medicare part D and vancomycin

[loria]

My dad was prescribed Vancomycin for C-dif (after a course of Flagyl failed to work) -- his insurance for his medicare part d refuses to pay for the medicine since he is in the 'donut hole--and hasn't spent enough on meds this year. he has NO money. (he is in his 80's and lives only on his social security--not a good retirement planner)--they are saying that this medicine will cost $2000--is there ANYTHING that i can do to argue with his part D insurer? this is really infuriating.

[byado18]

http://www.q1medicare.com/PartD-MoreOnT ... ageGap.php
is info on the Donut Hole -- not sure there is much you can do!

Suggest you call the MD and explain the situation and see if there is something else that might work that is less costly!

Good Luck!

[California Girl]

I work for a doctor and we are always running into the problem of insurances/Medicare not covering prescribed drugs.

See if your dad's doctor can prescribe a generic equivalent. Tell him/her it's too expensive, and the doctor should be willing to try and prescribe something that won't cost so much.

I don't know about Medicare, but with other insurances we can request a pre-authorization for them to cover the med if the patient has tried everything else and it has failed or not been tolerated well.

Also, check with the company that manufactures the drug. They often have plans to help people who can't afford their drugs, or at least discount programs. AstraZenica, Novartis and McKesson are a few I can think of at the moment.

Good luck!

[sailorgirl]

My mom was on Vanc for almost a year in an unsuccessful attempt to salvage an infected knee replacement. In retrospect I wish we opted for the surgical approach initially since that's where we ended up anyway. Vanc is tough to take and is the antibiotic of last resort, now she has a resistance to it, so she is really stuck if she needs it in the future.
I would discuss whether there are any alternatives.

[loria]

thanks all--i have to figure out how this donut hole stuff and part d works--if it is how i suspect then all my dad's regular meds are not going to be covered-- in terms of alternatives--well, there is a generic option, but in trials it has not proven to be as effective as the name brand. and in terms of non vancomycin options, we've exhausted all other and this is the option of last resort. This is rally a horrible situation and so many seniors (and others) face this all the time.

[byado18]

Check thi sout!

http://www.lilly.com/responsibility/ser ... /programs/

[patr]

Is he in the hospital? Or is this an outpatient treatment? My father was frequently treated with Vanco(IV) while in-patient; Medicare ALWAYS paid, no questions asked.

Perhaps he could be admitted and then treated; would it be covered under that scenario?

[LauraD]

I too was going to suggest the PAP that the Rx companies offer. If the doctor will write a script saying that Vanco is medically necessary insurance cannot be denied, also ask if the doc has samples, they get these at no cost from the Rx reps. Patr had a good suggestion, if all else fails, see if the doc will order IV Vanco at the hospital or IV clinic. Also, consider a probioticd along with the antibiotic. Antibiotics kill the bad bugs but also the good ones, probiotics will help with diarrhea, nausea and enhance the work of the antibiotic especially with CDiff where the gut is all out of wack. Laura

[GidgetPicklebrain]

"if it is how i suspect then all my dad's regular meds are not going to be covered"

Correct.

[BuffaloGal]

Check with the drug company and the Center for Medicare and Medicaid Services (CMS) to see if he qualifies for "extra help." His insurance company should help with this but you may need to make the calls on your own.

[Barb Y]

I am sure may be already aware of this but we have our Doctors request a prior authorization for payment when a specific med is needed and not covered. Best of luck. It is very sad that he (and you) have to go through this struggle when c-diff is struggle enough.

[loria]

Just found a potential program in massachusetts (where he lives) that might help him--sister is going to bring him the paperwork tonight--

but i also just looked up the stats on C-diff colitis ...25% mortality in elderly patients...not good at all...

[jimg20]

You are right in the middle of Diana's specialty. She is doing research for you now. There may be another drug that will cover that, but she needs to check. She is flying to New Orleans for her annual conference. She will have some answers for you in a few hours.

JIM