Tobi Podhaler Denied

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AnnaOrange

New member
Hi all, I recently switched employers and insurance providers. My new insurance in Aetna and they have denied Tobi Podhaler. I am in the appeals process but it is not looking too encouraging. I think I will be forced to switch back to nebulized tobramycin...and thus up my treatment times by another 40-minutes per day. Has this happened to anyone else and if so have you successfully fought the Podhaler denial? PS The Specialty Pharmacy that I am now forced to deal with is CVS Caremark and they have been an absolute nightmare to deal with. Total incompetence that is almost comical if I was not so frustrated to the point of understanding why some people would just give up the insurance fight altogether.
 
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triples15

Super Moderator
Hi Anna, and welcome!!

So sorry you are dealing with this. :( One of the most frustrating aspects of CF for me is when my insurance tries to dictate what medicine (and how much) I get. Ugh. The 2 appeals I've done, I lost. One was over the dosage of Serevent. The recommended dose (based on studies) for CFers is 2 puffs twice a day. My insurance would only approve 1 puff twice a day. Ugh. The other was Zithromax. They would only approve 3 tablets for a 30 day supply. Um, no, the dosing for us is M-W-F.... Ugh.

I'm sorry I don't have anything more encouraging to say. Just wanted to say I know how you feel and it's beyond frustrating. I've also had similar dealings with a pharmacies, where it's so bad it would honestly be comical if it wasn't so infuriating.

Anyway, welcome again, and I really hope that you are able to get the Podhaler! I'll keep my fingers crossed! And maybe someone else has something more constructive to add. :)

Autumn 34 w/CF
 
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vbs420

New member
Just to add, for all the Americans who may be thinking we've got it easy in Canada... our health-care is not "free", and I too deal with incompetent pharmacies/pharmacists and have constant issues with drug insurance, coverage, denials, etc.
 
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liveitup

New member
I have Aetna too..it is a nightmare. I use Accredo specialty pharmacy for my Tobi Pod. It was a process...letter from the dr, etc. I don't even know what number to give you - they always put the infertility line on my meds and transfer me... It's kinda funny since I just had a baby 8 months ago, and fertility meds are the last thing on my mind. Anyway, best wishes! Let us know how things turn out!
 
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nmw0615

New member
I don't really have any advice, but I offer my misery with Aetna. They've been denying my sister an MRI for severe back pain and now they're denying coverage for a few days of my most recent hospital stay. They've given me the most trouble out of every insurance company I've ever been with.
 
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BreeAlysia

New member
I have Aetna and my pod haler was approved. I used their specialty pharmacy. What reason are they giving for the denial? I pretty much fought every month for even my nebulized tobi with my last insurance company. I did have to fight a bit for the Pod Haler. Some issue with the quantity. I suspect next month will also be a fight. But I can usually get it fixed after a bunch of phone calls. But it's really frustrating. Have you told your doctor? When mine get involved, it usually gets fixed.
 
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AnnaOrange

New member
Thanks, all! I am in the process of appealing but will need to start old school inhaled tobramycin in the interim. I plan to log all problems with tobramycin (voice loss, scratchy throat, etc.) and hopefully that will help with the claim. Hope everyone has a great weekend!
 
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