets 20mg for just such ins bull crap. Her zofran is for cancer though.

RachelOC

Can you ask your doctor to prescribe the generic version Ondansetron instead of Zofran (Same ingredients) ? My doctor prescribes me the generic kind and it works just as well as "Zofran" and is half as expensive. It's possible that your insurance company would cover more pills because of the lower cost.