Insurance won't pay for 5 mg of Zyprexa!!!

Discussion in 'General Parenting' started by Alisonlg, Apr 18, 2007.

  1. Alisonlg

    Alisonlg New Member

    Have the rest of you run into this problem? After hearing how many of you have at least trialed Zyprexa with your difficult child's or whos difficult child's are currently on Zyprexa and saying that the 2.5 mg a day my son was on was sooooo low (in fact his discharging nurse at the psychiatric hospital said the same thing), I never expected a problem when we got the new script to bump up to 5 mg a day.

    I dropped off the Rx for 2.5 mg twice a day to the pharmacy on Thursday and as of today we are out of pills and the insurance is refusing to cover the Rx "for the safety of the patient!" I swear I felt like saying, "What about the safety of the three other patients on the insurance policy?" Because on the dose they feel is appropriate, I had a toddler-sized motorcycle thrown at my FACE during a rage! Grrrrrr.

    Of course, I have no direct phone number for the psychiatrist at the day hospital that actually prescribed the Zyprexa who would be the one to sign whatever authorization form the Insurance company wants (and the Insurance said that even AFTER they receive the form, they STILL may not approve the Rx!) and apparently they only do clinical rounds there on Wednesday mornings (which have now come and gone for the week). His assigned SW is out sick all week....Ugh.

    So, now husband is on his way to pick up 6 pills at full price from the pharmacy to get us through another 3 days. Joy.
     
  2. Stella Johnson

    Stella Johnson Active Member

    I got a denial like this a few years back for another drug difficult child was on but can't remember what it was. Turns out they just wanted an "authorization" from the doctor. Stupid since the doctor is the one who wrote the rx.... just another way for them to try to get of paying.

    Call and talk to someone at your ins co or if this is ins through an employer, have someone from HR talk to your insurance.

    Steph
     
  3. TerryJ2

    TerryJ2 Well-Known Member

    That's probably it (what Steph said), Alison. They just love jerking people around.
    I'm so sorry you're completly out, though. :frown:
    I'm sure it will work out. I'm chanting a mantra for you.
     
  4. huntersmom2002

    huntersmom2002 New Member

    DO YOU HAVE A COSTCO NEAR YOU? SEE IF THEY HAVE A GENERIC BRAND FOR Zyprexa. MY DOCTOR PUT ME ON FOCALIN I COULD NOT PAY 50.00, PLUS ANOTHER 50.00 FOR MY YEARLY ON MY INSURANCE. THEN THEY WENT TO ADDERALL(IT WOULD OF COST THE SAME), SO I GOT THE GENERIC FOR ADDERALL WHICH IS AMPHETIMINE SALTS AND I GET A 2 MONTH SUPPLY(NOT USING MY INSURANCE CARD)FOR 23.00. TRY THAT OUT. THEY SELL WHOLESALE.
     
  5. TerryJ2

    TerryJ2 Well-Known Member

    Some WalMarts are carrying scrips for $5. Lots of people are changing over. I've been going to Walgreens. I asked them if they were going to follow WalMart's lead and they said no. Sheesh. Seems like a no-brainer, but apparently they dont' have the capability to mass purchase like Walmart.
     
  6. JJJ

    JJJ Active Member

    Zyprexa doesn't have a generic. Our insurance company forced us to switch Tigger to Risperdal. Doesn't work nearly as well.
     
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