Insurance puts limitation on Zofran

[nogutsnoglory]

I take Zofran as an anti-nausea and vomiting medication but my insurance only gives me 12 pills per 6 week period. My doctor gave me a script for 50 with several refills but the pharmacy won't fill it because according to my insurance it's not a "medical necessity" and they don't care about treating symptoms. How is vomiting just a symptom? If one keeps vomiting they can't absorb food and can become severely dehydrated. Thankfully that's not my case and I take it more to avoid being nauseous but its so aggravating. Anyone else have any success getting this covered or know what the out of pocket expense is around?

 

[Essieluv]

That's ridiculous, I can't believe your insurance would refuse that! I take Zofran pretty much around the clock, and I've never heard a peep from my insurance, thank heavens. Perhaps you could get your doc to call the insurance company, as sometimes this has helped move things along and get coverage on drugs that they were refusing for me. Or maybe you could try the generic version (ondenestron I think it's called)? Sometimes I get the generic from my pharmacy, and it works just as good. I hope you get this figured out, rationing Zofran is not fun!

 

[nogutsnoglory]

The crazy part is that it is the generic they are giving me a problem over. I never even asked for brand! Maybe my GI can do a pre-auth and argue I need it.

I swear I think they just have me flagged as an expensive member and they can't deny my imaging, ibd meds and surgeries so they need to find a way to cut back.

 

[AuntieEm]

I have one of the Aetna plans and the Dr had to show "cause" for it. I don't use the name brand either but it was approved just at a higher level tier on my insurance plan.