Denial of Cromolyn Sodium

etabetac

New member
I've recently switched insurance, doctors, and pharmacies because of a move. I have been using Cromolyn Sodium for a year after not having used it for several years. I can tell it makes a difference in quality of life but not necessarily in terms of numbers. My insurance did a flat out denial with no appeal listed for the pharmacy (who say that's what they generally get when a medicine is denied). I have no proof that this medicine works.

My old doctor in another state and not on this plan can't write a letter explaining the proof that it's improved. My new doctor can't vouch that it has improved my condition. It's not terribly expensive out of pocket but every little bit counts. I'm on a PPO.

How do I go about a denial that doesn't show up as an appeal at the pharmacy, which is how it's always been done before. I don't even have a denial number. Part of me doesn't want to put up the fight on this med but that's probably just a factor of being sick from a virus. I don't understand how something the doctor prescribes that has no alternative available can be denied. Advair might also be a problem but it wasn't ready to be filled today.
 

etabetac

New member
I've recently switched insurance, doctors, and pharmacies because of a move. I have been using Cromolyn Sodium for a year after not having used it for several years. I can tell it makes a difference in quality of life but not necessarily in terms of numbers. My insurance did a flat out denial with no appeal listed for the pharmacy (who say that's what they generally get when a medicine is denied). I have no proof that this medicine works.

My old doctor in another state and not on this plan can't write a letter explaining the proof that it's improved. My new doctor can't vouch that it has improved my condition. It's not terribly expensive out of pocket but every little bit counts. I'm on a PPO.

How do I go about a denial that doesn't show up as an appeal at the pharmacy, which is how it's always been done before. I don't even have a denial number. Part of me doesn't want to put up the fight on this med but that's probably just a factor of being sick from a virus. I don't understand how something the doctor prescribes that has no alternative available can be denied. Advair might also be a problem but it wasn't ready to be filled today.
 

etabetac

New member
I've recently switched insurance, doctors, and pharmacies because of a move. I have been using Cromolyn Sodium for a year after not having used it for several years. I can tell it makes a difference in quality of life but not necessarily in terms of numbers. My insurance did a flat out denial with no appeal listed for the pharmacy (who say that's what they generally get when a medicine is denied). I have no proof that this medicine works.

My old doctor in another state and not on this plan can't write a letter explaining the proof that it's improved. My new doctor can't vouch that it has improved my condition. It's not terribly expensive out of pocket but every little bit counts. I'm on a PPO.

How do I go about a denial that doesn't show up as an appeal at the pharmacy, which is how it's always been done before. I don't even have a denial number. Part of me doesn't want to put up the fight on this med but that's probably just a factor of being sick from a virus. I don't understand how something the doctor prescribes that has no alternative available can be denied. Advair might also be a problem but it wasn't ready to be filled today.
 

etabetac

New member
I've recently switched insurance, doctors, and pharmacies because of a move. I have been using Cromolyn Sodium for a year after not having used it for several years. I can tell it makes a difference in quality of life but not necessarily in terms of numbers. My insurance did a flat out denial with no appeal listed for the pharmacy (who say that's what they generally get when a medicine is denied). I have no proof that this medicine works.

My old doctor in another state and not on this plan can't write a letter explaining the proof that it's improved. My new doctor can't vouch that it has improved my condition. It's not terribly expensive out of pocket but every little bit counts. I'm on a PPO.

How do I go about a denial that doesn't show up as an appeal at the pharmacy, which is how it's always been done before. I don't even have a denial number. Part of me doesn't want to put up the fight on this med but that's probably just a factor of being sick from a virus. I don't understand how something the doctor prescribes that has no alternative available can be denied. Advair might also be a problem but it wasn't ready to be filled today.
 

etabetac

New member
I've recently switched insurance, doctors, and pharmacies because of a move. I have been using Cromolyn Sodium for a year after not having used it for several years. I can tell it makes a difference in quality of life but not necessarily in terms of numbers. My insurance did a flat out denial with no appeal listed for the pharmacy (who say that's what they generally get when a medicine is denied). I have no proof that this medicine works.
<br />
<br />My old doctor in another state and not on this plan can't write a letter explaining the proof that it's improved. My new doctor can't vouch that it has improved my condition. It's not terribly expensive out of pocket but every little bit counts. I'm on a PPO.
<br />
<br />How do I go about a denial that doesn't show up as an appeal at the pharmacy, which is how it's always been done before. I don't even have a denial number. Part of me doesn't want to put up the fight on this med but that's probably just a factor of being sick from a virus. I don't understand how something the doctor prescribes that has no alternative available can be denied. Advair might also be a problem but it wasn't ready to be filled today.
 

Ratatosk

Administrator
Staff member
We recently had a similar problem for a different medication for ds. I went to pick it up and instead of $15 it was $80.10 for a one month supply. The pharmacy had no idea why it was denied.

I called the insurance company and they told me it was a non-formulary and therefore I had to pay 50% of the medication plus the $15 copay. I scoured the insurance website which had a list of formulary, non-formulary, restricted, noncovered drugs and his medication was listed as a formulary. So I called again. Nope it was considered a compounded medication, which isn't covered under our plan -- though we scoured our plan book -- both mine and HRs. Wasn't in there. A relative told us our doctor -- who is in another state -- could file an exception. Which we did.

A few weeks later we got a letter saying it wasn't covered and there were no appeals. Our doctor contacted the head of medical services and hit a roadblock as well... So we're still appealing.
 

Ratatosk

Administrator
Staff member
We recently had a similar problem for a different medication for ds. I went to pick it up and instead of $15 it was $80.10 for a one month supply. The pharmacy had no idea why it was denied.

I called the insurance company and they told me it was a non-formulary and therefore I had to pay 50% of the medication plus the $15 copay. I scoured the insurance website which had a list of formulary, non-formulary, restricted, noncovered drugs and his medication was listed as a formulary. So I called again. Nope it was considered a compounded medication, which isn't covered under our plan -- though we scoured our plan book -- both mine and HRs. Wasn't in there. A relative told us our doctor -- who is in another state -- could file an exception. Which we did.

A few weeks later we got a letter saying it wasn't covered and there were no appeals. Our doctor contacted the head of medical services and hit a roadblock as well... So we're still appealing.
 

Ratatosk

Administrator
Staff member
We recently had a similar problem for a different medication for ds. I went to pick it up and instead of $15 it was $80.10 for a one month supply. The pharmacy had no idea why it was denied.

I called the insurance company and they told me it was a non-formulary and therefore I had to pay 50% of the medication plus the $15 copay. I scoured the insurance website which had a list of formulary, non-formulary, restricted, noncovered drugs and his medication was listed as a formulary. So I called again. Nope it was considered a compounded medication, which isn't covered under our plan -- though we scoured our plan book -- both mine and HRs. Wasn't in there. A relative told us our doctor -- who is in another state -- could file an exception. Which we did.

A few weeks later we got a letter saying it wasn't covered and there were no appeals. Our doctor contacted the head of medical services and hit a roadblock as well... So we're still appealing.
 

Ratatosk

Administrator
Staff member
We recently had a similar problem for a different medication for ds. I went to pick it up and instead of $15 it was $80.10 for a one month supply. The pharmacy had no idea why it was denied.

I called the insurance company and they told me it was a non-formulary and therefore I had to pay 50% of the medication plus the $15 copay. I scoured the insurance website which had a list of formulary, non-formulary, restricted, noncovered drugs and his medication was listed as a formulary. So I called again. Nope it was considered a compounded medication, which isn't covered under our plan -- though we scoured our plan book -- both mine and HRs. Wasn't in there. A relative told us our doctor -- who is in another state -- could file an exception. Which we did.

A few weeks later we got a letter saying it wasn't covered and there were no appeals. Our doctor contacted the head of medical services and hit a roadblock as well... So we're still appealing.
 

Ratatosk

Administrator
Staff member
We recently had a similar problem for a different medication for ds. I went to pick it up and instead of $15 it was $80.10 for a one month supply. The pharmacy had no idea why it was denied.
<br />
<br />I called the insurance company and they told me it was a non-formulary and therefore I had to pay 50% of the medication plus the $15 copay. I scoured the insurance website which had a list of formulary, non-formulary, restricted, noncovered drugs and his medication was listed as a formulary. So I called again. Nope it was considered a compounded medication, which isn't covered under our plan -- though we scoured our plan book -- both mine and HRs. Wasn't in there. A relative told us our doctor -- who is in another state -- could file an exception. Which we did.
<br />
<br />A few weeks later we got a letter saying it wasn't covered and there were no appeals. Our doctor contacted the head of medical services and hit a roadblock as well... So we're still appealing.
 

etabetac

New member
Let me first point out I have no alternative to the policy I'm on. This was the job in I could get based on qualifications and my graduate school insurance was ending. It covers all public employees in this field.

So some discouraging news on the Advair front is that my insurance does something called Step Therapy so I have to fail at the first tier of med before insurance will pay for the next tier of drug. The first tier drug for Advair is Albuterol so before they'll cover the cost of Advair I need to prove albuterol doesn't work.

I need advice beyond denial of medicine but how to remain on a medicine I've taken for years instead of proving that a medicine I know doesn't work doesn't work. I can't afford to let my asthma component get out of control because then everything else goes downhill.
 

etabetac

New member
Let me first point out I have no alternative to the policy I'm on. This was the job in I could get based on qualifications and my graduate school insurance was ending. It covers all public employees in this field.

So some discouraging news on the Advair front is that my insurance does something called Step Therapy so I have to fail at the first tier of med before insurance will pay for the next tier of drug. The first tier drug for Advair is Albuterol so before they'll cover the cost of Advair I need to prove albuterol doesn't work.

I need advice beyond denial of medicine but how to remain on a medicine I've taken for years instead of proving that a medicine I know doesn't work doesn't work. I can't afford to let my asthma component get out of control because then everything else goes downhill.
 

etabetac

New member
Let me first point out I have no alternative to the policy I'm on. This was the job in I could get based on qualifications and my graduate school insurance was ending. It covers all public employees in this field.

So some discouraging news on the Advair front is that my insurance does something called Step Therapy so I have to fail at the first tier of med before insurance will pay for the next tier of drug. The first tier drug for Advair is Albuterol so before they'll cover the cost of Advair I need to prove albuterol doesn't work.

I need advice beyond denial of medicine but how to remain on a medicine I've taken for years instead of proving that a medicine I know doesn't work doesn't work. I can't afford to let my asthma component get out of control because then everything else goes downhill.
 

etabetac

New member
Let me first point out I have no alternative to the policy I'm on. This was the job in I could get based on qualifications and my graduate school insurance was ending. It covers all public employees in this field.

So some discouraging news on the Advair front is that my insurance does something called Step Therapy so I have to fail at the first tier of med before insurance will pay for the next tier of drug. The first tier drug for Advair is Albuterol so before they'll cover the cost of Advair I need to prove albuterol doesn't work.

I need advice beyond denial of medicine but how to remain on a medicine I've taken for years instead of proving that a medicine I know doesn't work doesn't work. I can't afford to let my asthma component get out of control because then everything else goes downhill.
 

etabetac

New member
Let me first point out I have no alternative to the policy I'm on. This was the job in I could get based on qualifications and my graduate school insurance was ending. It covers all public employees in this field.
<br />
<br />So some discouraging news on the Advair front is that my insurance does something called Step Therapy so I have to fail at the first tier of med before insurance will pay for the next tier of drug. The first tier drug for Advair is Albuterol so before they'll cover the cost of Advair I need to prove albuterol doesn't work.
<br />
<br />I need advice beyond denial of medicine but how to remain on a medicine I've taken for years instead of proving that a medicine I know doesn't work doesn't work. I can't afford to let my asthma component get out of control because then everything else goes downhill.
 

Melissa75

Administrator
>so before they'll cover the cost of Advair I need to prove >albuterol doesn't work.


Wow! Don't they realize that the costs of outa control asthma...e.g. hospital admissions and infections, are way higher than the drug.

Nurses hear squeaks if I just use albuterol, thus I was put on Advair and then Symbicort. (I still have squeaks...but shhhh.)

The "Condition Care" company that I think my husband's employer hires (not sure) was P.O.ed (as much as a stranger reading off a form can be) when I was not on an inhaled steriod in addition to the albuterol.

When I tried Sodium Cromolyn, my pulmo gave me an asthma and chronic bronchitis dx to get it covered. I hope that helps. I can mail you all my unopened sodium cromolyn of you want, just PM me...and be patient while I wait for the storm to end before I get to the post office ;-)
 

Melissa75

Administrator
>so before they'll cover the cost of Advair I need to prove >albuterol doesn't work.


Wow! Don't they realize that the costs of outa control asthma...e.g. hospital admissions and infections, are way higher than the drug.

Nurses hear squeaks if I just use albuterol, thus I was put on Advair and then Symbicort. (I still have squeaks...but shhhh.)

The "Condition Care" company that I think my husband's employer hires (not sure) was P.O.ed (as much as a stranger reading off a form can be) when I was not on an inhaled steriod in addition to the albuterol.

When I tried Sodium Cromolyn, my pulmo gave me an asthma and chronic bronchitis dx to get it covered. I hope that helps. I can mail you all my unopened sodium cromolyn of you want, just PM me...and be patient while I wait for the storm to end before I get to the post office ;-)
 

Melissa75

Administrator
>so before they'll cover the cost of Advair I need to prove >albuterol doesn't work.


Wow! Don't they realize that the costs of outa control asthma...e.g. hospital admissions and infections, are way higher than the drug.

Nurses hear squeaks if I just use albuterol, thus I was put on Advair and then Symbicort. (I still have squeaks...but shhhh.)

The "Condition Care" company that I think my husband's employer hires (not sure) was P.O.ed (as much as a stranger reading off a form can be) when I was not on an inhaled steriod in addition to the albuterol.

When I tried Sodium Cromolyn, my pulmo gave me an asthma and chronic bronchitis dx to get it covered. I hope that helps. I can mail you all my unopened sodium cromolyn of you want, just PM me...and be patient while I wait for the storm to end before I get to the post office ;-)
 

Melissa75

Administrator
>so before they'll cover the cost of Advair I need to prove >albuterol doesn't work.


Wow! Don't they realize that the costs of outa control asthma...e.g. hospital admissions and infections, are way higher than the drug.

Nurses hear squeaks if I just use albuterol, thus I was put on Advair and then Symbicort. (I still have squeaks...but shhhh.)

The "Condition Care" company that I think my husband's employer hires (not sure) was P.O.ed (as much as a stranger reading off a form can be) when I was not on an inhaled steriod in addition to the albuterol.

When I tried Sodium Cromolyn, my pulmo gave me an asthma and chronic bronchitis dx to get it covered. I hope that helps. I can mail you all my unopened sodium cromolyn of you want, just PM me...and be patient while I wait for the storm to end before I get to the post office ;-)
 

Melissa75

Administrator
>so before they'll cover the cost of Advair I need to prove >albuterol doesn't work.
<br />
<br />
<br />Wow! Don't they realize that the costs of outa control asthma...e.g. hospital admissions and infections, are way higher than the drug.
<br />
<br />Nurses hear squeaks if I just use albuterol, thus I was put on Advair and then Symbicort. (I still have squeaks...but shhhh.)
<br />
<br />The "Condition Care" company that I think my husband's employer hires (not sure) was P.O.ed (as much as a stranger reading off a form can be) when I was not on an inhaled steriod in addition to the albuterol.
<br />
<br />When I tried Sodium Cromolyn, my pulmo gave me an asthma and chronic bronchitis dx to get it covered. I hope that helps. I can mail you all my unopened sodium cromolyn of you want, just PM me...and be patient while I wait for the storm to end before I get to the post office ;-)
 
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