My LLMD started me on mepron and wanted to add Zithromax.

The insurance would only cover 3 pills. My LLMD put in an authorization for 12 pills per month, but apparently it was denied. Chapelle graciously called on my behalf and was told they would authorize 10! But when I called my pharmacy they said, No, only 3!

So I called the insurance and was told by a supervisor that 10 was approved and Target entered it wrong into the system. I called Target back and they tried again, and Nope!

Target called my insurance and spoke to processing, and was told only 3 pills are approved!

I called the insurance AGAIN and spoke to a different supervisor this time and was told, nope...only 3! And they couldn't explain why both Chapelle and I were told otherwise the first time.

Seems fishy. My 3 alternatives are:

1. Have LLMD submit another, more detailed, and convincing request
2. I could file an appeal
3. I could use biaxin instead. No problems.

I decided to try for the biaxin. If I have issues with it, it may give my LLMD more leverage to get the zith approved. I'm just furious as to how much time was wasted on this! Countless phone calls and hoops!

Does anyone else get this kind of run around?

Furthermore.....I was suppose to start the zith last week. Target won't have any biaxin til Monday. So I will be 2 weeks behind on my treatment. I will have been on Mepron for 3 whole weeks. I think Mepron needs another abx to work efficiently if I remember right. So, it's kind of a waste of mepron! And I KNOW Mepron is expensive.

I'm just curious if anyone else has gone through this? I can see where IV drugs may be an issue. But Zithromax??? I wonder if the Ins just wants to make it difficult for my LLMD to treat me. Maybe they are doing it because it's Lyme treatment and they want to screw the doctor? (My imagination is getting the better of me!)

Post Edited (Utahgal) : 2/27/2015 11:50:54 AM (GMT-7)

My LLMD wants me to take zith on Mon, Wed, and Fri. So, I would need 3 pills a week times 4 weeks per month. So I was prescribed 12 pills a month.

The insurance said zith comes in a 3 pack. So I would only get 3 pills. Then my doctor submitted the paperwork pleading for 12, and apparently they approved 10.

Well.....if they come in packs of 3, why would 10 even make sense? It's not even a multiple of 3! Lol. Shouldn't they approve either 9 or 12? Duh!

But then, it somehow got denied again and I was only cleared for 3. I just can't deal with that right now. Like Kenny Rogers says, "You gotta know when to hold 'em, Know when to fold 'em...." Ha!

I'll give biaxin a whirl. Sounds like fun!

I take 60 azithromycin per month, and so does my daughter. Insurance copay is $10! My prescription was never questioned.

Same thing happened to me! We had MVP and it was great, and then came along Obama care and all the insurance changes. We were switched over to Empire Blue Cross (we live in upstate NY) and now I'm having issues with every aspect of healthcare.....just when I need it the most!

Funny how my insurance was great.......when I didn't need it!

I have UnitedHealthcare.

Biaxin has a higher serum concentration than Zithromax and doesn't penetrate the tissues as well. For borrelia, Zithromax is preferred but a course of Biaxin may be needed later in therapy to decrease bacteria that may have found shelter in the blood. Tissue penetration is not sufficient enough with Biaxin IMO to eliminate borrelia from the tissues. I'm sorry.

Utahgal said...
Is there a way to purchase Zithromax through a mail order pharmacy at a good price?

Some of my customers were buying medications through a mail order out of Canada. I don't know much more than that. There are some places where you can buy it online but finding a reputable place seems more difficult.

Wow, this is crazy. That really stinks that you have to fight so hard what should be rightfully yours when you pay for insurance! I'm sorry you are dealing with this.

I have Blue Cross Blue Shield and I have not yet run into issues but I have only filled Doxy, Mino, Armour, bio-identical hormones, and nystatin. Crap, this totally reminded me to get my scripts filled for Babs treatment for next week, duh! Well, we'll see if they give me any grief.

I asked my LLMD about getting trouble when filling scripts for abx and he said never do it all at once. Just fill them as you approach each stage of treatment. But, I can see if you are needing more than one kind of abx per phase, that it could raise some red flags.

I hope you get this figured out soon!

Utahgal!

I just got off the phone with my LLMDs office. I had a question about why I had a script for both quinine and compounded quinine. I thought maybe it was due to side effects. She said some people have a had time getting insurance to cover the regular version and that compound versions for any abx are cheaper if you end up having to purchase out of pocket.

She also said many patients go through canadadrugs.com.