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.

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