Nuedexta denial from Medicare

[azgirl]

I have been taking nuedexta for the last month (samples from my doctor) while we tried to get the prescription filled. Medicare has denied and says we can appeal. Walgreens says our cost would be $1200 a month !

I think it has really helped with swallowing since I’ve gone from 3 nighttime choking/suctioning episodes to zero.

If you take nuedexta how are you getting it? Has anyone got Medicare to cover?

 

[Nikki J]

Usually reporting emotional lability is the way to get it covered.

There isn’t one big medicare rule though. It depends on the formulary and rules of your part d provider. Too late to change for this year but in general good idea to run your possible meds through the plan finder at medicare dot gov. You can usually see a notation there about any coverage issues ( like limit to number of pills) and I think PA required is there too.

Good luck!

 

[bigmark1954]

Nuedexta is a pain in the a$$ for me. I have BlueCross ins and they call it a "tier 3 medication". They only pay part of the cost, my part is about 300 bucks. I have been thinking about not taking it any more. It doesn't help with my EL that much.

If you end up having to buy it yourself shop around. Rite-Aid, CVS, Walmart, etc, have Neudexta for about $850. I have been on it for 4 years and I really hope a generic version comes out soon.

 

[KimT]

Just more proof we need a one-payer system that covers medically necessary procedures and drugs. I get Aciphex from Canada because it is not covered by any of the Part D policies I've seen. There are many other PPIs but Aciphex is the only one that works for me. Interestingly, BCBS covered it before it became generic, then they stopped covering both the generic and brand.

 

[Romeosc]

I quit taking after I got used to the facts!

 

[KarenNWendyn]

I second the need for a single payer system. The drug companies get rich of the backs of the consumers. You know those drugs don’t cost that much to make — particularly when the identical drugs are so much cheaper in Canada and Mexico. Let’s make America great again!

 

[azgirl]

My doctor did go with the emotional lability angle- even though the main reason was swallowing, so I don’t think an appeal will do any good.

We may have found a solution. One hospice we met with says they work with a compounding pharmacy that will provide it. They made the call to check during our meeting with them. Hope they don’t back out. Guess I just made my hospice decision

 

[azgirl]

Weird thing just happened. Walgreens just called and nuedexta copay is now $35!
Don’t know how or why but feeling relieved

 

[Nikki J]

Great! Maybe they deny automatically and then review? Was there time for your doctor to have appealed it?

 

[Livealot]

Our's was denied the first time too . Our doctor called and they agreed to pay for 3months.Since we use the VA now they pay for all the cost.This beast kills you in so many waysSo glad your insurance came through.

 

[azgirl]

Nikki,I suspect my doc got involved after I emailed her for help on Monday . She is a real fighter when it comes to advocating for her patients and knows the right words to use to get around Medicare . Love my doctor '