NC Medicaid & enzymes

[blindhearted]

I was wondering if anyone knew about this or not. It sounded like they are on the list because the FDA hadn't approved them. However I know that Zenpep & Creon have gottn approval but they are still on this list that went into effect July 1, 2010. I have a friend who called me about this & since I don't have Medicaid I told her I would ask up here. Has anyone had trouble getting their enzymes covered? If yes, What did u do about it? If no, how did u get around this issue? I told her since two have now been approved I would call Medicaid and ask about them. Not sure what she's gonna do if she can't get them coverd.

 

[blindhearted]

I was wondering if anyone knew about this or not. It sounded like they are on the list because the FDA hadn't approved them. However I know that Zenpep & Creon have gottn approval but they are still on this list that went into effect July 1, 2010. I have a friend who called me about this & since I don't have Medicaid I told her I would ask up here. Has anyone had trouble getting their enzymes covered? If yes, What did u do about it? If no, how did u get around this issue? I told her since two have now been approved I would call Medicaid and ask about them. Not sure what she's gonna do if she can't get them coverd.

 

[blindhearted]

I was wondering if anyone knew about this or not. It sounded like they are on the list because the FDA hadn't approved them. However I know that Zenpep & Creon have gottn approval but they are still on this list that went into effect July 1, 2010. I have a friend who called me about this & since I don't have Medicaid I told her I would ask up here. Has anyone had trouble getting their enzymes covered? If yes, What did u do about it? If no, how did u get around this issue? I told her since two have now been approved I would call Medicaid and ask about them. Not sure what she's gonna do if she can't get them coverd.

 

[Ratatosk]

We have Blue Cross Blue Shield and when I went to fill DS' Pancreaze, we were told no because it wasn't on the formulary list and therefore we'd have to pay half ($1900) for a three month supply.

The BCBS Formulary list had Creon and all the old enzymes that were no longer approved by the FDA, as well as a generic. The list was dated July 2010. So their committee reviewed the new enzymes and indicated they would not be adding pancreaze or zenpep to their formulary list. We were going to fight it, but DS' doctor seemed comfortable with prescribing creon and so far he hasn't had any issues.

We were going to have our doctor either fill out a form requesting an exception or a letter of medical necessity. AND we were going to involve our attorney.

The irony is that just a year ago a friend of mine's daughter was switched to creon and BCBS refused to cover it, told her she needed to come up with the full amount, about $4000 for a 3 month supply. Now apparently they're on board with creon, but ONLY creon. Sigh!

 

[Ratatosk]

We have Blue Cross Blue Shield and when I went to fill DS' Pancreaze, we were told no because it wasn't on the formulary list and therefore we'd have to pay half ($1900) for a three month supply.

The BCBS Formulary list had Creon and all the old enzymes that were no longer approved by the FDA, as well as a generic. The list was dated July 2010. So their committee reviewed the new enzymes and indicated they would not be adding pancreaze or zenpep to their formulary list. We were going to fight it, but DS' doctor seemed comfortable with prescribing creon and so far he hasn't had any issues.

We were going to have our doctor either fill out a form requesting an exception or a letter of medical necessity. AND we were going to involve our attorney.

The irony is that just a year ago a friend of mine's daughter was switched to creon and BCBS refused to cover it, told her she needed to come up with the full amount, about $4000 for a 3 month supply. Now apparently they're on board with creon, but ONLY creon. Sigh!

 

[Ratatosk]

We have Blue Cross Blue Shield and when I went to fill DS' Pancreaze, we were told no because it wasn't on the formulary list and therefore we'd have to pay half ($1900) for a three month supply.
<br />
<br />The BCBS Formulary list had Creon and all the old enzymes that were no longer approved by the FDA, as well as a generic. The list was dated July 2010. So their committee reviewed the new enzymes and indicated they would not be adding pancreaze or zenpep to their formulary list. We were going to fight it, but DS' doctor seemed comfortable with prescribing creon and so far he hasn't had any issues.
<br />
<br />We were going to have our doctor either fill out a form requesting an exception or a letter of medical necessity. AND we were going to involve our attorney.
<br />
<br />The irony is that just a year ago a friend of mine's daughter was switched to creon and BCBS refused to cover it, told her she needed to come up with the full amount, about $4000 for a 3 month supply. Now apparently they're on board with creon, but ONLY creon. Sigh!