Non-formulary Drug - Update at the end

[Ratatosk]

Non-formulary Drug

We're not eligible for schip and they don't allow us to pay into the program. Flat 200% over the income guidelines. Otherwise people might be tempted to cancel their children's insurance and rely on state insurance.

Called to request an exception this morning and everyone at BCBS in at computer training. Tomorrow I'll have to call.

 

[Ratatosk]

Non-formulary Drug

We're not eligible for schip and they don't allow us to pay into the program. Flat 200% over the income guidelines. Otherwise people might be tempted to cancel their children's insurance and rely on state insurance.

Called to request an exception this morning and everyone at BCBS in at computer training. Tomorrow I'll have to call.

 

[Ratatosk]

Non-formulary Drug

We're not eligible for schip and they don't allow us to pay into the program. Flat 200% over the income guidelines. Otherwise people might be tempted to cancel their children's insurance and rely on state insurance.

Called to request an exception this morning and everyone at BCBS in at computer training. Tomorrow I'll have to call.

 

[Ratatosk]

Non-formulary Drug

We're not eligible for schip and they don't allow us to pay into the program. Flat 200% over the income guidelines. Otherwise people might be tempted to cancel their children's insurance and rely on state insurance.

Called to request an exception this morning and everyone at BCBS in at computer training. Tomorrow I'll have to call.

 

[Ratatosk]

Non-formulary Drug

We're not eligible for schip and they don't allow us to pay into the program. Flat 200% over the income guidelines. Otherwise people might be tempted to cancel their children's insurance and rely on state insurance.
<br />
<br />Called to request an exception this morning and everyone at BCBS in at computer training. Tomorrow I'll have to call.

 

[ktsmom]

Non-formulary Drug

Hey Liza - Katy took 3 ml of 50 mg/ml Urso so I think that's the same dose as your DS but its early. Over the summer the doc switched her to a 250 mg tablet. She is right at 50 pounds.

Of all the meds she is on, the Urso gave us the most problem because of the need for compounding. It was also our largest copay, I presume because of what you mention about how to price it out.

I think there was some movement about FDA approvals for generic Urso like in the past month so that may have triggered the change?

On a related topic, does your DS have side effects that you know of from Urso? We have been re-working Katy's morning meds to try to alleviate a constant morning tummy problem. Of course when the med is 2x a day there's not much wiggle room. But we have temporarily stopped the morning Urso and no tummy aches (and the tummy aches were happening on the "old" dose as well). Or it could be coincidence. Sigh.

 

[ktsmom]

Non-formulary Drug

Hey Liza - Katy took 3 ml of 50 mg/ml Urso so I think that's the same dose as your DS but its early. Over the summer the doc switched her to a 250 mg tablet. She is right at 50 pounds.

Of all the meds she is on, the Urso gave us the most problem because of the need for compounding. It was also our largest copay, I presume because of what you mention about how to price it out.

I think there was some movement about FDA approvals for generic Urso like in the past month so that may have triggered the change?

On a related topic, does your DS have side effects that you know of from Urso? We have been re-working Katy's morning meds to try to alleviate a constant morning tummy problem. Of course when the med is 2x a day there's not much wiggle room. But we have temporarily stopped the morning Urso and no tummy aches (and the tummy aches were happening on the "old" dose as well). Or it could be coincidence. Sigh.

 

[ktsmom]

Non-formulary Drug

Hey Liza - Katy took 3 ml of 50 mg/ml Urso so I think that's the same dose as your DS but its early. Over the summer the doc switched her to a 250 mg tablet. She is right at 50 pounds.

Of all the meds she is on, the Urso gave us the most problem because of the need for compounding. It was also our largest copay, I presume because of what you mention about how to price it out.

I think there was some movement about FDA approvals for generic Urso like in the past month so that may have triggered the change?

On a related topic, does your DS have side effects that you know of from Urso? We have been re-working Katy's morning meds to try to alleviate a constant morning tummy problem. Of course when the med is 2x a day there's not much wiggle room. But we have temporarily stopped the morning Urso and no tummy aches (and the tummy aches were happening on the "old" dose as well). Or it could be coincidence. Sigh.

 

[ktsmom]

Non-formulary Drug

Hey Liza - Katy took 3 ml of 50 mg/ml Urso so I think that's the same dose as your DS but its early. Over the summer the doc switched her to a 250 mg tablet. She is right at 50 pounds.

Of all the meds she is on, the Urso gave us the most problem because of the need for compounding. It was also our largest copay, I presume because of what you mention about how to price it out.

I think there was some movement about FDA approvals for generic Urso like in the past month so that may have triggered the change?

On a related topic, does your DS have side effects that you know of from Urso? We have been re-working Katy's morning meds to try to alleviate a constant morning tummy problem. Of course when the med is 2x a day there's not much wiggle room. But we have temporarily stopped the morning Urso and no tummy aches (and the tummy aches were happening on the "old" dose as well). Or it could be coincidence. Sigh.

 

[ktsmom]

Non-formulary Drug

Hey Liza - Katy took 3 ml of 50 mg/ml Urso so I think that's the same dose as your DS but its early. Over the summer the doc switched her to a 250 mg tablet. She is right at 50 pounds.
<br />
<br />Of all the meds she is on, the Urso gave us the most problem because of the need for compounding. It was also our largest copay, I presume because of what you mention about how to price it out.
<br />
<br />I think there was some movement about FDA approvals for generic Urso like in the past month so that may have triggered the change?
<br />
<br />On a related topic, does your DS have side effects that you know of from Urso? We have been re-working Katy's morning meds to try to alleviate a constant morning tummy problem. Of course when the med is 2x a day there's not much wiggle room. But we have temporarily stopped the morning Urso and no tummy aches (and the tummy aches were happening on the "old" dose as well). Or it could be coincidence. Sigh.

 

[Ratatosk]

Non-formulary Drug

DS has been on the ursodiol (generic) suspension since he was a few weeks old and hasn't had any issues. We call it the cherry flavored vomit because that's pretty much what it tastes like -- cherry bile. <img src="i/expressions/face-icon-small-smile.gif" border="0">

He already takes a keflex, septra, vitamin A & E and a source CF vitamin in the morning. We do his zithromax before bed because we THOUGHT that had been causing him some GI upset, but that wasn't the case.
I looked at the formulary list and it only lists Ursodiol caps -- not tablets and the Actigall (name brand) is listed as a nonformulary. The capsule I think only comes in a 300 mg form.

I called BCBS right away this morning and asked about filing an exception. Why they didn't TELL me about this on Tuesday is beyond me -- I had to find out from DH's cousin who is a social worker. So the doctor has to fill out the form and send it to them. Was told to have them specifically address what other meds can be used in place of this. I'm sure the clinic has been thru all this before.

 

[Ratatosk]

Non-formulary Drug

DS has been on the ursodiol (generic) suspension since he was a few weeks old and hasn't had any issues. We call it the cherry flavored vomit because that's pretty much what it tastes like -- cherry bile. <img src="i/expressions/face-icon-small-smile.gif" border="0">

He already takes a keflex, septra, vitamin A & E and a source CF vitamin in the morning. We do his zithromax before bed because we THOUGHT that had been causing him some GI upset, but that wasn't the case.
I looked at the formulary list and it only lists Ursodiol caps -- not tablets and the Actigall (name brand) is listed as a nonformulary. The capsule I think only comes in a 300 mg form.

I called BCBS right away this morning and asked about filing an exception. Why they didn't TELL me about this on Tuesday is beyond me -- I had to find out from DH's cousin who is a social worker. So the doctor has to fill out the form and send it to them. Was told to have them specifically address what other meds can be used in place of this. I'm sure the clinic has been thru all this before.

 

[Ratatosk]

Non-formulary Drug

DS has been on the ursodiol (generic) suspension since he was a few weeks old and hasn't had any issues. We call it the cherry flavored vomit because that's pretty much what it tastes like -- cherry bile. <img src="i/expressions/face-icon-small-smile.gif" border="0">

He already takes a keflex, septra, vitamin A & E and a source CF vitamin in the morning. We do his zithromax before bed because we THOUGHT that had been causing him some GI upset, but that wasn't the case.
I looked at the formulary list and it only lists Ursodiol caps -- not tablets and the Actigall (name brand) is listed as a nonformulary. The capsule I think only comes in a 300 mg form.

I called BCBS right away this morning and asked about filing an exception. Why they didn't TELL me about this on Tuesday is beyond me -- I had to find out from DH's cousin who is a social worker. So the doctor has to fill out the form and send it to them. Was told to have them specifically address what other meds can be used in place of this. I'm sure the clinic has been thru all this before.

 

[Ratatosk]

Non-formulary Drug

DS has been on the ursodiol (generic) suspension since he was a few weeks old and hasn't had any issues. We call it the cherry flavored vomit because that's pretty much what it tastes like -- cherry bile. <img src="i/expressions/face-icon-small-smile.gif" border="0">

He already takes a keflex, septra, vitamin A & E and a source CF vitamin in the morning. We do his zithromax before bed because we THOUGHT that had been causing him some GI upset, but that wasn't the case.
I looked at the formulary list and it only lists Ursodiol caps -- not tablets and the Actigall (name brand) is listed as a nonformulary. The capsule I think only comes in a 300 mg form.

I called BCBS right away this morning and asked about filing an exception. Why they didn't TELL me about this on Tuesday is beyond me -- I had to find out from DH's cousin who is a social worker. So the doctor has to fill out the form and send it to them. Was told to have them specifically address what other meds can be used in place of this. I'm sure the clinic has been thru all this before.

 

[Ratatosk]

Non-formulary Drug

DS has been on the ursodiol (generic) suspension since he was a few weeks old and hasn't had any issues. We call it the cherry flavored vomit because that's pretty much what it tastes like -- cherry bile. <img src="i/expressions/face-icon-small-smile.gif" border="0">
<br />
<br />He already takes a keflex, septra, vitamin A & E and a source CF vitamin in the morning. We do his zithromax before bed because we THOUGHT that had been causing him some GI upset, but that wasn't the case.
<br />I looked at the formulary list and it only lists Ursodiol caps -- not tablets and the Actigall (name brand) is listed as a nonformulary. The capsule I think only comes in a 300 mg form.
<br />
<br />I called BCBS right away this morning and asked about filing an exception. Why they didn't TELL me about this on Tuesday is beyond me -- I had to find out from DH's cousin who is a social worker. So the doctor has to fill out the form and send it to them. Was told to have them specifically address what other meds can be used in place of this. I'm sure the clinic has been thru all this before.

 

[Ratatosk]

Non-formulary Drug

Banging head on desk. A month ago filed an exception to get a non-formulary medication covered, which had been covered for the past 6 years.

Today got a letter that it was denied by the medical director because compounding medications are not covered by our insurance, which I can't find reference to in our policy description manual. Was told not to bother appealing by the member service rep.

Tomorrow I have to pick up the refill. Wonder how much I'll get charged for it.

Again, there is NO OTHER substitute medication that can be used. The capsule dosage is too high. Wish I'd known this before I had to file my flexible benefit info for next year or I'd have flexed about several hundred dollars more out.

Though I think I'll file another appeal and if that doesn't work, get our attorney involved.

 

[Ratatosk]

Non-formulary Drug

Banging head on desk. A month ago filed an exception to get a non-formulary medication covered, which had been covered for the past 6 years.

Today got a letter that it was denied by the medical director because compounding medications are not covered by our insurance, which I can't find reference to in our policy description manual. Was told not to bother appealing by the member service rep.

Tomorrow I have to pick up the refill. Wonder how much I'll get charged for it.

Again, there is NO OTHER substitute medication that can be used. The capsule dosage is too high. Wish I'd known this before I had to file my flexible benefit info for next year or I'd have flexed about several hundred dollars more out.

Though I think I'll file another appeal and if that doesn't work, get our attorney involved.

 

[Ratatosk]

Non-formulary Drug

Banging head on desk. A month ago filed an exception to get a non-formulary medication covered, which had been covered for the past 6 years.

Today got a letter that it was denied by the medical director because compounding medications are not covered by our insurance, which I can't find reference to in our policy description manual. Was told not to bother appealing by the member service rep.

Tomorrow I have to pick up the refill. Wonder how much I'll get charged for it.

Again, there is NO OTHER substitute medication that can be used. The capsule dosage is too high. Wish I'd known this before I had to file my flexible benefit info for next year or I'd have flexed about several hundred dollars more out.

Though I think I'll file another appeal and if that doesn't work, get our attorney involved.

 

[Ratatosk]

Non-formulary Drug

Banging head on desk. A month ago filed an exception to get a non-formulary medication covered, which had been covered for the past 6 years.

Today got a letter that it was denied by the medical director because compounding medications are not covered by our insurance, which I can't find reference to in our policy description manual. Was told not to bother appealing by the member service rep.

Tomorrow I have to pick up the refill. Wonder how much I'll get charged for it.

Again, there is NO OTHER substitute medication that can be used. The capsule dosage is too high. Wish I'd known this before I had to file my flexible benefit info for next year or I'd have flexed about several hundred dollars more out.

Though I think I'll file another appeal and if that doesn't work, get our attorney involved.

 

[Ratatosk]

Non-formulary Drug

Banging head on desk. A month ago filed an exception to get a non-formulary medication covered, which had been covered for the past 6 years.
<br />
<br />Today got a letter that it was denied by the medical director because compounding medications are not covered by our insurance, which I can't find reference to in our policy description manual. Was told not to bother appealing by the member service rep.
<br />
<br />Tomorrow I have to pick up the refill. Wonder how much I'll get charged for it.
<br />
<br />Again, there is NO OTHER substitute medication that can be used. The capsule dosage is too high. Wish I'd known this before I had to file my flexible benefit info for next year or I'd have flexed about several hundred dollars more out.
<br />
<br />Though I think I'll file another appeal and if that doesn't work, get our attorney involved.