Why do insurance companies not cover PPIs such as prevacid?
I was taking prevacid for about three months after being given several samples. I now have a primary care physician. They called in a prescription for prevacid to my local pharmacy, who stated that I have to pay $159.99 for the prevacid, unless I have taken nexium or protonix before, which I have not. Are PPIs so dangerous that pharmacies do not want to take the risk? Or is it some other reason?
I do not know what Insurance company you have but they have a "Drug Formulary". This is a list of drugs your insurance company will pay for. This is strictly a COST issue, it has nothing to do with the safety or effectiveness of a given drug.
I think you mis-understood the pharmacist, the other drugs mentioned are in the Formulary and are possible substitution for Prevacid and your insurance company would pay for them.
Talk to your doctor about the problem, he/she can talk to the pharmacy and prescribe a drug the insurance will pay for and your doctor feels is safe and effective.
July 17th, 2010 at 5:57 am
Nexium or Protonix are also PPIs. Just like Prevacid. I’ve taken this maintenance drugs before for my GERD. Check if your insurance has set a ceiling in which you might already consumed for that particular illness. If you have GERD or acid reflux, try the water theraphy. Mine does not recurred for about 5 months now since I started water theraphy. Those PPIs are not cheap and sometimes difficult to find in local pharmacy. Note also the side effects of PPIs. What what I heard and learned from my doctors (gastroenterologists) Nexium is the best so far.
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July 17th, 2010 at 6:11 am
I have United Health Care. Starting this year they stopped covering my Prevacid. UHC wants me to use OTC medication like Nexium.
Not because it is dangerous, but because they feel OTCs are almost as good as the prescription stength. It is a matter of $$$. If it was dangerous, the FDA would have shout it down.
My Dr. prefers Prevacid for my condition. I am originally from India, and my uncle (he is a Dr. in the US) get me generic Prevacid from India made by Cipla Labs as LANZOL. The cost is (in India) $2 (yes, two dollars) per month for 30 capsules. This is cheaper than my Copay I had with UHC.
If you know someone from India, maybe they can get it for you. LANZOL is available in 15mg and 30mg strengths. CIPLA is a world-class pharmaceutical and their drugs are sold legally all over the world (except USA due to patent restrictions).
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July 17th, 2010 at 6:55 am
I do not know what Insurance company you have but they have a "Drug Formulary". This is a list of drugs your insurance company will pay for. This is strictly a COST issue, it has nothing to do with the safety or effectiveness of a given drug.
I think you mis-understood the pharmacist, the other drugs mentioned are in the Formulary and are possible substitution for Prevacid and your insurance company would pay for them.
Talk to your doctor about the problem, he/she can talk to the pharmacy and prescribe a drug the insurance will pay for and your doctor feels is safe and effective.
References :
July 17th, 2010 at 7:08 am
they are safe……..and expensive. The latter is why they don’t like to pay for them.
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lil old me. Pharmacist for 18 years