Home Forums General Discussion Getting Insurance to Cover Medication after Denial

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  • #463209
    redrock
    Participant

    Excuse my repetitiveness for those who have heard this before but I’m in dire straits and need advice.

    I am a CREST patient. Prior to going on AP I had severe Raynaud’s, an Anti-Centromere ANA of 1:1280, and high pulmonary pressure numbers.

    In August 2010 I began AP with 100 mg Brand Minocin twice a day every other day. Within 3 months my Raynauds was gone, my labs were normal, and eventually my pulmonary pressures were normal. I continued this same dose for 6 years and maintained complete remission.

    In January 2016 Brand Minocin no longer was covered by insurance and then became completely unavailable.

    Since then I have tried the following medications:

    Teva minocycline (generic)
    Dan doxycycline (generic)
    azithromycin (generic)
    Par minocycline (generic)
    Minomycin from New Zealand (brand)
    Aknemin from ? Germany? (brand)
    azithromycin (generic) again

    None of these medications have worked for me and now my symptoms are worse than they have ever been. My Raynaud’s is completely unbearable and I have gotten sicker with every passing day.

    Yesterday I saw a new doctor who was very familiar with AP and prescribed my Solodyn 115 mg twice a day, every other day. He advised he has several patients who have done well on this medication and that it was the closest thing to the original Brand Minocin. He called it into my pharmacy which is CVS Caremark.

    After a day of not receiving notification the prescription was ready, I called and was told it was being rejected by the insurance company and they had sent a preauthorization form to my doctor. I spoke with the doctor’s office. They had a lengthy conversation with CVS Caremark (the pharmacy arm of the insurance company). The doctor explained I had tried six other medications to no avail. I was told I would hear within 24 hours if they would agree to cover it.

    Tonight I received a voicemail from CVS Caremark saying my request was denied. The voicemail stated I would get a letter and could appeal.

    Does anyone have advice as to how to appeal such a determination? I am concerned that since Solodyn (and Minocin, for that matter) are basically acne medications, that my chance of appeal will be low because AP is an off-label use of the medication. I need to know how to proceed in trying to get this medication covered. I checked Good Rx and found the cheapest cost if I paid cash is $489 a month. This is not feasible for me.

    Can someone please give me some advice as to how to proceed? I am at the end of my rope.

    Thanks.

    #463210
    whaleharbor
    Keymaster

    There should be some kind of form/communication avenue with your insurance company directly that the doctor will fill out. I know they probably did and sent it to CVS…but it might be better for him to go direct to the payer, the insurance company. Meanwhile, this is a HUGE issue for everyone (not just us here). I would contact my Congressional Representative. It’s outrageous to pay insurance (I pay stupid high amounts) and have them decide what they will pay for…which normally means they try to pay for nothing. I’m sorry you are going through this. I would fight the insurance company DIRECTLY and not through CVS. I know others will chime in with even better ideas. Hang in there.

    Minocycline 100mg every other day with food...lots of food: Zydus brand. Celecoxib 200mg twice per day: Greenstone brand.

    #463214
    PhilC
    Participant

    Yesterday I saw a new doctor who was very familiar with AP and prescribed my Solodyn 115 mg twice a day, every other day. He advised he has several patients who have done well on this medication and that it was the closest thing to the original Brand Minocin.

    He’s wrong. Solodyn is minocycline in the form of an extended-release tablet. Solodyn is not bioequivalent to Minocin because the pharmacokinetics are different. And since you are a scleroderma (CREST) patient, I question the use of pulsed dosing — especially considering that your condition continues to deteriorate due to lack of effective treatment.

    If you are eligible, this program may help (temporarily):
    http://www.solodyn.com/instant-savings-offer

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #463215
    redrock
    Participant

    There should be some kind of form/communication avenue with your insurance company directly that the doctor will fill out. I know they probably did and sent it to CVS…but it might be better for him to go direct to the payer, the insurance company. Meanwhile, this is a HUGE issue for everyone (not just us here). I would contact my Congressional Representative. It’s outrageous to pay insurance (I pay stupid high amounts) and have them decide what they will pay for…which normally means they try to pay for nothing. I’m sorry you are going through this. I would fight the insurance company DIRECTLY and not through CVS. I know others will chime in with even better ideas. Hang in there.

    The argument was not with CVS, the pharmacy, but CVS Caremark which is where you go to when you go on the insurance company website to see how much a product costs. It’s the pharmacy arm of the insurance company and where claims and appeals are made. Good idea to call legislator, thanks.

    #463216
    redrock
    Participant

    Yesterday I saw a new doctor who was very familiar with AP and prescribed my Solodyn 115 mg twice a day, every other day. He advised he has several patients who have done well on this medication and that it was the closest thing to the original Brand Minocin.

    He’s wrong. Solodyn is minocycline in the form of an extended-release tablet. Solodyn is not bioequivalent to Minocin because the pharmacokinetics are different. And since you are a scleroderma (CREST) patient, I question the use of pulsed dosing — especially considering that your condition continues to deteriorate due to lack of effective treatment.

    If you are eligible, this program may help (temporarily):
    http://www.solodyn.com/instant-savings-offer

    Phil

    I discovered this program last night and was so relieved as it looked like it would only cost $25 a month. Well, today I spent 2 hours at the pharmacy and another half hour on the phone finding it’s not what it appears. Bottom line is, the claims made on their website are incorrect. First, the $25 coupon only applies if your insurance covers the drug. It reduces your cost. If your insurance does not cover the drug, your cost used to be $75 a month but is now $225. This change was made October 18. I asked the rep on the phone if they planned to update the website and she said no. She said the fine print indicates things might change. The conversation did not end well.

    Regarding your point about pulsed dosing, which we’ve discussed before, I was on pulsed dosing for SIX years and was in full remission with normal labs, normal pulmonary pressures, and no symptoms. The reason I have relapsed is not because of pulsed dosing. It’s because my body apparently only responds to Brand Minocin.

    I’m beaten down and sick of fighting. I will obtain a 90 day supply of Zydus capsules and see what happens. The past year of chasing different down doctors and overseas drugs has exhausted me physically and financially, and I am done.

    #463217
    PhilC
    Participant

    Regarding your point about pulsed dosing, which we’ve discussed before, I was on pulsed dosing for SIX years and was in full remission with normal labs, normal pulmonary pressures, and no symptoms.

    Just because it worked for six years doesn’t mean that it will always work. Bacteria can and do become resistant to minocycline. Dr. Brown rotated antibiotics every four or five years, and I seem to recall that antibiotic resistance was the reason he did that.

    So far, your experience has been totally consistent with whatever bacteria you are infected with (mycoplasma?) having developed resistance to minocycline (which probably includes all tetracyclines). Your experience with azithromycin also points to antibiotic resistance. Previously you wrote that azithromycin was working at first, but it quickly lost effectiveness. That tells me that your bacteria have acquired the ability to defeat antibiotics, or at least the ones you’ve taken so far — it’s the only explanation that makes sense.

    Here’s some info that may be helpful: Several years ago it was reported on here that Dr. F. in California was using twice the normal dose of minocycline (the generic kind) as a substitute for Minocin. I doubt that that’s really necessary for most people, as long as they’re on a good generic. But in your case it might be helpful, especially if you were to take it every day. Unfortunately, that still may not be enough, which is why I think you should ask your doctor to prescribe clindamycin to supplement the mino. Clindamycin usually works very well against mycoplasmas, and since you haven’t taken that your bacteria may not be resistant to it.

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #463222
    CMS12
    Participant

    Redrock – The only generic you haven’t tried is Torrent. It does work for me and I failed Teva, Watson, and Par as well as doxycycline. I recall that when Richie could no longer get Minocin he switched to Torrent with success. Not sure where you’re located but Kroger offers Torrent (King Soopers in Denver where I am). You might want to give it a try. If that doesn’t work I’d go the compounding route like Spiffy. That was what I was going to do if I couldn’t find Torrent.

    Sorry you are struggling so much. It is frustrating. Hopefully, some day Minocin will be available again. Good luck, Cindy.

    #463223
    redrock
    Participant

    Redrock – The only generic you haven’t tried is Torrent. It does work for me and I failed Teva, Watson, and Par as well as doxycycline. I recall that when Richie could no longer get Minocin he switched to Torrent with success. Not sure where you’re located but Kroger offers Torrent (King Soopers in Denver where I am). You might want to give it a try. If that doesn’t work I’d go the compounding route like Spiffy. That was what I was going to do if I couldn’t find Torrent.

    Sorry you are struggling so much. It is frustrating. Hopefully, some day Minocin will be available again. Good luck, Cindy.

    That’s next on my list if Zydus doesn’t help. But I guess Zydus is the same as Teva? I don’t know. The pharmacist told me the Torrent was twice the price because it was a capsule and I wasn’t sure what to get. I did see a new doctor last week who used to do compounded but now has gotten away from it.

    #463225
    PhilC
    Participant

    But I guess Zydus is the same as Teva?

    Zydus = old Teva
    Teva = old Actavis = old Watson
    Torrent = old Ranbaxy

    The pharmacist told me the Torrent was twice the price because it was a capsule and I wasn’t sure what to get.

    That’s a weird answer. Zydus mino is also a capsule. Maybe you should call a different pharmacy.

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #463226
    redrock
    Participant

    I misspoke. She said Torrent was twice the price because it was a tablet.

    It’s interesting that Torrent is the new favored child if it used to be Ranbaxy as I remember many years ago people railing against Ranbaxy.

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