dye-free amoxicillin not covered by insurance
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Anonymous
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After some experimentation, we have determined that the red dye in children's amoxicillin makes my daughter go completely nuts. So I located a pharmacy that could mix up a dye free batch (from a different generic lab). We have Anthem insurance, and generic prescriptions are supposed to be $10, but the pharmacy charged us $20.99. They didn't tell me ahead of time that it would cost more, and I was short on time at pick up and couldn't wait around for someone to explain the charges. At home, I logged on to our insurance portal and it appears that our formulary only covers one generic lab's product (Dr. Reddy's lab), and this is the preparation with the red dye. The dye-free is manufactured by West-ward labs. I didn't know formularies got that specific. The pharmacist even made a note on the script that DD is allergic to red dye. Has anyone else had a similar experience? What did you do? It looks like there may be a way to request a preauthorization for non-formulary medications, but the website is aggravatingly vague on the process. DD is only 3, so I can expect many, many scripts for amoxicillin in the years to come and I would like to cut our expenses if I can.
FWIW, the prescription plan is also denying us coverage for DD's compounded Prevacid. They cover the capsules, which make a terrible compound, and Prilosec powder. And that's it. So we are switching to Prilosec because otherwise we'll be forking over $160/month. I am beyond frustrated and not sure where to start. I called Anthem directly, and they told me to talk to the pharmacist to price other options. The pharmacist says they need an actual script to do that, because of the way compounding works (they need to figure out how much powder would be used). I finally found our formulary list online, and I sure hope they really will cover the Prilosec powder, because I'm not sure what to expect out of the appeal process. |
Anonymous
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In my experience you'll need to call te insurance or have your doctor call. They'll deny it and tell you you have to try xyz first, at which point you, with doctors letters, can appeal and maybe be approved.
I don't know how practical that is for a medicine she isn't on often. When I had to do it, it was for a long-term medicine. |
Anonymous
| the doctor who wrote the prescription needs to be the one who noted the allWeft. They also need to be the one who fills out this prior authorization form with the reason for her needing the dye free bein that she's allergic to the dye. |
Anonymous
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Our benefits include a service called "health advocate" that's meant to help you identify procedures and negotiate appeals with the insurance. Do you perhaps have something similar?
Also, I would be inclined to go through the hassle for something that's a daily long term medication like prevacid, but for an abx script -- perhaps step back and take a sanity check. Is the $11 difference really worth however long of your time to get it sorted out? I totally understand getting frustrated and wanting to make it work on principle, but really...if you really are thinking you'll be using it so often where that will make a difference, I would be more worried about why your DD needs or is prescribed abx on a monthly basis. *insert spiel about overuse of abx here* |
Anonymous
| FWIW, my kids are 10 and 6 and neither has ever been prescribed amoxicillin (or any antibiotic, for that matter). |
Anonymous
| Can you just open the capsules and mix into applesauce or pudding or yogurt? |
Anonymous
^^^thats what we did starting at 6mos old. |
Anonymous
| Can you call around and see which pharmacies have which? recently, we've been given white amoxicillin at several pharmacies and they don't even have the pink stuff anymore. |
Anonymous
Yes, this. Exactly. You don't want your kid on Amoxicillin, or any other antibiotic, very often. |
Anonymous
| Honestly for ten extra bucks its not worth the battle. I mean my oldest is 10 and my youngest is 3 and I think Ive had to get amoxicillin twice in my decade of parenting so its not a great expense over time. |
Anonymous
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As others have said, the amox isn't a big deal. Next time get a different prescription. My DD is allergic to penicillin so can't take amox.
The Prevacid is a different issue and you run into this with allergy meds too. I haven't found that the insurance is willing to bend on these issues. Google work arounds for tips on how to figure it out. |
Anonymous
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OP here.
1. Of course I have called around. That's how I located the pharmacy that filled the script in the first place. 2. It doesn't seem to have anything to do with which pharmacy fills the script. The place I went was in network. It seems to be a matter of formulary coverage. 3. The health advocate was a helpful suggestion. I will look into that. 4. I agree that antibiotics are overprescribed, but my kid is clearly not as robust as yours are. Most of the immune system is in the gut, and when you've got gut issues (she's been on Prevacid since 9 weeks), you get sick more. We typically wait until she's had the croupy cough for 3 weeks or more before we resort to antibiotics. 5. Her eating habits are unpredictable. It would be fabulous if I could be sure that she would eat whatever we sprinkled the capsule contents into, but we tried this with other things and she just didn't get the full dose that way. I guess I mainly just wanted to know where to start--doctor, insurance, HR. Based on these replies, I think we'll talk to HR first. |
Anonymous
| OP, have your doctor call the insurance directly and figure out what needs to be done. It may be over the phone, or something that has to be faxed, or an entire appeal process but your doctor will know the questions to ask and the insurance will probably be more up front with them. If it can be authorized over the phone, bonus. If not, they can at least get the ball rolling right then. |
Anonymous
| I believe my daughter has a red dye sensitivity as well and we cannot find a dye free version of amoxycillin / appreciate the post |
Anonymous
| One of my kids is allergic to amoxicillin (hives), the other reacts to red dye. The good thing about antibiotics is there are so many others out there. Tell your pharmacist/doctor that you need something else. That said, paying $21 for dye free abx seems fine to me. I don't see the problem. |