Nexium and Insurance

[ivan1801]

As read in many blogs over the past few years... United Health Care is cutting out Nexium scripts.  Our doctor had raised my wife's scrip from 40 mg qd to 40 mg BID, after assessment and endoscopy and after trials of other medecines failed to alleviate symptoms... After three months ins said "NO" and the doctor supposedly told the ins company that another drug or a lower dosage would in fact be acceptable... effectively countermanding his own advise and my wife's own experience months earlier.  Our pharmacist.. off the record of course... stated that If the doctor had not gone along with the insurance company then he would have faced a substantial decrease in  reimbursement from the insurance company.  The ins co has stated that my wife can appeal... but that with the doctor's new "assessment" it is virtually unlikely that any appeal would work... The doctor can but wont appeal... his revenue is at stake... and he frankly is refusing to call us back... and though I have spoken a few times with his UAP... he is not going to address this question again.  We cannot even get a scrip to pay for the Nexium ourselves because that would leave the doctor open to liability...( ie telling the ins co that my wife does not need it... while issuing a scrip for it) and I have been advised that if we pursue the problem we may receive a letter from the doctor that he refuses to treat either me or my wife any more... That is allowed in Florida... and it has happened to me before forcing me to drive 25 miles away to the next doc... This is a rural area... and this doc is basically "IT" for that specialty


This discussion is related to nexium vs prilosec otc.

[gnorb]

In defense of United Health Care, Nexium in the US is WAY too expensive. ($6/pill?! Seriously AstraZeneca?) That said, it looks like your doc is a first class moron who I wouldn't trust my health to. If you can find another one, do so. Immediately. And I wouldn't give up on pursuing the issue. (Who the heck tried to bully you into shutting up, anyway?) Denying you care because he put his foot in his mouth doesn't mean your wife should have to suffer.

That said, why can't your wife get something else, like Protonix or Prevacid? Heck, even Omeprazole is available out there for cheap. Obviously there are a lot more details to this, but based on your statement, I stand by mine about your current doc. Moron, first class, all that jazz.

Ask ANOTHER doctor for an alternative--preferably a gastroenterologist--If you can afford to pay SOME for your medications, then you can go the Canadian pharmacy route. I use Blue Sky Drugs, which I found through PharmacyChecker.com, a site recommended by the AARP. (You can price-shop there.) They require a script, but obviously don't take insurance. If your doc is willing to write a script they'll take it. I bought from them Neksium (Esomeprazole, Nexium under a slightly different name and sold by AstroZeneca internationally) for about $100 for 4 months ($25/month. Not bad) when my insurance company said they wouldn't pay for it.

Good luck.