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JuliaFaith

Insurance will only pay for 6 of 30 tablets

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Ds was instructed to take Alinia for another 30 days after just finishing 30 days. We had no problem getting it covered before. Now with a new insurance company (UHC) they have only agreed to pay for 6 tablets in a 31 day time-frame! This prescription costs around $700 for 1-month.

 

So, I remembered that our dr. said this might happen and looked at my notes. Have a name/no. of a pharmacy in Canada to see how much it will cost there (Mark's Pharmacy). Someone else told me I first have to see a dr. there and then get prescription in order to buy up there.

 

Anyone dealt with this issue?

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My sister's insurance did the same thing, but she was able to get an overide I think after many calls. I will forward her this post and hopefully she will comment on how she was able to get them to pay.

Colleen

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Ds was instructed to take Alinia for another 30 days after just finishing 30 days. We had no problem getting it covered before. Now with a new insurance company (UHC) they have only agreed to pay for 6 tablets in a 31 day time-frame! This prescription costs around $700 for 1-month.

 

So, I remembered that our dr. said this might happen and looked at my notes. Have a name/no. of a pharmacy in Canada to see how much it will cost there (Mark's Pharmacy). Someone else told me I first have to see a dr. there and then get prescription in order to buy up there.

 

Anyone dealt with this issue?

 

I don't think you need to see a dr in Canada to get a rx filled, as long as you have a rx from a dr from US they will fill it.

 

Linda

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Juliafaith- This is what my sisiter said about her insurance company. Not sure if this will help or not.

Colleen

 

I only got one override, that's all most will allow. Ended up paying over 100 per child per month. Dennis' company switched insurance companies, and although there are lots of bad things about ,as long as we get our meds at Rite-Aid or mail order they have been paying for everything. What is the medicine she mentioned? I haven't heard of it. Other choice is to switch med if possible, b/c they would pay for longer use of other antibiotics, just not Zith.

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I haven't had to deal with this issue, but did some research a while back when I assumed that insurance was going to stop paying. You can often find meds online for much cheaper than your local retail pharmacy. Just be sure that you are using a legit pharmacy (one that actually requires a prescription) so that you can be comfortable that you are actually getting legit meds.

 

Check out pharmacychecker.com or legitscript.com. Also, the National Association of Boards of Pharmacy has a short list of pharmacies that are accredited. http://www.nabp.net/programs/accreditation/vipps/find-a-vipps-online-pharmacy/

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I don't think you'll be able to get Alinia compounded here in the US. I tried a few months ago when I found out they have aluminum in them (for the coloring of course!), and was unable to. I believe it is still under patent, which prevents the compounding pharmacies from getting the generic drug.

 

Whenever running into this issue, though, it is good to remember about the compounding pharmacies. They can be a lot cheaper, and as a bonus you can avoid some additional bad ingredients.

 

Yes, plenty of pharmacies out there. I do believe most will want a prescription, but sounds like that's no problem given your situation. I do believe there are pharmacies out there that do not require a prescription, but I think they are a bit harder to find.

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Thank you for all your ideas. Since we needed it in a couple of days had to fill at the pharmacy. But I did call a pharmacy in Canada and it was $1.23/tab. vs. $23/tab in the US! They had to order it out of London and it would have taken 2-3 weeks which was too long. It really makes you wonder about the pharmaceutical companies (although have been wondering about them for other reasons as well).

 

Figure it will not hurt to file an appeal with our insurance although they will want to talk with the dr. and not sure if dr. would want to do that since they do not deal with insurance at all. Worth a try at $500 for 24 tabs. I feel for everyone else having to deal with insurance and illness at the rate we are having to in order to get healthy.

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I haven't had to deal with this issue, but did some research a while back when I assumed that insurance was going to stop paying. You can often find meds online for much cheaper than your local retail pharmacy. Just be sure that you are using a legit pharmacy (one that actually requires a prescription) so that you can be comfortable that you are actually getting legit meds.

 

Check out pharmacychecker.com or legitscript.com. Also, the National Association of Boards of Pharmacy has a short list of pharmacies that are accredited. http://www.nabp.net/programs/accreditation/vipps/find-a-vipps-online-pharmacy/

Thank you. Wrote these in my medical book in case this comes up again. Will probably check with the place in Canada too since the cost is so low. Take care.

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