Anyone Dealt with Aetna successfully?

[jannyjo]

Hi Ladies,

I am looking to get Aetna to pay more of my copay for Zofran so that I can afford it. Has anyone dealt successfully with them on a similar issue? The zofran would make life so much easier on me and my family, but our current copay is about $200 per week for my script.

Thanks in advance,
Janet

[nomore]

Hi,

We have Aetna and have had for both of my pregnancies. Our co-pay for zofran is 12 pills for $25- now. (8 mgs or 4 mgs). Truthfully, oral zofran really isnt quite as effectivfe for me as IV.

Here is a tip. IV zofran and home health care is covered at 100% on my plan. Not even a co-pay. If you need hydration (which I did, I was dehydated even ON 24 hour hydration), getting the aetna to cover IV zofran shouldnt be an issue. (You may also need to get a PICC line for this though). You can also try the sub-q pumps (although I do not have experience in that).

Good luck,

Robin

[aaronsmommy]

The problem is that every plan, every state is different. Sometimes the plan is even different depending on the employer you get it from.
You can try this program http://www.togetherrxaccess.com/index.html
to see if the company will help out with meds. I think it is mostly for people who don't have coverage, so I don't know if it will help you.
The home health thing, like everyone else suggested is a way I got around restrictive limits and copays for zofran. I used the subcutaneous pump (from the home health company Matria) and got it covered 100%, it does involve needles, but they are tiny, and you don't need an IV.
I was also wondering if your pharmacy copays go toward your annual maximum? If you have to pay any coinsurance for the rest of your care, you will most likely hit your annual maximum this year unless it is really high, so you might as well pay for the zofran now, because you won't have to pay for the other things later.

[mammaclare]

Just an FYI about togetherrxaccess.com....the program only provides discount, not free, and only to people with NO rx coverage at all. And, only for on-label indications, which HG is not. My company is a part of the group that participates so I am fmailiar with the program.

SO, I wouldn;t waste time there. It is a great resource for the right audience but we aren't that group.

The best you can do is simply try and get the maximum number of pills allowed in each refill--that way you get the most possible for your $200. Or, you can try a mail in 90 day supply...my guess is that it would be kicked back as Zof isn't considered a "maintenance" medication (like blood pressure meds for example) but heck-worth a try.

I think Emily has been successful getting a lot of pills per co-pay but I also think she is having a really rough week right now so I don't know that she will read this or reply.

[RebeccaM]

I don't have Aetna insurance (my prescription plan is through Medco), but the ONLY way we have been able to afford my Zofran is by getting a 90-day mail order supply. There is a max copay of $50 for using mailorder under my plan, otherwise I would be paying 20% which would be completely unaffordable. I believe it is pretty common for insurance companies to give better deals when you order prescriptions through the mail. I did have to get special approval to get the amount I needed, but they were very willing to approve it (thank goodness). It is DEFINITELY worth a try to look into this. Good luck and I hope you figure something out.

[jannyjo]

Thanks for the suggestion Rebecca. Unfortunately, my copay for the mail order scripts doesn't save me any money. I wish we had a cap like that on the mail order scripts. We have to pay 25%, of their negotiated price, if it is a Brand name prescription and there is no generic.
Aetna has a price a drug feature that gives the 90 mail order pharmacy price side by side with the walk in pharmacy quote. I am pulling my hair out. The last two days have been he** because it seems to be getting worse again. I have a feeling that a hospital visit is in my very near future.

Thanks again,
Janet

[emily]

Hi Janet,

I had Aetna with my first pg. That was 4 years ago. It was a plan that paid 100% and I STILL had problems getting stuff covered. I tell you what, Aetna still owes me money!

With the Aetna plan I had, I had a flat co-pay that would cover 30 pills. My current insurance is different and will bascially cover as much zofran as I want, but only 30 days worth (though that 30 days can be up to 120 pills). Kinda strange that they are so generous with the zofran.

Anyhow, my suggestion would be to get home therapy and get it in an IV. Make sure that is indeed a cheaper route for you. The zofran works so much better through IV anyhow.

Good luck!

Emily

[RebeccaM]

Janet,

I'm so sorry you're feeling worse! It's a terrible situation to be in. Like Emily and some of the others suggested, maybe try home IV's. Maybe it would be cheaper. I hope you get some fluids and Zofran soon and start feeling better.