Re: Amphotericin B -- our ins wants prior approval

[Guest guest]

,

 

Amphotericin B is not FDA approved for G-tube administration.  It is only

approved for IV or IM administration.  It is only for life threatening

infections where prior medications have failed.   This is most likely the

reason it has not been approved.

 

Has the insurance company sent you anything in writing explaining their

decision? If not, ask them to send you a written explaination ( your policy & or

state insurance board probably has a policy/procedure for this type of

situation).  You have the right to this information to allow you the

opportunity to fully understand the lack of approval or the denial. 

 

When you are told the reason or what further information is required for their

review you will have a means to appeal a denial or gather the requested

information.

 

In prior approval situations, the doctor is usually asked to provide the prior

course of treatment that has failed and why this drug is needed.  Since this is

to be administred via the G-tube instead of the FDA approved methods, that also

needs to be explained.

 

Most insurance policies do not cover anything that is outside of the FDA

approved dosage, administration methods or for conditions not approved by the

FDA.

 

If you have any questions, reply to me off the board.

 

Joyce

 

From: brd5 <brd5@...>

Subject: Amphotericin B -- our ins wants prior approval

Date: Tuesday, January 4, 2011, 6:54 PM

 

Does everyone here have a hard time getting this stuff approved?

Dr. R prescribed it for my daughter back in early Nov and I'm still fighting

with the insurance company trying to get this stuff. Part of it may be since

it's usually an IV med, but we are giving it via a g-tube, so I think that's

confusing them.

I've spent so much time on the phone with them this morning, and we've gotten

pretty much nowhere. It's very frustrating, and I'm afraid this may be the case

for more meds we get as we progress down the road.

[Guest guest]

Sometimes we have to pay out of pocket for rxes and I find good compounding

pharmacies will often have these MUCH, MUCH cheaper than other pharmacies. Try

Coastal or Hopewell and ask them how much.

I know oral vancomycin was $750 at my local pharmacy and $70 at Coastal

Compounding. So, ridiculous and unaffordable versus tolerable.

Caryn

>

> Does everyone here have a hard time getting this stuff approved?

>

> Dr. R prescribed it for my daughter back in early Nov and I'm still fighting

with the insurance company trying to get this stuff. Part of it may be since

it's usually an IV med, but we are giving it via a g-tube, so I think that's

confusing them.

>

> I've spent so much time on the phone with them this morning, and we've gotten

pretty much nowhere. It's very frustrating, and I'm afraid this may be the case

for more meds we get as we progress down the road.

>

>

>

[Guest guest]

>

> ,

>  

> Amphotericin B is not FDA approved for G-tube administration.  It is only

approved for IV or IM administration.  It is only for life threatening

infections where prior medications have failed.   This is most likely the

reason it has not been approved.

IM is intramuscular? I know Dr. R & Dr. G both prescribe amphotericin B to our

kids and I doubt they are doing it by IV or injection. I know in the archives I

saw it mentioned as an oral compound.

> Has the insurance company sent you anything in writing explaining their

decision? If not, ask them to send you a written explaination ( your policy & or

state insurance board probably has a policy/procedure for this type of

situation).  You have the right to this information to allow you the

opportunity to fully understand the lack of approval or the denial. 

That is a good point. I will ask them to send me something in writing.

Thanks,

[Guest guest]

Amphoterecin B used to be available in a capsule - it was a light tan

coloured powder - then we lived in Singapore at the time we used it and got

it there - it was quite inexpensive I recall - Dr G prescribed it so one

would think that it was readily available here too!

_____

From: [mailto: ] On Behalf Of Joyce

Herron

Sent: Tuesday, January 04, 2011 6:48 PM

Subject: Re: Amphotericin B -- our ins wants prior approval

,

Amphotericin B is not FDA approved for G-tube administration. It is only

approved for IV or IM administration. It is only for life threatening

infections where prior medications have failed. This is most likely the

reason it has not been approved.

Has the insurance company sent you anything in writing explaining their

decision? If not, ask them to send you a written explaination ( your policy

& or state insurance board probably has a policy/procedure for this type of

situation). You have the right to this information to allow you the

opportunity to fully understand the lack of approval or the denial.

When you are told the reason or what further information is required for

their review you will have a means to appeal a denial or gather the

requested information.

In prior approval situations, the doctor is usually asked to provide the

prior course of treatment that has failed and why this drug is needed.

Since this is to be administred via the G-tube instead of the FDA approved

methods, that also needs to be explained.

Most insurance policies do not cover anything that is outside of the FDA

approved dosage, administration methods or for conditions not approved by

the FDA.

If you have any questions, reply to me off the board.

Joyce

From: brd5 <brd5@... <mailto:brd5%40> >

Subject: Amphotericin B -- our ins wants prior approval

<mailto:%40>

Date: Tuesday, January 4, 2011, 6:54 PM

Does everyone here have a hard time getting this stuff approved?

Dr. R prescribed it for my daughter back in early Nov and I'm still fighting

with the insurance company trying to get this stuff. Part of it may be since

it's usually an IV med, but we are giving it via a g-tube, so I think that's

confusing them.

I've spent so much time on the phone with them this morning, and we've

gotten pretty much nowhere. It's very frustrating, and I'm afraid this may

be the case for more meds we get as we progress down the road.

[Guest guest]

We ordered it from Friendly Hills Pharmacy (562)693-3791. Tell them you are a

patient of Dr. G's and they will call him for the Rx. It was in a capsule and

very inexpensive...

From: crosswilsons@...

Date: Wed, 5 Jan 2011 12:25:13 -0800

Subject: RE: Amphotericin B -- our ins wants prior approval

Amphoterecin B used to be available in a capsule - it was a light tan

coloured powder - then we lived in Singapore at the time we used it and got

it there - it was quite inexpensive I recall - Dr G prescribed it so one

would think that it was readily available here too!

_____

From: [mailto: ] On Behalf Of Joyce

Herron

Sent: Tuesday, January 04, 2011 6:48 PM

Subject: Re: Amphotericin B -- our ins wants prior approval

,

Amphotericin B is not FDA approved for G-tube administration. It is only

approved for IV or IM administration. It is only for life threatening

infections where prior medications have failed. This is most likely the

reason it has not been approved.

Has the insurance company sent you anything in writing explaining their

decision? If not, ask them to send you a written explaination ( your policy

& or state insurance board probably has a policy/procedure for this type of

situation). You have the right to this information to allow you the

opportunity to fully understand the lack of approval or the denial.

When you are told the reason or what further information is required for

their review you will have a means to appeal a denial or gather the

requested information.

In prior approval situations, the doctor is usually asked to provide the

prior course of treatment that has failed and why this drug is needed.

Since this is to be administred via the G-tube instead of the FDA approved

methods, that also needs to be explained.

Most insurance policies do not cover anything that is outside of the FDA

approved dosage, administration methods or for conditions not approved by

the FDA.

If you have any questions, reply to me off the board.

Joyce

From: brd5 <brd5@... <mailto:brd5%40> >

Subject: Amphotericin B -- our ins wants prior approval

<mailto:%40>

Date: Tuesday, January 4, 2011, 6:54 PM

Does everyone here have a hard time getting this stuff approved?

Dr. R prescribed it for my daughter back in early Nov and I'm still fighting

with the insurance company trying to get this stuff. Part of it may be since

it's usually an IV med, but we are giving it via a g-tube, so I think that's

confusing them.

I've spent so much time on the phone with them this morning, and we've

gotten pretty much nowhere. It's very frustrating, and I'm afraid this may

be the case for more meds we get as we progress down the road.

[Guest guest]

You can get it compounded into a powder form and that is how my insurance

covered it. It is quite expensive ­ it was around $1500/bottle (30 day

supply with dosing at 4/day). I think I got it from Hopewell Pharmacy in NJ

and they were able to get it covered.

Laureen

On 1/4/11 10:54 AM, " brd5 " <brd5@...> wrote:

>

>

>

>

>

> Does everyone here have a hard time getting this stuff approved?

>

> Dr. R prescribed it for my daughter back in early Nov and I'm still fighting

> with the insurance company trying to get this stuff. Part of it may be since

> it's usually an IV med, but we are giving it via a g-tube, so I think that's

> confusing them.

>

> I've spent so much time on the phone with them this morning, and we've gotten

> pretty much nowhere. It's very frustrating, and I'm afraid this may be the

> case for more meds we get as we progress down the road.

>

>

>

>

>

>

>