Why the EFF do I have insurance?

babyluv617 · July 2010

If it's going to cost me $217 per month for C's prevacid?

(*#Q%*(E*($&@%

Can anyone tell me alternatives? I need to put a call in to the pedi, but I'm not really sure about giving him a class C drug anyway.

papagena · July 2010

I know Walgreens has a $25 (or something) card that you can buy that may reduce the cost of prescriptions.

And I EFFing hear you on the insurance rants. After having BCBS crappy insurance from a nonprofit job, private, high deductible HSA insurance (which I actually liked better, to be honest, but no prescription coverage) and then one of the Cadillac insurance plans, I can vent quite a bit...

Boizmom · July 2010

Nothing compares to Prevacid. They don't make a generic of it either. That being said, my son has been on Bathanechol and Zantac, neither worked. We were given the option for Azithromycin and Reglan which I wouldn't go near.

Azithromycin is an antibiotic, it's supposed to make the stomach empty quicker that way there's nothing in there for baby to spit up. But, it's a friggin' antibiotic, why on Earth would I give that to my child when he doesn't have an infection?

Then there's Reglan. It's supposed to do the same thing, empty the stomach faster, but with it being a black label drug I said H*LL NO. (In some children is causes almost seizure like tics, they don't stop until you stop the medication.)

Bethanechol, 50% of children who take it, it helps them a great deal. 25% it doesn't help at all, it's a wash. 25% it makes things worse. Guess where my son fell? It made his issues worse.

So he's on Prevacid. And he's on Neocate...a $50 formula. It's Amino Acid based, completely dairy and soy free. He's done great on it, thank goodness because he was losing weight rapidly. He's still "little" but he's doing so much better.

Oh and I can rant right there with you. The State of Texas passed new Legislation (went into effect in January) that Insurance has to cover the cost of Amino Acid based formulas, namely Neocate. I got all the information from my son's GI Dr...they are supposed reimburse you. Well, when I contacted my Insurance they told me that they do not follow State laws, that with our plan they only have to follow Federal Law. What a bunch of BS. That's the same BS they told me when they wouldn't pay for my son's newborn screening, it's State Law that it be done, so they won't cover it because it's not a medically necessary procedure. Anyway, so we are spending $550/month on my son's formula plus the Prevacid (thankfully though for name brand Rx our cost is $45 - less then the formula!)

jennterrell · July 2010

when they first put DS on Prevacid, we signed up for some discount card on the manufacturer's website that would have made it $25/mo for a few months. We ended up switching to the generic form of Zantac instead, and then we were able to take him off meds by 6 mo.

Talk to your pediatrician. They are often clueless when it comes to cost. When we told ours the cost differences in the meds, he was surprised. Sometimes they might also have samples they would give you.

Dobie_Mama · July 2010

papagena:
I know Walgreens has a $25 (or something) card that you can buy that may reduce the cost of prescriptions.

This! I'm not sure if Prevacid is covered or not, but we have the Walgreens card for S and it helps with a lot of stuff. We have equally crappy coverage (that we pay a butt load for, don't get me started!).

babyluv617 · July 2010

walgreens is about an hour and fifteen minutes away. =(

And he's not a spitter. He's terribly uncomfortable, arching, and screaming. =(

papagena · July 2010

Another option - around here our United Way actually has coupons/vouchers for help with prescription costs. I'm not sure if it is a national thing, or even if it is truly a United Way initiative. That said, (again, don't know if this is national either) our United Way has a 211 informational line which helps people figure out where certain services can be accessed - if we were having to get something that expensive, I'd go ahead and give it a call and see if there were any programs available. $207 for an ongoing prescription isn't easy for a young family.

DizzyBlonde · July 2010

Actually, I'd check on the generic, because the patent expired last November and it appears that there is now a generic available (Lansoprazole) that may not have been available even a few months ago. According to some reports, the generic is about 50% of the cost of the brand name, which would make a huge difference for you (and maybe it would be covered since it's a generic instead of a name brand?) I don't know how they do the dosing, but I'd also talk to the pedi and see if there is a way to give the OTC stuff, which may be even less expensive (though definitely not covered by most insurance, but still eligible for many FSAs).

danjou21 · July 2010

Boizmom:
Azithromycin is an antibiotic, it's supposed to make the stomach empty quicker that way there's nothing in there for baby to spit up. But, it's a friggin' antibiotic, why on Earth would I give that to my child when he doesn't have an infection?

Erythromycin is used for reflux, not azithromycin, but I would avoid this if possible.

Omeprazole (Prilosec), Ranitidine (Zantac), and famotidine (Pepcid) are all good choices. Prilosec is the same class as prevacid, which are the most effective. Zantac would likely be your cheapest choice. Reglan is also a cheap option, but can cause diarrhea. All of these are very safe for short term use, so don't stress about the safety.

Have the pharmacy call your insurance company and see what they prefer. Some insurance companies prefer one drug over the other in a category. They also might not pay for either Prevacid or Prilosec because they are over the counter now, which is why your price is so high (because I'm assuming they prescribed the solu-tabs, which yes, are horrifically expensive). You could also ask your pharmacy about the cost of getting the compounded prevacid (or prilosec) which should be significantly cheaper, if they do compounding.

GL!

babyluv617 · July 2010

he has been on ranitidine and it's not enough =(

danjou21 · July 2010

babyluv617:
he has been on ranitidine and it's not enough =(

Then I would get price quotes for compounded (liquid) prilosec. It is generic and should be less, even if not covered by insurance. The prevacid solu-tabs are like $3 a pill, so there is no getting around the high cost of those suckers. You might have to do some calling around, but it should at least be cheaper but as effective as prevacid.

babyluv617 · July 2010

I called the insurance then Doctor's office. They're sending a prior authorization, hoping it will help. We'll see.

Boizmom · July 2010

danjou21:
Boizmom:
Azithromycin is an antibiotic, it's supposed to make the stomach empty quicker that way there's nothing in there for baby to spit up. But, it's a friggin' antibiotic, why on Earth would I give that to my child when he doesn't have an infection?
Erythromycin is used for reflux, not azithromycin, but I would avoid this if possible.
Omeprazole (Prilosec), Ranitidine (Zantac), and famotidine (Pepcid) are all good choices. Prilosec is the same class as prevacid, which are the most effective. Zantac would likely be your cheapest choice. Reglan is also a cheap option, but can cause diarrhea. All of these are very safe for short term use, so don't stress about the safety.
Have the pharmacy call your insurance company and see what they prefer. Some insurance companies prefer one drug over the other in a category. They also might not pay for either Prevacid or Prilosec because they are over the counter now, which is why your price is so high (because I'm assuming they prescribed the solu-tabs, which yes, are horrifically expensive). You could also ask your pharmacy about the cost of getting the compounded prevacid (or prilosec) which should be significantly cheaper, if they do compounding.
GL!

Oh woops! Thanks! LOL, didn't catch my mistake there.

JenGK · July 2010

We use generic Prevacid, which we have specially compounded so that it does not contain alcohol. I'd check and see if you can use the generic.

nluvntexas · July 2010

Have you explored food allergies? It seems more and more common lately, but very few pediatricians talk about it because the symptoms are so similar to acid reflux... Allergies/intolerances can cause anything from constipation to distemper to rashes to actual sickness (chronic ENT problems or flu symptoms) and everything between. DD was horribly constipated for like four months, and we were prescribed a stupid expensive laxative for her... It was a class c too and I decided I'd rather suffer through an elimination diet before using it daily for her, and it turned out that she can't process dairy correctly. I know quite a few people iRL and online that had similar experiences. I also know a few that found it truly was reflux, but it's still surprising how often they are diagnosed in place of each other.

Boizmom · July 2010

nluvntexas:
Have you explored food allergies? It seems more and more common lately, but very few pediatricians talk about it because the symptoms are so similar to acid reflux... Allergies/intolerances can cause anything from constipation to distemper to rashes to actual sickness (chronic ENT problems or flu symptoms) and everything between. DD was horribly constipated for like four months, and we were prescribed a stupid expensive laxative for her... It was a class c too and I decided I'd rather suffer through an elimination diet before using it daily for her, and it turned out that she can't process dairy correctly. I know quite a few people iRL and online that had similar experiences. I also know a few that found it truly was reflux, but it's still surprising how often they are diagnosed in place of each other.

My son not only has reflux but he has a milk protein allergy which is why he is on Neocate. Top it off that he has a spasmodic pylorus and we've got real issues with him. Prevacid helps "paralyze" the pylorus which makes it work properly and it helps with the reflux.

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Why the EFF do I have insurance?

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