Zofran and insurance

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Zofran and insurance

Postby Cecca » Jun 19, 2004 4:48 pm

Hi Everyone,
Just wondering how people deal/dealt with the issue of getting Zofran without going into debt? I may one day try for pg #3, and if so I want to be fully prepared. No one ever mentioned Zofran to me during my first three pregnancies (2 children, one baby lost to termination).

My insurance requires me to pay 30% of drug costs, and limits Zofran to 12 eight milligram tablets per 30 days. This doesn't seem like near enough if one can take 24 mg/day max when needed. Am I correct about that? In that case, can the MD just demand more, or is it really up to the insurance comapany?

Also, my formulary website lists Zofran and Zofran ODT. What is ODT? Is that dissolvable, or liquid, or are those the same thing? I've read about all these on this board but can't seem to quite figure it out.

Thanks for any help with this. Sorry if these are repetitive questions, but it's all new to me!

Cecca
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Postby emily » Jun 19, 2004 9:13 pm

I hope you get some answers to your questions, I will be watching. I was so lucky with my first one in that all of my zofran was paid for by the ins. and I actually think I was taking more than 24 mg a day. But my new ins. is not going to be so generous... and what I really want is the pump.
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Postby PamelaRose » Jun 20, 2004 1:08 pm

32 mg/day is the amount for the worst... Some insurance co's will pay for more Zofran if it's doctor prescribed, but most do cap at a certain # of pills per month. You can get Zofran oral, liquid, IV, sublingual. Even companies that won't pay for oral Zofran will pay for it if it's hospital-administered, which is stupid because they'd be saving if they paid in the first place to keep us OUT of the hospital. But lots of ladies who can't afford it on their own get it through ER or hospital visits. Not ideal, but it works. I've also heard of women who got around fighting about oral Zofran by using a Zofran infusion pump. For some reason (because it's administered and monitored more closely?) insurance companies seem more willing to pay for this. The best way is to call and ask questions. Most people can find at least some way around regulations that go against HGers. Good luck!
Pamela

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Postby RebeccaM » Jun 22, 2004 10:26 am

Zofran ODT (Orally Disintegrating Tablets) are the sublingual form. I couldn't handle taking pills with water so these were my life savers. When we were recently choosing a new insurance plan, the biggest factor for me was how much Zofran would cost me. One plan didn't cover the ODT's so that was out of the question. Luckily the one we chose has a very good prescription plan.

Pamela has some great insights. I second everything she said. :) Try calling your insurance company and explaining everything. Or have your doctor call. I believe this has worked for several women.
Rebecca
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