I'm So Angry

Jordan2 · ‎03-16-2010

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.

arrabella · ‎03-12-2010

@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.

Imaoldhippie · ‎06-10-2015

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.

BE THE PERSON YOUR DOG THINKS YOU ARE! (unknown)

DrKelli · ‎03-10-2010

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.

CatsyCline · ‎07-24-2013

Omeprazole is Prilosec OTC not Zantac (Ranitidine)

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

hayseed00 · ‎11-24-2011

@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.

CatsyCline · ‎07-24-2013

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.

Kachina624 · ‎03-10-2010

@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.

New Mexico☀️Land Of Enchantment

Jordan2 · ‎03-16-2010

@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.