Insurance won't let me get refills

KRISS · 01-21-2007, 05:26 PM

Is anyone else on Emends? My onc gave me this to take on the first 3 days of chemo. I take one an hour before treatment and then one each morning for the 2 days after. It is for nausea and vomitting. I am having me second AC treatment tomorrow so went to get my refill today (comes in a 3 pill packet) and was told insurance would only allow one fill every 21 days. I have treatment every 14. They don't care and since it is Sunday could not talk to anyone at oncs office. Regular price is $325. So now I'm worried that I will be sick all week. They still give me drugs through port before I start but how different will it be with out this drug? Any suggestions?

chrisy · 01-21-2007, 06:12 PM

Kriss,

As if chemo wasn't sucky enough - to have bureaucracy get in the way just adds insult to injury. I'd get on the horn first thing in the morning with your insurance, maybe have your oncs office call too and see if they can get this decision reversed. I was denied over a certain number of something (Zofran I think) without a special note from the doctor. Maybe call your oncs office first and see what they can do on their end.

Good luck tommorrow

chris

Jean · 01-21-2007, 06:53 PM

Kriss,

You need that med (Emends) I took that during my chemo treatment also.
Can't imagine not having it....yes it will make a major difference. That is
a great med for nausea control. I had something similiar occur - first thing
call your insurance carrier and ask for manager in charge to clear the denial.
I don't know if your onc. will give you that med if the insurance does not
supply it since it is so exspensive. Do not take no for an answer when you speak with your insurance and ask for the very top people. The script
already calls for a 14 day renewal so they will have to recognize that your
chemo schedule is evey 2 wks. This is so unnecessary and no one should
have to deal with this.

Good Luck and let us know how you make out.

Jean

Mary Jo · 01-21-2007, 06:58 PM

Absolutely ridiculous. As someone else stated, as if chemo isn't bad enough but then to add insult to injury and have to face all the red tape. It really makes me sick. As everyone else stated, call your insurance company and fight it tooth and nail.

Why can't that part of illness be easier? So so sad for people to have to deal with insurance company stuff a long with not feeling well.

My heart goes out to you and pray pray pray that your insurance company reverses their decision.

Mary Jo

rinaina · 01-21-2007, 07:43 PM

So sorry you have to deal with this. I did take Emend also and it worked like a charm along with compazene and ativan as Rx for the first 3-4 days. You need to call the insurance and speak to the highest up person you can talk to there and also have your onc write a narrative, (you can write one too), stating the reason you need it in 14 days vs 21 days. I sure hope this gets resolved before your next treatment. I had minimal nausea thanks to the above drug combinations. I am praying for you that it all works out.

pel50 · 01-21-2007, 08:13 PM

I too was treated with Emend when I was on an every three week cycle of A/C. it worked great for me too. i found the three week cycle allowed me to recover from the A/C and I had a few days of feeling OK before my next treatment.

Good luck with your insurance.

Bev · 01-21-2007, 08:36 PM

I don't know what doing chemo w/o emend is like and don't want to know.

I would say put the emend on a credit card so as not to delay treatment. Call your state insurance board. They will contact the insurance company. You could also try to get your pharmacist to call, and as others have said you can ask to speak to a manager.

Read your insurance policy. I think eventually your insurance company will pay.It could take a couple of months though. They just need prodding. BB

cafe1084 · 01-21-2007, 09:04 PM

There just isn't much bargaining with the insurance companies....they must be trained not to give a damn about personal suffering. Zofran 8 MG- one before tx, again that evening, then twice a day for the next 2 days is an excellent alternative if you get nowhere with the EMEND...Zofran has become a very close companion of mine and I don't leave home without it!

Good Luck!
Steph

tousled1 · 01-22-2007, 07:32 AM

Kriss,

I think it all depends on how your prescription is written. You should make sure that your script states that you are having chemo every 2 weeks instead of every 3. You can also ask your oncologist for a prescription for Phenergan, which can be written for 30 pills. It is usually used to treat nausea that you get later.

Soccermom · 01-22-2007, 07:35 AM

Dea Kriss...
Ask your Onc if they have any samples? OR contact the manufacturer and explain? Perhaps these suggestions might help.

1-866-EMEND-Rx (1-866-363-6379)

Marcia

RhondaH · 01-22-2007, 08:03 AM

TALK TO YOUR ONC NURSE!!!! Mine wouldn't even cover it so I just paid for it out of pocket (had 6 dose dense TEC so times $300 for a 3 day, it cost me $1800...the pharmacy DROPPED when I pd for it, but I needed it so I took it out of my house fund). When my onc nurse found out, SHE got on the phone with the insurance and within 20 min told me to stop by the pharmacy and pick up my refund (my copay was $30 so it ended up costing me $180). These nurses are PHENOMINAL. I think they should have an ONCOLOGY NURSE DAY...i just don't know HOW they do it. Take care and God bless.

Rhonda

Colleen007 · 01-22-2007, 08:07 AM

Check with the Insurance Company. It could be that they'll approve it but that you have to get it through their mail order area vs. your local pharmacy (that's what happened with me). The other thing to look into is a different anti-nausea such as Zofran. Maybe your oncologist can write you another prescription for that and you can go back and forth as needed until your next refill becomes available.

KRISS · 01-22-2007, 12:51 PM

Thanks Ladies

We went early today before my treatment and Onc called and balled them out. Saying they need to keep up on things because standard treatment protocol is no longer always 3 wk intervals. It did not help with today but we won't have a problem on the next 6. They did not have a sample so my nurse. And Yes God LOVE Them, she shot me up with Ativan and sent me home with some pills as well. She said It may not controll the nausea as well but I won't care. I'll just sleep through it. Hahaha. Thanks for the suggestions and the concern I appreciate it. Well it's off to the couch for a day or two. Have a peaceful week. Kriss

Yorkiegirl · 01-22-2007, 12:51 PM

Now my Insurance Co. ( Tri-Care) only allowed so many Zofran, until my Onc stated that I was getting Dose Dense Chemo, also had a problem at first with my Neulasta, Onc stated again that I was getting Dose Dense. All was approved. for a whole year for me.

Now my Zofran for 20 pills was $628.00, by my Co-Pay is only $9.00.

SusanV · 01-22-2007, 04:32 PM

Kriss,

Glad things worked out...at my hospital where I got chemo, the nurses tried to give me the emend after I had already taken it at home. I was told that they could give it to me there instead of getting a script filled at the pharmacy, and then they would just bill my insurance. I was hoping that you would get some from your onc. I hope you are feeling well, and I am glad you got this ironed out for next time. Thank god for ativan !!

Thinking of you

KRISS · 01-23-2007, 02:57 AM

Ativan not as good as Emands. As you can see it is not even 5 and I've been up scince about 3. The massive headache started towards the end of my cytoxen drip around 1pm and has not let up. The nausea hit around 8. So poppin the zofran. I had virtually no problems on my first treatment until day 3. So I'm not sure if this is due to not having the Emends or if this is an accumulative affect of the DD AC. Any ideas? And how do you get rid of this headache? I agree with Sue Chemo sucks no matter how neccassary it is. kriss

tousled1 · 01-23-2007, 08:14 AM

Kriss,

Unfortunately DD A/C does have a cumulative effect. I was fortunate that I never actually got sick with it but I contribute that to taking the EMEND. I'm not saying I sailed through it by any means. I would have chemo and feel ok for about 2 days and then it was like walking into a brick wall! I got so exhausted all I could do was sleep, my counts dropped constantly and I was getting Neulasta shots for the white count and Procrit for the red counts. Just when I'd start feeling almost human again - WHAM, it was time for chemo again. Somehow we all get through it. We tend to be stronger than we think. I know that the Taxatere was worse for me than the A/C. The Decadron premed wound me up tighter than a kite and I had severe neuropathy with it. Just think you're half way done with the A/C. As for the headache just try laying down in a quiet, dark room. Also ice packs may help. Good luck to you.

KRISS · 01-23-2007, 10:01 AM

What is Neuropathy?

RhondaH · 01-23-2007, 10:59 AM

it is numbness and tingling in your hands and feet. I STILL have some and I will be 2 yrs out from chemo 5/16. Take care and god bless.

Rhonda

karen raines hunt · 01-23-2007, 03:53 PM

Hi Kriss,

I was also on Emend.......thank goodness!! Anyway, I met some other women during my chemo infusions whose insurance would not pay for the drug, so the onc nurses always had some from the drug reps on hand, just in case. Check with your nurses............I bet they will have it for you.

Good luck!

Karen