Saturday, October 25, 2014

Sunday, June 21, 2009 CTMEDTECH, Community Member, asks

Q: Insurance company cuts costs and refuses to pay for my stomach medications

Do proton inhibitors all have the same basic main ingredients? I was taken off Nexium bc of Insurance purposes and now on protonix which does not work. I have to try 3 different inhibitors (have in the past) before the insurance companies agree to pay to go back on the Nexium. All of this aggrivation is because Nexium is so expensive. Over $200.00 for a 30 day supply. What ticks me off is this is the medication my gastroenterologist felt would work for me and it has but in  the meantime, the insurance company decides its costing them too much and Im assuming they are cutting back. I told them that I didnt purposely pick out the most costly and if something cheaper wouod work, I would gladly take it. In the meantime, my stomach is suffering tremendously. Any suggestions are appreciated. SmileThanks!

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Answers (1)
Jan Gambino, Health Guide
6/21/09 8:42am

Hello! I was just visiting my aunt last week and she said the same thing-her insurance company will not pay for the medication that is working the best to control her reflux symptoms.

You might need to make some phone calls to your insurance company. I was just on the phone with my insurance co last week and it is maddening-say your name, punch in your id number, transfer, transfer, hold, etc. You might be able to get to someone who can help you with an appeal to their decision. It doesn't make sense for them to pay for medication that does not work. Sometimes the doctors office has to write a letter, sometimes the member can fuss with the system and find a solution.

The PPI's are known by their brand names: Prevacid, Prilosec, Nexium, Protonix. Some people find that one medication works better than another.

Good luck....Jan

CTMEDTECH, Community Member
6/21/09 3:05pm

Thanks Jan, I appreciate your response. What a nightmere this has been. Ive already been through speaking to the insurance company~~they wont budge. I have to see another gastroenterologist which of course will probably want me to go tests all over again~~I am a nurse and trust me, these drs may be good but most of them over do it with the testing. The insurance company wants the actual notes to prove Ive been on these meds. The thing is, most drs give you samples to try and if they dont work, they usually dont chart it. Its only when they write the physical prescription that proves what youve been on which is my case. I spoke with someone at Nexium and  of course they love to hear that you are taking their product but Im not sure they are willing to help in other ways~~We'll see. Thanks again for everything. Hope your aunt gets some help as well.


Warm regards,

Robin from CT.

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By CTMEDTECH, Community Member— Last Modified: 11/17/10, First Published: 06/21/09