ok so today i go to refill my pulmozyme and i been no this medication for all my life. but i recently just got my medicare part a and b and d insur in may of this year.i also do have cigna and medicaid but the medicaid is fixing to go away as of my medicare. with that said today i go and refill my medicene and bear in mind i havent refilld this medicene since last yr as i was never compliant they gave all kinds of reasons all to do with one another.so now im stuck with not knowing what to do <img src="i/expressions/face-icon-small-sad.gif" border="0"> i need this nebulizer obviosly its the nebs that are a problem but i was able to refill my hypertonic saline??no problem with that and thats a nebulizer???what the heck but my social worker at my docs office said i shouldnt be using neither as i do have cigna?but everywhere ive gone ive given all the rite insur info all of them so i dont understand whats up.as never been an issue before and she made it sound like i can get in alot of trouble so when iv been refilling all these meds why wasnt this said before?so dont know what to do and i obviosly if i can go with the copay of medicare of course id do that over cigna and my local pharmacy has never had a problem with this so if it was a problem wouldnt they have told me that?answers please on what to do with my pulmozyme <img src="i/expressions/face-icon-small-sad.gif" border="0"> ive never been in this issue before thanks
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Today i was declined refill on my pulmozyme????!
- Thread starter carly23
- Start date
ok so today i go to refill my pulmozyme and i been no this medication for all my life. but i recently just got my medicare part a and b and d insur in may of this year.i also do have cigna and medicaid but the medicaid is fixing to go away as of my medicare. with that said today i go and refill my medicene and bear in mind i havent refilld this medicene since last yr as i was never compliant they gave all kinds of reasons all to do with one another.so now im stuck with not knowing what to do <img src="i/expressions/face-icon-small-sad.gif" border="0"> i need this nebulizer obviosly its the nebs that are a problem but i was able to refill my hypertonic saline??no problem with that and thats a nebulizer???what the heck but my social worker at my docs office said i shouldnt be using neither as i do have cigna?but everywhere ive gone ive given all the rite insur info all of them so i dont understand whats up.as never been an issue before and she made it sound like i can get in alot of trouble so when iv been refilling all these meds why wasnt this said before?so dont know what to do and i obviosly if i can go with the copay of medicare of course id do that over cigna and my local pharmacy has never had a problem with this so if it was a problem wouldnt they have told me that?answers please on what to do with my pulmozyme <img src="i/expressions/face-icon-small-sad.gif" border="0"> ive never been in this issue before thanks
ok so today i go to refill my pulmozyme and i been no this medication for all my life. but i recently just got my medicare part a and b and d insur in may of this year.i also do have cigna and medicaid but the medicaid is fixing to go away as of my medicare. with that said today i go and refill my medicene and bear in mind i havent refilld this medicene since last yr as i was never compliant they gave all kinds of reasons all to do with one another.so now im stuck with not knowing what to do <img src="i/expressions/face-icon-small-sad.gif" border="0"> i need this nebulizer obviosly its the nebs that are a problem but i was able to refill my hypertonic saline??no problem with that and thats a nebulizer???what the heck but my social worker at my docs office said i shouldnt be using neither as i do have cigna?but everywhere ive gone ive given all the rite insur info all of them so i dont understand whats up.as never been an issue before and she made it sound like i can get in alot of trouble so when iv been refilling all these meds why wasnt this said before?so dont know what to do and i obviosly if i can go with the copay of medicare of course id do that over cigna and my local pharmacy has never had a problem with this so if it was a problem wouldnt they have told me that?answers please on what to do with my pulmozyme <img src="i/expressions/face-icon-small-sad.gif" border="0"> ive never been in this issue before thanks
mamaScarlett
Active member
is it possible that the prescription has just expired? if it was a year ago its probably expired by now and the pharm can't fill it till they get a new order from doc.
just a thought...maybe i'm totally off, but i've gone to fill things before that i haven't used in a long time only find out that they were from a year+ ago...
you'll have to be upfront with the docs and tell them you want to be compliant now and need new orders for your meds. if the doc writes the order i don't see why you'd have a problem getting the pulmozyme.
hope things work out for you!
just a thought...maybe i'm totally off, but i've gone to fill things before that i haven't used in a long time only find out that they were from a year+ ago...
you'll have to be upfront with the docs and tell them you want to be compliant now and need new orders for your meds. if the doc writes the order i don't see why you'd have a problem getting the pulmozyme.
hope things work out for you!
mamaScarlett
Active member
is it possible that the prescription has just expired? if it was a year ago its probably expired by now and the pharm can't fill it till they get a new order from doc.
just a thought...maybe i'm totally off, but i've gone to fill things before that i haven't used in a long time only find out that they were from a year+ ago...
you'll have to be upfront with the docs and tell them you want to be compliant now and need new orders for your meds. if the doc writes the order i don't see why you'd have a problem getting the pulmozyme.
hope things work out for you!
just a thought...maybe i'm totally off, but i've gone to fill things before that i haven't used in a long time only find out that they were from a year+ ago...
you'll have to be upfront with the docs and tell them you want to be compliant now and need new orders for your meds. if the doc writes the order i don't see why you'd have a problem getting the pulmozyme.
hope things work out for you!
mamaScarlett
Active member
is it possible that the prescription has just expired? if it was a year ago its probably expired by now and the pharm can't fill it till they get a new order from doc.
<br />just a thought...maybe i'm totally off, but i've gone to fill things before that i haven't used in a long time only find out that they were from a year+ ago...
<br />you'll have to be upfront with the docs and tell them you want to be compliant now and need new orders for your meds. if the doc writes the order i don't see why you'd have a problem getting the pulmozyme.
<br />hope things work out for you!
<br />just a thought...maybe i'm totally off, but i've gone to fill things before that i haven't used in a long time only find out that they were from a year+ ago...
<br />you'll have to be upfront with the docs and tell them you want to be compliant now and need new orders for your meds. if the doc writes the order i don't see why you'd have a problem getting the pulmozyme.
<br />hope things work out for you!
P
pencf
Guest
Carly,
That sucks! I can't believe you haven't been on Pulmozyme since last year....that is what you said isn't it???
I would contact Pulmozyme directly and see if they can help.
There are also some private foundations who help fund CF meds for patients in need...contact your local CFF to see if there is one your area.
Lastly, CF Pharm might be good place to call....see if they will take any of your insurances. They also have a program that helps pay for meds. CF is such a Financially catastrophic disease.....none of the medications are even close to being reasonable! Pulmozyme if prescribed 2x a day is Over $4000 for a month....CASTON is $5000 per month, and TOBI is $5000 per month....who has that kind of money....even the copays are over the top! And Obama wants to the MEDICAID and MEDICARE programs to fund the Health Care REFORM....WHAT???? How does that make sense taking care away for people the gov'mnt already deemed needy enough to get help....and you are going to take it away! THAT is CRAzY!
Mom of 2, 19 w/o CF, 15 yr old with CF
That sucks! I can't believe you haven't been on Pulmozyme since last year....that is what you said isn't it???
I would contact Pulmozyme directly and see if they can help.
There are also some private foundations who help fund CF meds for patients in need...contact your local CFF to see if there is one your area.
Lastly, CF Pharm might be good place to call....see if they will take any of your insurances. They also have a program that helps pay for meds. CF is such a Financially catastrophic disease.....none of the medications are even close to being reasonable! Pulmozyme if prescribed 2x a day is Over $4000 for a month....CASTON is $5000 per month, and TOBI is $5000 per month....who has that kind of money....even the copays are over the top! And Obama wants to the MEDICAID and MEDICARE programs to fund the Health Care REFORM....WHAT???? How does that make sense taking care away for people the gov'mnt already deemed needy enough to get help....and you are going to take it away! THAT is CRAzY!
Mom of 2, 19 w/o CF, 15 yr old with CF
P
pencf
Guest
Carly,
That sucks! I can't believe you haven't been on Pulmozyme since last year....that is what you said isn't it???
I would contact Pulmozyme directly and see if they can help.
There are also some private foundations who help fund CF meds for patients in need...contact your local CFF to see if there is one your area.
Lastly, CF Pharm might be good place to call....see if they will take any of your insurances. They also have a program that helps pay for meds. CF is such a Financially catastrophic disease.....none of the medications are even close to being reasonable! Pulmozyme if prescribed 2x a day is Over $4000 for a month....CASTON is $5000 per month, and TOBI is $5000 per month....who has that kind of money....even the copays are over the top! And Obama wants to the MEDICAID and MEDICARE programs to fund the Health Care REFORM....WHAT???? How does that make sense taking care away for people the gov'mnt already deemed needy enough to get help....and you are going to take it away! THAT is CRAzY!
Mom of 2, 19 w/o CF, 15 yr old with CF
That sucks! I can't believe you haven't been on Pulmozyme since last year....that is what you said isn't it???
I would contact Pulmozyme directly and see if they can help.
There are also some private foundations who help fund CF meds for patients in need...contact your local CFF to see if there is one your area.
Lastly, CF Pharm might be good place to call....see if they will take any of your insurances. They also have a program that helps pay for meds. CF is such a Financially catastrophic disease.....none of the medications are even close to being reasonable! Pulmozyme if prescribed 2x a day is Over $4000 for a month....CASTON is $5000 per month, and TOBI is $5000 per month....who has that kind of money....even the copays are over the top! And Obama wants to the MEDICAID and MEDICARE programs to fund the Health Care REFORM....WHAT???? How does that make sense taking care away for people the gov'mnt already deemed needy enough to get help....and you are going to take it away! THAT is CRAzY!
Mom of 2, 19 w/o CF, 15 yr old with CF
P
pencf
Guest
Carly,
<br />
<br />That sucks! I can't believe you haven't been on Pulmozyme since last year....that is what you said isn't it???
<br />
<br />I would contact Pulmozyme directly and see if they can help.
<br />There are also some private foundations who help fund CF meds for patients in need...contact your local CFF to see if there is one your area.
<br />Lastly, CF Pharm might be good place to call....see if they will take any of your insurances. They also have a program that helps pay for meds. CF is such a Financially catastrophic disease.....none of the medications are even close to being reasonable! Pulmozyme if prescribed 2x a day is Over $4000 for a month....CASTON is $5000 per month, and TOBI is $5000 per month....who has that kind of money....even the copays are over the top! And Obama wants to the MEDICAID and MEDICARE programs to fund the Health Care REFORM....WHAT???? How does that make sense taking care away for people the gov'mnt already deemed needy enough to get help....and you are going to take it away! THAT is CRAzY!
<br />
<br />Mom of 2, 19 w/o CF, 15 yr old with CF
<br />
<br />That sucks! I can't believe you haven't been on Pulmozyme since last year....that is what you said isn't it???
<br />
<br />I would contact Pulmozyme directly and see if they can help.
<br />There are also some private foundations who help fund CF meds for patients in need...contact your local CFF to see if there is one your area.
<br />Lastly, CF Pharm might be good place to call....see if they will take any of your insurances. They also have a program that helps pay for meds. CF is such a Financially catastrophic disease.....none of the medications are even close to being reasonable! Pulmozyme if prescribed 2x a day is Over $4000 for a month....CASTON is $5000 per month, and TOBI is $5000 per month....who has that kind of money....even the copays are over the top! And Obama wants to the MEDICAID and MEDICARE programs to fund the Health Care REFORM....WHAT???? How does that make sense taking care away for people the gov'mnt already deemed needy enough to get help....and you are going to take it away! THAT is CRAzY!
<br />
<br />Mom of 2, 19 w/o CF, 15 yr old with CF
Before assuming your insurance flat-out won't cover it, I do agree with Christian in that you do need to get a new script and find out if the only reason it wasn't covered is due to it being expired, since that it really simple to remedy. Emily's current insurance requires a new script to be written every 6mo even if there are refills remaining, and no script is 'good' more than a year after the original prescribing date regardless of the insurance you have or pharmacy you use. You may also need a pre/prior-authorization for it, which can be a hassle but generally isn't that big of a deal to obtain.
Before assuming your insurance flat-out won't cover it, I do agree with Christian in that you do need to get a new script and find out if the only reason it wasn't covered is due to it being expired, since that it really simple to remedy. Emily's current insurance requires a new script to be written every 6mo even if there are refills remaining, and no script is 'good' more than a year after the original prescribing date regardless of the insurance you have or pharmacy you use. You may also need a pre/prior-authorization for it, which can be a hassle but generally isn't that big of a deal to obtain.
Before assuming your insurance flat-out won't cover it, I do agree with Christian in that you do need to get a new script and find out if the only reason it wasn't covered is due to it being expired, since that it really simple to remedy. Emily's current insurance requires a new script to be written every 6mo even if there are refills remaining, and no script is 'good' more than a year after the original prescribing date regardless of the insurance you have or pharmacy you use. You may also need a pre/prior-authorization for it, which can be a hassle but generally isn't that big of a deal to obtain.
Carly, you might want to give this a gander:
<a target=_blank class=ftalternatingbarlinklarge href="http://www.cfpaf.org/
">http://www.cfpaf.org/
</a>
The qualifications aren't strict at all, but I should tell you that they only cover nebulized medications. I have this and I get my hypertonic saline absolutely free every month! It might do you some justice to check it out, as that would rectify your pulmozyme inadequacy.
<a target=_blank class=ftalternatingbarlinklarge href="http://www.cfpaf.org/
">http://www.cfpaf.org/
</a>
The qualifications aren't strict at all, but I should tell you that they only cover nebulized medications. I have this and I get my hypertonic saline absolutely free every month! It might do you some justice to check it out, as that would rectify your pulmozyme inadequacy.
Carly, you might want to give this a gander:
<a target=_blank class=ftalternatingbarlinklarge href="http://www.cfpaf.org/
">http://www.cfpaf.org/
</a>
The qualifications aren't strict at all, but I should tell you that they only cover nebulized medications. I have this and I get my hypertonic saline absolutely free every month! It might do you some justice to check it out, as that would rectify your pulmozyme inadequacy.
<a target=_blank class=ftalternatingbarlinklarge href="http://www.cfpaf.org/
">http://www.cfpaf.org/
</a>
The qualifications aren't strict at all, but I should tell you that they only cover nebulized medications. I have this and I get my hypertonic saline absolutely free every month! It might do you some justice to check it out, as that would rectify your pulmozyme inadequacy.
Carly, you might want to give this a gander:
<br /><a target=_blank class=ftalternatingbarlinklarge href="http://www.cfpaf.org/
">http://www.cfpaf.org/
</a><br />
<br />The qualifications aren't strict at all, but I should tell you that they only cover nebulized medications. I have this and I get my hypertonic saline absolutely free every month! It might do you some justice to check it out, as that would rectify your pulmozyme inadequacy.
<br /><a target=_blank class=ftalternatingbarlinklarge href="http://www.cfpaf.org/
">http://www.cfpaf.org/
</a><br />
<br />The qualifications aren't strict at all, but I should tell you that they only cover nebulized medications. I have this and I get my hypertonic saline absolutely free every month! It might do you some justice to check it out, as that would rectify your pulmozyme inadequacy.
Hi Carly, yeah, first check to see if the prescription itself has not expired. If it hasn't , since you have parts A and B medicare, you should still be covered for pulmozyme. I have medicare as my primary for A and B as well as part D for my prescriptions. Now, since pulmozyme has to be nebulized, it is covered under part B medicare, you just have a 20% out of pocket expense which should be picked up by one of your other insurances (Cigna or medicaid). I have been on pulmozyme since my dx in 2005 and medicare has picked it up no problem, my medigap insurance has always picked up the remaining 20% tab that medicare does not cover. The same goes with any nebbed med that is on the formulary such as atrovent, albuterol, hypertonic saline, TOBI, pulmocort. The ones that aren't covered under part B are Colistin and Cayston (too early, it will probably be added on the formulary within a few years hopefully, Colistin isn't because it isn't FDA approved to be nebbed for PA...at least that was the explanation that was given to me). Good luck, you should have coverage one way or another...you may have to go through a pharmacy that processes medicare, many retail drug stores do not, so it is usually somewhere like Foundation care (which by the way, rocks!) or Curascript (which I do not like...it took forever to get my meds straightened out when I used them).
Jenn
Jenn
Hi Carly, yeah, first check to see if the prescription itself has not expired. If it hasn't , since you have parts A and B medicare, you should still be covered for pulmozyme. I have medicare as my primary for A and B as well as part D for my prescriptions. Now, since pulmozyme has to be nebulized, it is covered under part B medicare, you just have a 20% out of pocket expense which should be picked up by one of your other insurances (Cigna or medicaid). I have been on pulmozyme since my dx in 2005 and medicare has picked it up no problem, my medigap insurance has always picked up the remaining 20% tab that medicare does not cover. The same goes with any nebbed med that is on the formulary such as atrovent, albuterol, hypertonic saline, TOBI, pulmocort. The ones that aren't covered under part B are Colistin and Cayston (too early, it will probably be added on the formulary within a few years hopefully, Colistin isn't because it isn't FDA approved to be nebbed for PA...at least that was the explanation that was given to me). Good luck, you should have coverage one way or another...you may have to go through a pharmacy that processes medicare, many retail drug stores do not, so it is usually somewhere like Foundation care (which by the way, rocks!) or Curascript (which I do not like...it took forever to get my meds straightened out when I used them).
Jenn
Jenn