Non-formulary Drug - Update at the end

[hmw]

Non-formulary Drug

I am assuming they convert the capsules into syrup for you because the pills are too high a dose for him to be able to take due to his age/weight? If so, I wonder if you can appeal... since he is taking the COVERED medication but in the only way that is safe for him- taking the covered medication on the insurance company's terms would overdose him.

That just sounds ridiculous- the sugar syrup costs almost nothing and he is taking the exact same pills that they DO cover. <img src="i/expressions/face-icon-small-mad.gif" border="0">

It would be another matter entirely if you were having the pharmacy compound it just because he didn't want to swallow pills...?! I do not understand this at all. They will jump at the slightest loophole just to try and make us pick up more of the cost>>> So on second thought, I guess I completely understand that. They got to keep raking in those enormous profits. It just completely irritates me.

 

[hmw]

Non-formulary Drug

I am assuming they convert the capsules into syrup for you because the pills are too high a dose for him to be able to take due to his age/weight? If so, I wonder if you can appeal... since he is taking the COVERED medication but in the only way that is safe for him- taking the covered medication on the insurance company's terms would overdose him.

That just sounds ridiculous- the sugar syrup costs almost nothing and he is taking the exact same pills that they DO cover. <img src="i/expressions/face-icon-small-mad.gif" border="0">

It would be another matter entirely if you were having the pharmacy compound it just because he didn't want to swallow pills...?! I do not understand this at all. They will jump at the slightest loophole just to try and make us pick up more of the cost>>> So on second thought, I guess I completely understand that. They got to keep raking in those enormous profits. It just completely irritates me.

 

[hmw]

Non-formulary Drug

I am assuming they convert the capsules into syrup for you because the pills are too high a dose for him to be able to take due to his age/weight? If so, I wonder if you can appeal... since he is taking the COVERED medication but in the only way that is safe for him- taking the covered medication on the insurance company's terms would overdose him.

That just sounds ridiculous- the sugar syrup costs almost nothing and he is taking the exact same pills that they DO cover. <img src="i/expressions/face-icon-small-mad.gif" border="0">

It would be another matter entirely if you were having the pharmacy compound it just because he didn't want to swallow pills...?! I do not understand this at all. They will jump at the slightest loophole just to try and make us pick up more of the cost>>> So on second thought, I guess I completely understand that. They got to keep raking in those enormous profits. It just completely irritates me.

 

[hmw]

Non-formulary Drug

I am assuming they convert the capsules into syrup for you because the pills are too high a dose for him to be able to take due to his age/weight? If so, I wonder if you can appeal... since he is taking the COVERED medication but in the only way that is safe for him- taking the covered medication on the insurance company's terms would overdose him.

That just sounds ridiculous- the sugar syrup costs almost nothing and he is taking the exact same pills that they DO cover. <img src="i/expressions/face-icon-small-mad.gif" border="0">

It would be another matter entirely if you were having the pharmacy compound it just because he didn't want to swallow pills...?! I do not understand this at all. They will jump at the slightest loophole just to try and make us pick up more of the cost>>> So on second thought, I guess I completely understand that. They got to keep raking in those enormous profits. It just completely irritates me.

 

[hmw]

Non-formulary Drug

I am assuming they convert the capsules into syrup for you because the pills are too high a dose for him to be able to take due to his age/weight? If so, I wonder if you can appeal... since he is taking the COVERED medication but in the only way that is safe for him- taking the covered medication on the insurance company's terms would overdose him.
<br />
<br />That just sounds ridiculous- the sugar syrup costs almost nothing and he is taking the exact same pills that they DO cover. <img src="i/expressions/face-icon-small-mad.gif" border="0">
<br />
<br />It would be another matter entirely if you were having the pharmacy compound it just because he didn't want to swallow pills...?! I do not understand this at all. They will jump at the slightest loophole just to try and make us pick up more of the cost>>> So on second thought, I guess I completely understand that. They got to keep raking in those enormous profits. It just completely irritates me.

 

[Ratatosk]

Non-formulary Drug

They don't make a suspension. He takes 7.5 ml of 20 mg/ml solution. The capsules are 300 mg. Frustrating.

 

[Ratatosk]

Non-formulary Drug

They don't make a suspension. He takes 7.5 ml of 20 mg/ml solution. The capsules are 300 mg. Frustrating.

 

[Ratatosk]

Non-formulary Drug

They don't make a suspension. He takes 7.5 ml of 20 mg/ml solution. The capsules are 300 mg. Frustrating.

 

[Ratatosk]

Non-formulary Drug

They don't make a suspension. He takes 7.5 ml of 20 mg/ml solution. The capsules are 300 mg. Frustrating.

 

[Ratatosk]

Non-formulary Drug

They don't make a suspension. He takes 7.5 ml of 20 mg/ml solution. The capsules are 300 mg. Frustrating.

 

[Mommafirst]

Non-formulary Drug

Oh good god, that is ridiculous and incredibly frustrating!!!!! Insurance issues frustrate the heck out of me!!

Does your state have any kind of child with medical issues program that covers the co-pays? I was absolutely swamped in co-pays before I realized our state has a program called BCMH (Bureau of Children with Medical Handicaps). I was told that there was no way we would qualify with our salaries. It sucks when you look like you do well on paper, but your expenditures still out weigh what you have coming in. But CF is actually one of those things that qualifies a good deal more people (I won't say everyone, I don't know). Now that we have BCMH, I don't pay anything out of pocket for doctor visits or meds.

 

[Mommafirst]

Non-formulary Drug

Oh good god, that is ridiculous and incredibly frustrating!!!!! Insurance issues frustrate the heck out of me!!

Does your state have any kind of child with medical issues program that covers the co-pays? I was absolutely swamped in co-pays before I realized our state has a program called BCMH (Bureau of Children with Medical Handicaps). I was told that there was no way we would qualify with our salaries. It sucks when you look like you do well on paper, but your expenditures still out weigh what you have coming in. But CF is actually one of those things that qualifies a good deal more people (I won't say everyone, I don't know). Now that we have BCMH, I don't pay anything out of pocket for doctor visits or meds.

 

[Mommafirst]

Non-formulary Drug

Oh good god, that is ridiculous and incredibly frustrating!!!!! Insurance issues frustrate the heck out of me!!

Does your state have any kind of child with medical issues program that covers the co-pays? I was absolutely swamped in co-pays before I realized our state has a program called BCMH (Bureau of Children with Medical Handicaps). I was told that there was no way we would qualify with our salaries. It sucks when you look like you do well on paper, but your expenditures still out weigh what you have coming in. But CF is actually one of those things that qualifies a good deal more people (I won't say everyone, I don't know). Now that we have BCMH, I don't pay anything out of pocket for doctor visits or meds.

 

[Mommafirst]

Non-formulary Drug

Oh good god, that is ridiculous and incredibly frustrating!!!!! Insurance issues frustrate the heck out of me!!

Does your state have any kind of child with medical issues program that covers the co-pays? I was absolutely swamped in co-pays before I realized our state has a program called BCMH (Bureau of Children with Medical Handicaps). I was told that there was no way we would qualify with our salaries. It sucks when you look like you do well on paper, but your expenditures still out weigh what you have coming in. But CF is actually one of those things that qualifies a good deal more people (I won't say everyone, I don't know). Now that we have BCMH, I don't pay anything out of pocket for doctor visits or meds.

 

[Mommafirst]

Non-formulary Drug

Oh good god, that is ridiculous and incredibly frustrating!!!!! Insurance issues frustrate the heck out of me!!
<br />
<br />Does your state have any kind of child with medical issues program that covers the co-pays? I was absolutely swamped in co-pays before I realized our state has a program called BCMH (Bureau of Children with Medical Handicaps). I was told that there was no way we would qualify with our salaries. It sucks when you look like you do well on paper, but your expenditures still out weigh what you have coming in. But CF is actually one of those things that qualifies a good deal more people (I won't say everyone, I don't know). Now that we have BCMH, I don't pay anything out of pocket for doctor visits or meds.

 

[hmw]

Non-formulary Drug

The pharmacist makes the suspension out of those very same pills though... and that sugar syrup can't cost more than a couple dollars (far less than it would cost to cover if Max was taking a 300mg dose of those pills!) It just seems insane to me to not cover it. At the most, all you should be liable to pay for is the cost of the syrup used to make the suspension, if they want to nitpick.

If all appeals don't work, the pharmacist, I am sure, can stipulate to exactly how many pills it takes to make that suspension. Maybe he can do exactly that, and Max's dr can write the script in that way (i.e. 1/2 capsule per day since it appears he takes 150mg) and you can ask to pay the pharm for the suspension syrup separately (i.e. the way you'd pay for the FlavoRx they can add to abx.) Then for all the insurance company knows you'll be opening the caps and dumping half of one on his food from now on. Stupid, stupid, stupid.

 

[hmw]

Non-formulary Drug

The pharmacist makes the suspension out of those very same pills though... and that sugar syrup can't cost more than a couple dollars (far less than it would cost to cover if Max was taking a 300mg dose of those pills!) It just seems insane to me to not cover it. At the most, all you should be liable to pay for is the cost of the syrup used to make the suspension, if they want to nitpick.

If all appeals don't work, the pharmacist, I am sure, can stipulate to exactly how many pills it takes to make that suspension. Maybe he can do exactly that, and Max's dr can write the script in that way (i.e. 1/2 capsule per day since it appears he takes 150mg) and you can ask to pay the pharm for the suspension syrup separately (i.e. the way you'd pay for the FlavoRx they can add to abx.) Then for all the insurance company knows you'll be opening the caps and dumping half of one on his food from now on. Stupid, stupid, stupid.

 

[hmw]

Non-formulary Drug

The pharmacist makes the suspension out of those very same pills though... and that sugar syrup can't cost more than a couple dollars (far less than it would cost to cover if Max was taking a 300mg dose of those pills!) It just seems insane to me to not cover it. At the most, all you should be liable to pay for is the cost of the syrup used to make the suspension, if they want to nitpick.

If all appeals don't work, the pharmacist, I am sure, can stipulate to exactly how many pills it takes to make that suspension. Maybe he can do exactly that, and Max's dr can write the script in that way (i.e. 1/2 capsule per day since it appears he takes 150mg) and you can ask to pay the pharm for the suspension syrup separately (i.e. the way you'd pay for the FlavoRx they can add to abx.) Then for all the insurance company knows you'll be opening the caps and dumping half of one on his food from now on. Stupid, stupid, stupid.

 

[hmw]

Non-formulary Drug

The pharmacist makes the suspension out of those very same pills though... and that sugar syrup can't cost more than a couple dollars (far less than it would cost to cover if Max was taking a 300mg dose of those pills!) It just seems insane to me to not cover it. At the most, all you should be liable to pay for is the cost of the syrup used to make the suspension, if they want to nitpick.

If all appeals don't work, the pharmacist, I am sure, can stipulate to exactly how many pills it takes to make that suspension. Maybe he can do exactly that, and Max's dr can write the script in that way (i.e. 1/2 capsule per day since it appears he takes 150mg) and you can ask to pay the pharm for the suspension syrup separately (i.e. the way you'd pay for the FlavoRx they can add to abx.) Then for all the insurance company knows you'll be opening the caps and dumping half of one on his food from now on. Stupid, stupid, stupid.

 

[hmw]

Non-formulary Drug

The pharmacist makes the suspension out of those very same pills though... and that sugar syrup can't cost more than a couple dollars (far less than it would cost to cover if Max was taking a 300mg dose of those pills!) It just seems insane to me to not cover it. At the most, all you should be liable to pay for is the cost of the syrup used to make the suspension, if they want to nitpick.
<br />
<br />If all appeals don't work, the pharmacist, I am sure, can stipulate to exactly how many pills it takes to make that suspension. Maybe he can do exactly that, and Max's dr can write the script in that way (i.e. 1/2 capsule per day since it appears he takes 150mg) and you can ask to pay the pharm for the suspension syrup separately (i.e. the way you'd pay for the FlavoRx they can add to abx.) Then for all the insurance company knows you'll be opening the caps and dumping half of one on his food from now on. Stupid, stupid, stupid.