Insurance issues with Prilosec

April 13, 2004

Hi,

Colin has been on Prilosec since he was a newborn and now our new

insurance company won't pay for it. They will only pay for the

Prilosec OTC version of the drug, which according to Colin's GI

doctor's nurse, is a different medication. I can tell a huge

difference in Colin's reflux, and he is even telling me now when the

food comes up that it hurts and he is eating less. Any tips for

getting the insurance company to pay for it again? I do have an

appt. with the doctor on the 23rd so maybe he can write a letter.

Colin (RSS, g-tube) and Hayden - 40 mo. twins

Grant - 3.5 mo.

April 13, 2004

Hi,

From what I understand even if you switch insurance companies they can not

change the continuity of care. They have in your case so I would have the

GI doctor write a letter and explaining the differences in the drug OTC and

RX and also how it has affected Colin. I think you can fight this and win.

J

>

> Reply-To: RSS-Support

> Date: Tue, 13 Apr 2004 23:54:37 -0000

> To: RSS-Support

> Subject: Insurance issues with Prilosec

>

> Hi,

>

> Colin has been on Prilosec since he was a newborn and now our new

> insurance company won't pay for it. They will only pay for the

> Prilosec OTC version of the drug, which according to Colin's GI

> doctor's nurse, is a different medication. I can tell a huge

> difference in Colin's reflux, and he is even telling me now when the

> food comes up that it hurts and he is eating less. Any tips for

> getting the insurance company to pay for it again? I do have an

> appt. with the doctor on the 23rd so maybe he can write a letter.

>

> Colin (RSS, g-tube) and Hayden - 40 mo. twins

> Grant - 3.5 mo.

>

April 14, 2004

Hi ,

So far our insurance is still paying for prilosec. However, the last

time we saw Dr H, she told us that if they didn't want to pay, she

would change his prescription from prilosec to prevacid. You may

want to look into that.

Good luck,

Judith, Steve, (RSS) and (non RSS) 4 year old twins

April 15, 2004

,

We were having the same problem with prilosec and our ins. company. Have the

dr. write a letter stating that it needs to be given by G-tube and that over the

counter version won't work.

We have to get it approved every time there is a new refill on the prescription

but at least it is covered for now.

Another thing is check with the case manager with ins. company and have them

check with the pharmaist with the ins. company. There is a loop hole it is just

figure out how it has to be done.

The other thing is the medication has to be mixed in a special pharmacy because

of how they make it into a liquid form so work with them too. Usually the

pharmacy connected to the hospital.

Maloy mom to Tori g tube prilosec cyptahepadine