topic Re: I'm So Angry in Community Chat

I'm So Angry

Jordan2 — Wed, 01 Apr 2020 15:54:21 GMT

I went to an ENT ( ear, nose, throat) doctor yesterday. I took care of my elderly mother, she fell back in October, went through a lot over three months ( she passed away). So back in October I developed an irritation in my throat which caused me to cough. I neglected myself, because I was so wrapped up with my mother. The doctor said due to stress he diagnosed I have GERD. My health insurance, Oscar said the medication Omeprazole 40 mg needs prior authorization. Well they said GERD didn't meet the criteria for the approval for the medication, so I was denied. The medication would have been zero cost to me with my plan. I had to go to GoodRX, and print out a coupon for the medication. It cost me $24 out of my pocket, instead of being able to get it for no cost to me with my insurance. I don't understand why acid reflux isn't a diagnosis for this medication? To anyone who has no medication coverage, always check out GoodRX before you go to the pharmacy.

Re: I'm So Angry

arrabella — Wed, 01 Apr 2020 15:58:01 GMT

@Jordan2 wrote:
I went to an ENT ( ear, nose, throat) doctor yesterday. I took care of my elderly mother, she fell back in October, went through a lot over three months ( she passed away). So back in October I developed an irritation in my throat which caused me to cough. I neglected myself, because I was so wrapped up with my mother. The doctor said due to stress he diagnosed I have GERD. My health insurance, Oscar said the medication Omeprazole 40 mg needs prior authorization. Well they said GERD didn't meet the criteria for the approval for the medication, so I was denied. The medication would have been zero cost to me with my plan. I had to go to GoodRX, and print out a coupon for the medication. It cost me $24 out of my pocket, instead of being able to get it for no cost to me with my insurance. I don't understand why acid reflux isn't a diagnosis for this medication? To anyone who has no medication coverage, always check out GoodRX before you go to the pharmacy.

I have GERD and that's the medication I take and my insurance pays 99% of the cost. Less than $1.00 for a 3 months supply.

Re: I'm So Angry

Imaoldhippie — Wed, 01 Apr 2020 16:00:30 GMT

I have GERD also. Medicare/Humana has tried to get my doctor to stop prescribing me Omeprazole. Guess they figure if you can buy the Zantac over the counter they dont need to pay for a script.

Re: I'm So Angry

DrKelli — Wed, 01 Apr 2020 16:07:10 GMT

Except the FDA pulled all the Zantac off the shelf recently. Is there an OTC for Omeprazole?

I suffer from acid reflux too--I had to switch to previcid (I think that's the name). I used to take Zantac.

Re: I'm So Angry

CatsyCline — Wed, 01 Apr 2020 16:09:47 GMT

Omeprazole is Prilosec OTC not Zantac (Ranitidine)

Prilosec or generic Omeprazole can be purchased at drugstore no Rx needed

Re: I'm So Angry

hayseed00 — Wed, 01 Apr 2020 16:10:58 GMT

@Jordan2 I have RA and take Enbrel injection weekly. there was never any problem with my insurance paying for it, I worked for the state and had the Empire plan. When I turned 65 last year and had to have Medicare, then all of a sudden Enbrel wasn't covered. I called my Rhumatologist and he sent in a special form and I then had it approved. I wonder if your MD can do the same for Omeprazole, but possibly the dosage is what the problem is related to. My husband takes a 20 mg dose, but when it use to be 10mg it was a problem getting authorization from his insurance, and it was related to the dosage, when it was changed to 20 mg. there was no problem. Sorry for the loss of your Mom.

Re: I'm So Angry

CatsyCline — Wed, 01 Apr 2020 16:14:53 GMT

i had GERD when i worked due to workplace stress. My doctor prescribed Protonix. took that for about 5 yrs. it can cause problems with bone density.

Re: I'm So Angry

Kachina624 — Wed, 01 Apr 2020 16:27:01 GMT

@Imaoldhippie Omeprazeole and Zantac are two different unrelated drugs. Taken over a period of time,Omeprazeole can be very dangerous which is probably why your insurer suggested it should be discontinued. You can educate yourself about its side-effects by doing a little reading online. Too many people are indiscriminately taking it too long since it became unregulated. My doctor took me off of it.

Re: I'm So Angry

Jordan2 — Wed, 01 Apr 2020 16:32:54 GMT

@hayseed00 wrote:
@Jordan2 I have RA and take Enbrel injection weekly. there was never any problem with my insurance paying for it, I worked for the state and had the Empire plan. When I turned 65 last year and had to have Medicare, then all of a sudden Enbrel wasn't covered. I called my Rhumatologist and he sent in a special form and I then had it approved. I wonder if your MD can do the same for Omeprazole, but possibly the dosage is what the problem is related to. My husband takes a 20 mg dose, but when it use to be 10mg it was a problem getting authorization from his insurance, and it was related to the dosage, when it was changed to 20 mg. there was no problem. Sorry for the loss of your Mom.

@hayseed00 the office called me this morning, I was told he did try to get authorization but they denied it. The thing that bothers me is I pay over $700 a month for the "privilege" of having this insurance. If I had bought over the counter Omeprazole it would have been the 20mg dosage, CVS brand for $24.50, so it paid to get the medication prescribed by the doctor.

Re: I'm So Angry

goldensrbest — Wed, 01 Apr 2020 16:35:47 GMT

Why not buy over the counter?

Re: I'm So Angry

NickNack — Wed, 01 Apr 2020 16:58:30 GMT

@Jordan2 You can buy omeproazole over the counter, but it's probably cheaper with Good RX. I have taken omeprazole for Gerd for many years. The gastroenterologist told me it would be dangerous for me not to take it because of the risk of some type of cancer.

I am not overweight and tried many different things with diet before seeing a gastroenterologist. I pay $1 for a 90 day prescription with my health insurance.

I don't understand why your insurance would say that. I would try to get your doctor to get a prior approval for it.

Re: I'm So Angry

FlyersGirl — Wed, 01 Apr 2020 16:53:23 GMT

@Jordan2

Hoping you can get this resolved/covered by your insurance.

In the interim, there are generic brands of omeprazole that you can get for $15 or less at 20 mg/42 pills. Sometime these are even cheaper when on sale. Since Walmart/Target etc all have generics, so you do not have to take the OTC name brand Prilosec. So for about $30/2 boxes of 20 mg-42 pills, you could get 42 days of dosage. Better value than the GoodRX deal, at least for now. (assuming the GoodRX deal is for a 30 day supply)

Re: I'm So Angry

catmama — Wed, 01 Apr 2020 17:03:48 GMT

@Jordan2 - are you taking Vitamin C? This is not a medical diagnose, but I want to tell you my story. Last fall I ran out of Andrew Lessman's Vit C which I have been taking for years. Ran to the vitamin store and purchased a bottle of what I assumed was a good quality Vit C. A a few weeks later I started having issues with my throat, coughing and burping. Thought it might be GERD or heartburn. Stopped drinking sparking water, wine and anything acidic. But it didn't clear up. Was about to contact the dr when I watched Andrew on HSN early last month and he was talking about Vit C and the fact that most brands use ascorbic acid, which is acid and can cause issues such as I was experiencing. Looked at my brand and sure enough it was ascorbic acid. Quit taking it, ordered Andrew's and a month later, my issues have cleared up.

Re: I'm So Angry

sidsmom — Wed, 01 Apr 2020 17:07:07 GMT

I would do anything to figure out the cause & to eliminate that cause immediately. All the stress can have detrimental effects, especially

in this day/age of COVID-19. Greater than 0 chance it's food related.

Re: I'm So Angry

SeaMaiden — Wed, 01 Apr 2020 17:10:38 GMT

@goldensrbest wrote:
Why not buy over the counter?

Try using GoodRX.... I have a prescription cream that insurance will not cover....it costs $90 out of pocket.....$51 using GoodRX.

Re: I'm So Angry

Imaoldhippie — Wed, 01 Apr 2020 18:17:37 GMT

@Kachina624 .........no they are not unrelated, they both are for acid reflux (GERD). I am educated in these 2 drugs since I worked for a gastroenterologist for 6 years and have GERD which I take Omeprazole for.

Just heard where FDA has ordered Zantac off the market.

Re: I'm So Angry

Kachina624 — Wed, 01 Apr 2020 18:24:56 GMT

@Imaoldhippie Yes, there's a thread on Zantac. It disappeared off the shelves several months ago so don't know what the big deal is today.

Re: I'm So Angry

noodleann — Wed, 01 Apr 2020 18:27:56 GMT

FDA Requests Removal of All Ranitidine Products (Zantac) from the Market

FDA Advises Consumers, Patients and Health Care Professionals After New FDA Studies Show Risk to Public Health

The U.S. Food and Drug Administration today announced it is requesting manufacturers withdraw all prescription and over-the-counter (OTC) ranitidine drugs from the market immediately. This is the latest step in an ongoing investigation of a contaminant known as N-Nitrosodimethylamine (NDMA) in ranitidine medications (commonly known by the brand name Zantac). The agency has determined that the impurity in some ranitidine products increases over time and when stored at higher than room temperatures and may result in consumer exposure to unacceptable levels of this impurity. As a result of this immediate market withdrawal request, ranitidine products will not be available for new or existing prescriptions or OTC use in the U.S.

Re: I'm So Angry

Jordan2 — Wed, 01 Apr 2020 18:30:21 GMT

@catmama wrote:
@Jordan2 - are you taking Vitamin C? This is not a medical diagnose, but I want to tell you my story. Last fall I ran out of Andrew Lessman's Vit C which I have been taking for years. Ran to the vitamin store and purchased a bottle of what I assumed was a good quality Vit C. A a few weeks later I started having issues with my throat, coughing and burping. Thought it might be GERD or heartburn. Stopped drinking sparking water, wine and anything acidic. But it didn't clear up. Was about to contact the dr when I watched Andrew on HSN early last month and he was talking about Vit C and the fact that most brands use ascorbic acid, which is acid and can cause issues such as I was experiencing. Looked at my brand and sure enough it was ascorbic acid. Quit taking it, ordered Andrew's and a month later, my issues have cleared up.

@catmama I do take vitamin c, have been for eons, no problem. I really think this is stress related. Hopefully I won't have to take the medication for too long. The CVS brand Omeprazole 20 mg was $24.50, so it was a no brainer to use the GoodRX coupon for the prescription. It also bothers me, if people don't know about GoodRX, they are probably paying at least double what I paid.

Re: I'm So Angry

depglass — Wed, 01 Apr 2020 18:47:15 GMT

I am fortunate to have a friend who is a Pharm D. (doctorate in pharmacy) She told me Omeprazole has a rebound affect, which is part of the reason I had been taking it for years and years. She suggested a switch to Zantac generic, ranitadine. Worked great. Then they pulled ranitadine and I went back to my old standby, Alka Seltzer. I don't have symptoms very much at all anymore, and the Alka Seltzer deals with it just fine. I also think my original issue was stress, it all started back in my working life. Now its just the occasional spicy meal.