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Medical Forum / Diseases and Disorders / Diabetes / December 2006Byetta Insurance
Has anyone had problems with Anthem paying for Byetta? I was told today it is off formulary and "step treatment non-compliant". The agent did say maybe my endo could call in and get them to cover it, but that strikes me as odd. I have been on Metformin and Starlix for years. Ironically, they paid 100% of the cost of the needles I picked up today (I am working off free samples from my "drug pusher" at the moment). Since I do not use insulin, I wonder what their silly computer thinks the needles are for? If anyone else has been down this road, maybe I can benefit from your experience if I am going to have to argue my case. > Has anyone had problems with Anthem paying for Byetta? I was told today > it is > off formulary and "step treatment non-compliant". What does that mean? You don't need Byetta because you're not "sick enough" (bad enough numbers) or something??? bj > > Has anyone had problems with Anthem paying for Byetta? I was told today > > it is [quoted text clipped - 3 lines] > (bad enough numbers) or something??? > bj It may simply be that the doc has to explicitly state that Metformin and whatever else aren't sufficient to control the OP's BG.  SignatureAF "Non Sequitur U has a really, really lousy debate team." --artyw raises the bar on rec.sport.baseball >> Has anyone had problems with Anthem paying for Byetta? I was told >> today it is >> off formulary and "step treatment non-compliant". > > What does that mean? You don't need Byetta because you're not "sick > enough" (bad enough numbers) or something??? It means the insurance company won't pay for Byetta (off formulary) AND it won't approve it even if something else doesn't work (step treatment non-compliant). Step treatment means you have to try other drugs first and then if they don't work you can finally prescribe the med. I take Benicar and Zetia after step therapy with an ace inhibitor (cough) and niacin (flushing). C My insurance required a letter from my doc explaining that I had "failed" conventional T2 medicines before the insurance company would pay for Byetta. This is the same insurance compnay that has paid for my (rising) A1c's for 7+ years, and which sends me all kinds of mail about my diabetes. Go figure. Maybe a similar letter from your endo would do the trick for you. Good luck. > Has anyone had problems with Anthem paying for Byetta? I was told today it is > off formulary and "step treatment non-compliant". The agent did say maybe my [quoted text clipped - 6 lines] > If anyone else has been down this road, maybe I can benefit from your experience > if I am going to have to argue my case. > My insurance required a letter from my doc explaining that I had > "failed" conventional T2 medicines before the insurance company would [quoted text clipped - 3 lines] > would do the trick for you. > Good luck. Same here, it took two denials, follow up by two physicians (my diabetes doctor and an endo) and several letters before Blue Shield finally approved it. All in all, it took about 3-4 months. I also had my company's health benefits coordinator call the insurance company, and I also called the manufactuer (Amlyn, I think?) and they also called the insurance company. Just keep at them. > Has anyone had problems with Anthem paying for Byetta? I was told today > it is [quoted text clipped - 13 lines] > experience > if I am going to have to argue my case. I get my prescription meds from Express Scripts, my endo wrote a script, looked like any other script. I sent it to Express Scripts and 10 days later received 3 x 10mcg Byetta pens. That was a 3 month supply and cost me $9. She did not include any letters of explanation, however, they might have called her about it that I don't know about. Anon > I get my prescription meds from Express Scripts, my endo wrote a script, > looked like any other script. I sent it to Express Scripts and 10 days later [quoted text clipped - 4 lines] > > Anon Wow, you've got good insurance! I use Express Scripts too, but my co-pay is $30 per month for byetta. I think the 10 mcg retails around here for about $250 per pen. >> I get my prescription meds from Express Scripts, my endo wrote a script, >> looked like any other script. I sent it to Express Scripts and 10 days [quoted text clipped - 9 lines] > co-pay is $30 per month for byetta. I think the 10 mcg retails around > here for about $250 per pen. I was in the military for 30 years and have Tricare for life medical. They contract with Express Scripts for mail order prescriptions. With them I pay $9 for name brand 3 month supply and $3 for non-name brand 3 month supply. If I use local pharmacies it is $9 for a one month supply. If they have the med in the formulary, I get meds free from military pharmacies but that is hassle for me to go to the base. > >> I get my prescription meds from Express Scripts, my endo wrote a script, > >> looked like any other script. I sent it to Express Scripts and 10 days [quoted text clipped - 16 lines] > med in the formulary, I get meds free from military pharmacies but that is > hassle for me to go to the base. That's good, I'm glad our veterans get a decent break on the meds, they can get expensive. |
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