F.U. pharmaceutical companies

oregontrailmom · August 2015

Ugh, I just got off the phone with my perinatologist (high risk doctor) and my insurance might not cover my Makena injections which are progesterone shots that I need because of my history of preterm labor. Because the Makena company has a monopoly on this drug they can charge $1500 for each shot. I need one shot a week for 20 weeks which will cost $30,000. If pharmacies were still allowed to compound the drug it would cost $20 a shot which is what we paid during my last pregnancy.

The doctor office is going to call insurance personally now and try to get them on board with this drug but I might now be able to get it now. I'm already having lots of noticeable contractions which at this point aren't doing anything to my cervix but who knows when that will change. My first was born at 33 weeks and I started dilating at 28 weeks with my second baby so my chances of having another preterm labor are extremely high. I can't believe that despite our great insurance we have I can't even get the medical care that I need to keep this baby in.

hopes4baby · August 2015

That sucks. A lot. What about the daily shot or the suppositiory? Does your doctor think they might work in case the insurance doesn't bend on the weekly one?

lrobb004 · August 2015

That's awful. Hopefully your doctor will have some luck with the insurance company. Preterm labor is so scary and its awful that something to help that is so difficult to get. Prayers that something is worked out.

minivanmafia · August 2015

Thats really really crappy. However, if your Dr's office is calling to try and get it approved that a good sign. I work at a family physicians office (totally different, I know but hear me out) and we have to call and argue with insurance companies all the time to get prior authorization approved for certain meds that they don't want to pay for. Sometimes a PA isn't even necessary because the insurance companies flat out refuse to pay. HOPEFULLY your Drs. office can get this approved and you won't have to worry. Also, thankfully your dealing with this now and not during week 20. I know insurance companies are douchebags but I really really hope they wouldnt deny this medication that could potentially save a life. Thats just ludicrous but I know stranger things have happened. Good luck and keep us posted! Edit: typo

kbedfox · August 2015

I'm not too familiar with progesterone injections, but is there any chance you could use suppositories? They might be cheaper. I actually bought them with my last cycle of fertility treatments and didn't use them because my levels were naturally high, so if you can use them, I'm happy to donate them to you. Sounds creepy, donating suppositories lol but they've never been opened and are just sitting in my refrigerator.

lovelydaye · August 2015

That's awful, I'm so sorry! If you have insurance through work sometimes HR can also advocate for you. Hopefully your dr will be able to get you some good news. Its always incredible to me how useless "insurance" can be sometimes when it is so expensive in the first place!!

oregontrailmom · August 2015

@natsfans84 that's really sweet to offer but the lady I talked to today said they should cover the suppositories if they won't cover the injections. She said they would help but studies show that they aren't quite as affective as the injections so they really want me getting the shots.

Hopefully the communication will get the insurance to come around.

notasycophant · August 2015

@oregontrailmom , I have the same problem. But my RE assured me that suppositories are just as effective give and take 0.01%. There are numerous studies that prove crinone is just as good as PIO's.
I'm 15 weeks and so far it's been brilliant. This is totally non biased as I've tried both PIO's and Crinone.

oregontrailmom · August 2015

That's good to hear @notasycophant

notasycophant · August 2015

https://www.ncbi.nlm.nih.gov/pubmed/20347079

Just something to back up my claims.

ladybutler · August 2015

Last pregnancy it wasn't covered. We paid $80 (10ml) for a pharmacy to compound it. Could you call around to different pharmacy to see what there cash price would be?

oregontrailmom · August 2015

For some reason we can't get it compounded right now at a pharmacy. There is only one place around here in the city that does it and it currently can't produce it right now, but I have no idea why. It happened at the very end of my last pregnancy too but thankfully I only needed a couple more shots so we used Makena then and insurance covered it just fine.

Timmysgal02 · August 2015

Oh my goodness gracious. Man, your a trooper! I am glad your doctors are trying to call, and you can get it compounded!

VitaLuna · August 2015

Insurance drives me nuts, as do pharmaceutic companies charging outlandish prices. While I don't directly deal with it, I hear it from patients. A med we used to prescribe would run $500/mo OOP with one company, $50 with another, etc. We stopped prescribing it.

Is this a med you'll be getting from a retail pharmacy? If your doctor can't get any traction, sometimes contacting the drug company directly and pleading your case will get you steep discount coupons for it at a pharmacy.

oregontrailmom · August 2015

No pharmacies carry Makena, They would have to mail it directly to me or the doctor.

SoSweetTea1124 · August 2015

I'm sorry, this sucks! Fx that your doc makes some headway with the insurance company! Insurance companies are ridiculous.

Sprinkles07 · August 2015

Ugh that's awful! T&Ps you can get it covered.

MississippiCatfish · August 2015

Maybe your insurance could work with an in-network compounding pharmacy to have them shipped to you. I can see why, logically, they do not want to agree to pay $1500/injection if you say it's possible to get a version from a compounding pharmacy for $20/injection. It isn't ethical, in my opinion, for them to leave you high and dry in the mean time, but it makes sense to me to have the injections compounded and shipped (to you or your provider, I don't know who administers them.)

FreshBakedBrownies · August 2015

@oregontrailmom what's so special about the Makena progesterone compared to regular progesterone in oil?
It wasn't that many months ago that both Braun pharmacy (near me in the Lincoln park Chicago area) and Freedom Fertilty had the progesterone in oil in stock with no issues ordering it. Periodically I know some pharmacies have run out, but I was always able to find it somewhere.
But maybe you really need that specific (crazy expensive) brand??

oregontrailmom · August 2015

I honestly don't know why it's all so crazy. During my last pregnancy there was talk of laws changing so that local pharmacies couldn't compound it anymore and it was total political bs that was just so the pharmaceutical company could make more money. I don't know if that is the case now or not.
My ob just said that the only one they can get for me at this point is the makena. Maybe I'll ask if there are any other pharmacies that do compounding that I could drive to even if they are farther away.

isgro2014 · August 2015

oregontrailmom said:
Ugh, I just got off the phone with my perinatologist (high risk doctor) and my insurance might not cover my Makena injections which are progesterone shots that I need because of my history of preterm labor. Because the Makena company has a monopoly on this drug they can charge $1500 for each shot. I need one shot a week for 20 weeks which will cost $30,000. If pharmacies were still allowed to compound the drug it would cost $20 a shot which is what we paid during my last pregnancy.

The doctor office is going to call insurance personally now and try to get them on board with this drug but I might now be able to get it now. I'm already having lots of noticeable contractions which at this point aren't doing anything to my cervix but who knows when that will change. My first was born at 33 weeks and I started dilating at 28 weeks with my second baby so my chances of having another preterm labor are extremely high. I can't believe that despite our great insurance we have I can't even get the medical care that I need to keep this baby in.

I haven't read all the way through your thread yet. Thoughts and prayers to you first! Second, the $30,000 dollars will be reached in a matter of days if not hours for a baby in the NICU. Hopefully your insurance can see that, or someone can bring it to their attention. Good luck!

Edited:autcorrect

oregontrailmom · August 2015

isgro2014 said:

oregontrailmom said:
Ugh, I just got off the phone with my perinatologist (high risk doctor) and my insurance might not cover my Makena injections which are progesterone shots that I need because of my history of preterm labor. Because the Makena company has a monopoly on this drug they can charge $1500 for each shot. I need one shot a week for 20 weeks which will cost $30,000. If pharmacies were still allowed to compound the drug it would cost $20 a shot which is what we paid during my last pregnancy.

The doctor office is going to call insurance personally now and try to get them on board with this drug but I might now be able to get it now. I'm already having lots of noticeable contractions which at this point aren't doing anything to my cervix but who knows when that will change. My first was born at 33 weeks and I started dilating at 28 weeks with my second baby so my chances of having another preterm labor are extremely high. I can't believe that despite our great insurance we have I can't even get the medical care that I need to keep this baby in.

I haven't read all the way through your thread yet. Thoughts and prayers to you first! Second, the $30,000 dollars will be reached in a matter of days if not hours for a baby in the NICU. Hopefully your insurance can see that, or someone can bring it to their attention. Good luck!

Edited:autcorrect

Seriously! My first was a preemie who spent 21 days in the NICU and his bills were over $100,000.

I think I found a pharmacy across state lines that I can drive to and get it compounded if insurance still won't agree to the other one.

marissajc · August 2015

They charge that much to cover the cost of research while making the drug. It's not that they have a monopoly, but there is a patent on their research for so many years so they can make their money back, then when the patent is void the generics come out. Generics are cheaper because they don't have to pay to research the drug in order to manufacture it. Have you tried to contact the manufacturer to see if they are offering a trial card or something? Insurances really suck with the expensive medications, I work in a pharmacy and half my day is spent on the phone trying to make sense of their rejections

kristajean15 · August 2015

Oh no! I also have to go through makena now for the shots. My High risk doctor said that compound pharmacies are not allowed to make it anymore because of the huge pharmacy in Mass that had the problems with staff infections! I have a history of pre term labor as well and it's the only thing that gets me through my pregnancies!

oregontrailmom · August 2015

teammjc said:

They charge that much to cover the cost of research while making the drug. It's not that they have a monopoly, but there is a patent on their research for so many years so they can make their money back, then when the patent is void the generics come out. Generics are cheaper because they don't have to pay to research the drug in order to manufacture it. Have you tried to contact the manufacturer to see if they are offering a trial card or something? Insurances really suck with the expensive medications, I work in a pharmacy and half my day is spent on the phone trying to make sense of their rejections

I never realized that but I guess it makes sense. It's still ridiculous that insurance can reject it when it would cost so much more if I had a preemie.

oregontrailmom · August 2015

I was able to get the Makena shots! Insurance finally came around, and I go in tomorrow for my first injection. I'm really glad it came through because contractions have already started for me at 15 weeks. I can feel them all the time if I'm on my feet too much. They aren't progressing anything yet but I'm hoping that the progesterone will calm my uterus down.

RN0107 · August 2015

oregontrailmom said:
I was able to get the Makena shots! Insurance finally came around, and I go in tomorrow for my first injection. I'm really glad it came through because contractions have already started for me at 15 weeks. I can feel them all the time if I'm on my feet too much. They aren't progressing anything yet but I'm hoping that the progesterone will calm my uterus down.

I'm so glad you were able to get it!

bublesmiled · August 2015

I think it's ridiculous that insurance companies dictate our care and not our doctors. Glad they came around, sorry for the stress that you had to go through in the process.

DaisyTortilla · August 2015

I agree with PP that is absolutely ridiculous! I'm sorry you are going through this, hope it all gets resolved in your favor. Prayers for baby to stay in as long as possible!

anotherctg · August 2015

I'm glad it worked out!

isgro2014 · August 2015

oregontrailmom said:
I was able to get the Makena shots! Insurance finally came around, and I go in tomorrow for my first injection. I'm really glad it came through because contractions have already started for me at 15 weeks. I can feel them all the time if I'm on my feet too much. They aren't progressing anything yet but I'm hoping that the progesterone will calm my uterus down.

Awesome news!!!

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