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Interesting Zofran tid-bit

PostPosted: Oct 04, 2004 1:52 pm
by emily
I was on the phone with the ins. co this morning. We have medical finally! Whoohoo. It has been 3 years since dh had a full time job (he left shortly after Sept. 11th to go back to college) and thus, we haven't had decent medical. Anyhow, I was checking on some info for our vision plan and decided to check some info regarding Zofran. Our health ins. contracts out our perscription coverage to an outside co. They really push their mail order option. I had checked online to cross reference with their formulary and it did show coverage for both 4 and 8 mg Zofran in both oral and sublinguial.

Long story short, the lady on the phone told me that 8 mg, 4 times a day would be an $11000 perscription and it wasn't covered. LOL I mean, this is the insurance lady and she seemed shocked. But I told her I knew it was covered monthly, and she said that yes, I could get it from my local retail pharmacy for $25 for a 120 pill, 30-day supply. (The $11K was for a 3 month mail order supply).

So, the point here is that she didn't think I had any Zofran coverage until I asked her to check other ways of filling the perscription. If I hadn't been persistent, I might have thought I didn't have any coverage.

And the other point, or question really is, I have to pay a $25 co-pay no matter how big the script. So, since it would be a 30-day supply, can my Dr. write me that large of a perscription? I mean the insurance told me it would be $25 for a 120 pill script. My other Dr. even though it was the same script of 8 mg 4 X day, only wrote it out for 30 pills, not 30 days. I want to save on my co-pays if possible.

Emily

PostPosted: Oct 04, 2004 8:18 pm
by mammaclare
Doctors don't have time to navigate all the companies' individual coverage policies. If you have a good OB, simply tell them that you have already spoken with your insurer and ask him/her to write the script exactly as you want it.

My own insurance covered my Z my whole PG, but only in 30 tab quantites, so I had to refill about every 5-7 days at $10 a pop. I didn't complain, however, as I was happy to get it at all~!

PostPosted: Oct 05, 2004 1:17 pm
by erin
My insurance will cover it in 60 tab quantities, regardless of 4 or 8 mg, so it definately pays to call and ask. My prescription coverage is also like yours, they do not cover it mail order becuase they do not consider it a "maintenance" drug (even though for us it is for awhile). They only cover retail pharmacy fills.

Bottom line, call becuase they are all different.

Erin
Alex 8/16/03
bean 3/18/05 (Zofran and 3 weeks of sub-q Reglan pump, now tapering out Reglan)

Watch the pharmacy too!

PostPosted: Oct 05, 2004 2:06 pm
by dolphinsnb
FYI - Watch how your pharmacy fills your prescription. I'm pretty sure my doctor wrote me a script for 30 days/pills, but the pharmacy only gave me 24. (Didn't notice at first - makes it hard to fight.)

Also, I'm sure my doctor wrote a script for 90 days of prenatal vitamins, but a different pharmacy only filled it with 30 pills...and charged me the same $25 copay!

So, make sure you know exactly what your script is for and then check to see how the pharmacy fills it before you leave!

Shannon

Watch the pharmacy too!

PostPosted: Oct 05, 2004 2:10 pm
by dolphinsnb
FYI - Watch how your pharmacy fills your prescription. I'm pretty sure my doctor wrote me a script for 30 days/pills, but the pharmacy only gave me 24. (Didn't notice at first - makes it hard to fight.)

Also, I'm sure my doctor wrote a script for 90 days of prenatal vitamins, but a different pharmacy only filled it with 30 pills...and charged me the same $25 copay!

So, make sure you know exactly what your script is for and then check to see how the pharmacy fills it before you leave!

Shannon

PostPosted: Oct 05, 2004 5:43 pm
by RebeccaM
Emily,

My prescription plan sounds exactly like yours, although I haven't inquired about mail order costs. But I know it's $25 for a 30-day supply. My plan (next time I'm pg) is to have the doc write the Rx for 8 mg pills at 32 mg. a day, so even if I dont use it all in a month, I will be getting the max for my money. My precription plan during my last pregnancy gave me 12 pills at a time for $25. I'm much happier with this new plan. :)

I actually had the phramacy accidently give me double my prescription of Zofran one time. I considered just keeping it, but it was about $400 worth of pills and I felt bad and didn't want the nice pharmacist to get in trouble so I returned them. :?

PostPosted: Oct 05, 2004 9:34 pm
by emily
Thanks for all of the replies. I definitely plan on 120 8 mg pills for $25. It does pay to call. I am so glad I am calling before I am pregnant. With my first, by the time I needed to call, I was too sick to persue these things.

Emily

PostPosted: Oct 07, 2004 11:03 pm
by Linablu
The insurance I was on in IL (1st half of pregnancy) paid for whatever quantity my OB ordered at whatever my copay was. When we moved, my hubby's new insurance fought and fought us, not wanting to pay for Zofran. Finally, after my OB submitted paperwork for the 3rd time, they agreed to pay for 9 pills at a time, for a $25 copay! It was RIDICULOUS! Every few days, I had to fork over $25 for 9 bleemin' pills!

PostPosted: Oct 08, 2004 9:16 am
by emily
Oh Chrissy, that is really tough. With my first PG I had EXCELLENT coverage. And it really came in handy. I paid less than $500 out of pocket for an $80,000 ish pg. However, shortly after DD was born, DH quit his job to return to school full time. This really has been a blessing but we have been without good medical coverage until August when dh became employed full time again. In taking a job, health coverage was the number one thing we were looking at because we knew we wanted another baby. DH took a lower salary to get better benefits because we knew with a pregnancy coming up, it would "pay" us more.

We are TTC asap because DH knows he will pretty much be tied to his job until after our next baby is born due to health insurance.

PostPosted: Oct 08, 2004 12:50 pm
by Linablu
Emily:

Is this the same Emily I was exchanging emails with? The same one who had a MISERABLE pregnancy just this past year? If so, you're seriously going to try to get pregnant again ASAP? :shock:

PostPosted: Oct 08, 2004 4:42 pm
by emily
LOL Nope, that is NOT me! My daughter turned three this past summer ;) And even then, it seems too soon to face HG again!