insurance denied prevacid

Discussion in 'The First Year' started by w101ttd, Sep 30, 2010.

  1. w101ttd

    w101ttd Well-Known Member

    My girl has bad reflux.she was on zantac, prilosec.but nothing worked.her doc just prescribed prevacid.but my insurance keep denying it. We have been paying for the med at full price (10 bucks/pill, 100/month supply). Does anyone know where I can buy it cheaper? I don't know why this med ridisculously expensive.but it works.
  2. twoplustwo

    twoplustwo Well-Known Member

    No idea. Maybe you could have our doc office call your insurance to see why it's being denied and what your other options may be.
  3. eagleswings216

    eagleswings216 Well-Known Member

    We got a letter from our insurance saying they would no longer pay for the prevacid as of Oct. 1. Our doctor is going to write a letter and try to get an exception - we, too, tried everything else and nothing worked except Prevacid. We hope to be off of it soon, but for now, our doc is going to try and get it approved for us.

    Basically, they are no longer covering Prevacid for anyone because for most adults, there are lots of other options, including a generic. Problem is, there is no generic of the dissovable tablet for the babies. I think if you doc approaches it that way, the insurance might pay for it. That's what we're going to try.

    Doc said if that doesn't work, we can get the generic Prevacid tabs and sprinkle the little balls in their solid food. She said that won't work QUITE as well, but it's better than nothing.
  4. w101ttd

    w101ttd Well-Known Member

    Yeah our doc tried for days now but they kept denying it. Now our doc is working on another med for her.its been a long time since I saw her that happy. She is so happy and plays without crying and screaming. Well, I just go ahead and pay for it then. Damn insurance company!!
  5. Katheros

    Katheros Well-Known Member

    I took Prevacid for a short time while I was pregnant for heartburn. My insurance at the time would only cover a month's supply and that was it, after a month I would have had to pay out of pocket. A guy I worked with at the time said his insurance company wouldn't pay for it either. My twins are 5 now, so that's how long ago that was! I guess it's just too expensive and insurance companies don't want to pay for it.
  6. mandywellman

    mandywellman Well-Known Member

    MY girls are on prevacid and insurance does not cover it either but they are on liquid form.. I did not know there was a disolving tablet form. IT blows. But it works and keeps them happy and not fussy so I just pay it. I am hoping they can come off it soooon! Been on it since about 1 month old and they are almost 6 months now!

    sorryy but maybe ask about liquid version,,,my girls get it twice a day 1ml each time and I pay about 45$ per baby so 90$ a month for ours
  7. Moodyzblu

    Moodyzblu Well-Known Member

    These insurance companies need to stop trying to play Dr and let the REAL Dr's decide what meds our children (our us parents) need. I have this same problem with special meds that one my children needs and certain meds that I need. It just doesn't seem right.
    4 people like this.
  8. twoplustwo

    twoplustwo Well-Known Member

  9. BubbleDragon

    BubbleDragon Well-Known Member

    You can look up "Buffer Babies" - it's a system that mixes up over the counter versions of meds (prevacid, etc) into a liquid at the appropriate dose for your babe. Do a search for it and get into contact with the researcher heading it up, and he'll send you forms to sign up and send you the supplies. It still is fairly expensive, but you get the appropriate dose (which is MUCH higher than most docs will prescribe anyway)....
  10. TwinxesMom

    TwinxesMom Well-Known Member

    Have they been on axid? Jessy was on it and it helped
  11. w101ttd

    w101ttd Well-Known Member

    My girl has been on zantac and prilosec. But none of them worked. She was always unhappy and uncomfortable. Since she takes prevacid, she becomes a happy baby. I don't care how much it costs.if its working, I don't want to try another med.she has been suffering from reflux since she is teething too. She chews on everything even crayons haha. So at least her reflux got taken care of.
  12. bbyboo1323

    bbyboo1323 Well-Known Member

    My insurance covered it but I recieved a letter a few weeks ago from Anthem saying they no longer would be covering it and it would go up to Tier 2 or 3 making it mega expensive. They suggested generics and to speak to my dr regarding it. However we no longer take it but we still recieved the letter because it was a past meds.

    On a reflux board I was on, Buffer Babies was a huge success for many.

    Also check out
  13. slugrad1998

    slugrad1998 Well-Known Member

    I have been on the prescribing end of this and insurance companies are so hard to work with. What your doctor needs to do if the prior authorization was denied is appeal. Some companies take appeals by letter. Some require the doc to call and talk to their doc. In my experience, if I explain that zantac and prilosec did not work and prevacid is the only other thing approved for infants, I have always gotten it covered. I do not recommend the prevacid liquid because it is not stable in solution and you get inconsistencies in dose (it loses effectiveness sometimes before the month is over). Most companies will approve the solutabs for children but if that is what your company is fighting then you can use the capsules and just empty the beads into cereal or babyfood.

    That being said, it may still be expensive. On my insurance it was a tier 3 because it was brand name and my copay was $50 a month

    Another option is to have your ped prescribe a higher dose and break it in half to make it last 2 months.
  14. JessiePlus2

    JessiePlus2 Well-Known Member

    Both of my twins were on Prevacid from 2 months to 12 months. Insurance denied it as well, so our doctor gave us samples for that entire year. He was so sick and tired of insurance companies denying coverage, that he just gave all his patients samples. We'd go in every month and pick up a bag of samples. Honestly it was great as we didn't have to fight with the insurance company and still got the medicine we needed. (And it was free!)
  15. slugrad1998

    slugrad1998 Well-Known Member

    That's great that your doctor could do that. Samples are getting harder and harder for doctors to obtain, so I have no idea how he had enough! We used samples mainly to see if a med worked before someone paid for it. The other option is contacting the company who makes the drug because sometimes they have savings cards or coupons for people who pay out of pocket.
  16. JessiePlus2

    JessiePlus2 Well-Known Member

    This was 3 years ago, so I don't know if that made any difference. I have no clue how he managed to get so many samples, but I was very thankful!
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