Daily Azithromycin and insurance

[JJMom39]

I am wondering how those who have kids on daily azithromycin for PANDAS get their insurance companies to pay for a 30-day supply of the medication. Ds9 was taking prophylactic azith (two 250 mg tablets twice per week), and our insurance would only pay for 6 pills at a time. Although it was annoying, it was manageable because we used our allotted 6 pills every 10 days so refills were doable. But now, he will be taking 500 mg per day (one 500 mg tablet). Our insurance will pay for three 500 mg tablets at a time, so that means I will have to order a refill and pick it up every 3 days!! It seems the only way around this is if ds has one of the diagnoses approved by our insurance company for extended use. This includes things like chronic sinusitis, Lyme, babesiosis, cystic fibrosis. He does not have any of these diagnoses. Has anyone else run into this problem, and if so, how did you deal with it? Did you find a way around it, or are you running to the pharmacy every 5 seconds?

[Tamistwins]

My mother had this exact issue when Dr. B put her on a month supply. You just have to get the pharmacist to override it, they will prob need to fax something for the doctors office to fill out. The only problem was that it cost around 50 dollars. My children used to be on liquid azith and we never encountered this problem.

[nicklemama]

There may be an appeals process for this that your doctor can state its medically necessary. We had this problem w/ our HMO. Never got to the appeals process. I kept getting the 6 pills at a time. We switched insurance at the first opportunity and have had no further problems w/ it. We now have a standard BCBS policy.

[NVAmom]

We had this problem. Initially Insurance would only approve 3 pills at a time. after 2 weeks they would not cover any refills. We appealed multiple times and ended up paying out of pocket.