Posted By Posting
Mar 07, 2009
momtomaia2005
BCBS won't cover my kids' Prevacid anymore!!
I just got a letter in the mail that our BC/BS PPO is no longer going to cover Prevacid (which both of my kids take) or generic Protonix (which I take). They want everyone to switch to generic Prilosec. I'm willing to try it for myself, but I'm absolutely NOT willing to gamble with my kids' health. They are both doing well on Prevacid. I am beyond livid right now. DH's employer pays up the whazoo for this insurance (small company), and this is what we get for it?? It does say that the doctor can try to get authorization approved for the Prevacid if the generic Prilosec isn't appropriate, but what are the odds that they'll approve it for both of my kids? I'm so mad I can't see straight right now.
Mar 07, 2009
shelleylisabeth
mine either!
WE just started on the Prevacid 2 weeks ago but have found the same to be true. We also use bcbs and fully intend to fight this since they do cover preventative meds but not until we've seen our new doc and have our upper GI done to prove that Nick does have reflux (not that there's even the tiniest question in my mind). Why do insurance companies have to work against us so much???
Mar 07, 2009
isobel'smamma
Sara, Mom to Isobel 10/01/08 Dx Silent reflux @ 6 wks. Prevacid 22.5mg split in 2 doses. Pepcid .5ml twice a day. Diagnostically confirmed milk protein, egg and cat allergy. Suspected corn, pea and squash allergy. Trialed Alimentum and Elecare without success, currently on Isomil Advance RTF with moderate success. Barium Swallow and UGI 3/08 Pondering a ph probe and endoscopy.
I'm on bcbs and they cover Isobel's prevacid with doctors med neccessity letter.
Mar 07, 2009
kubicki5
Julie - I have three children. My youngest Katie is my refluxer. My first Ben was very colicy and is ADHD. My middle Jakob is pretty easy going. Katie had it bad as a baby no sleep for two years. She was on Nutramagin, Prevacid and Zantac. Thought we were through it but after age three it came back big time. After her scope she was put on Prevacid 45mg a day and mylanta as needed. Scope was in Sept. Showed damage in stomach and espophogus. It took about 7 months of medication and Reflux diet for her to start feeling better.
It actually isn't as hard as it sounds. I was livid too but all it took was a call from the doctor.

You should be able to get both kids approved.

good luck

Mar 07, 2009
maiam
maia m - GERD. Nissen Fundoplication w/hiatal hernia repair.
Mom to
Son (10) GERD(aspiration pneumonias, apnea, tracheomalacia), Food allergy, Asthma
Daughter (6) GERD, Heart Murmur, Food Allergy, Asthma, Mold allergy
Ditto. Our doc wrote letters stating that my kids did not respond to the other meds, and needed coverage for the med that worked for them (Nexium).
Mar 07, 2009
momtomaia2005
The only other med. that my kids have been on is Zantac, though. The letter says that we have to have tried this generic Prilosec in the past 3 months to even get coverage for the Prevacid anymore. I hope that a call from my kids' ped. will solve this. Should I get their gastro involved too? I am just so incredibly pissed right now.
Mar 07, 2009
isobel'smamma
Sara, Mom to Isobel 10/01/08 Dx Silent reflux @ 6 wks. Prevacid 22.5mg split in 2 doses. Pepcid .5ml twice a day. Diagnostically confirmed milk protein, egg and cat allergy. Suspected corn, pea and squash allergy. Trialed Alimentum and Elecare without success, currently on Isomil Advance RTF with moderate success. Barium Swallow and UGI 3/08 Pondering a ph probe and endoscopy.
I'd contact the GI - I'm sure he's dealt with this type of situation before. Usually the communications I get from BCBS SEEM definitive but I've found that a call or letter from a doctor works wonders. You may have to initially pay out of pocket and fight for reimbursement. I know it totally sucks - I had to pay out of pocket for Isobel's first month, then I had the doc write a letter.
Mar 08, 2009
jeddsmommy
Jessica, Mommy to Jedd, severe reflux, severe food and oral aversions, Finally G tube free!!! VSD repair 4-24-07 (open heart surgery), hypospadias, repaired 3 times and Ear tubes Visit Jedd at his CB site: www.caringbridge.org/visit/jedd
The insurance co will respond better if the GI sends the letter. IT is their area of expertise, KWIM.

Also I would make sure to put in there what other meds have been tried and why they failed. I would also hit them in the money pocket. Let them know that if your child does NOT get the meds they need to keep their GERD in check you could be looking at serious damage that could lead to in patient stays as well as possible aversions that would required ST or OT from them.

Ins. co. respond to things when they think MONEY will be involved. Sad but true.

Mar 08, 2009
debbieb
Debbie, Mom to:
Derek,10/29/02 GERD,Can't have any legumes(soy, being the worse), allergic to PN/Tree Nuts, struggled to gain weight for years, my "picky" eater,Takes Zegerid. Johnny, 12/05/99 GERD, managed by diet, allergic to cashews/pistachios.
I found this chart on the Blue Cross,Blue Shield website that compares Generic Prilosec to the other PPI's. They say it is just as good, but if not as strong, so if you are on 30mg Prevacid, you need 40mg Prilosec. I don't mean to say what works better, but this is what they are saying. Tips To Help Your Patients For patients initiating therapy: consider prescribing Prilosec OTC 20mg daily. If necessary, increase to 2 Prilosec OTC tablets daily. For current PPI users: Use the following PPI Dosing Conversion Chart If you have patients who are currently taking a branded PPI, consider Prilosec OTC. If Patient’s Daily Dose is: Consider Prescribing Prilosec OTC Prevacid 15mg Prilosec OTC 20mg once daily Prevacid 30mg Prilosec OTC 20mg TWO tablets daily Protonix 20mg Prilosec OTC 20mg once daily Protonix 40mg Prilosec OTC 20mg TWO tablets daily Nexium 20mg Prilosec OTC 20mg TWO tablets daily Nexium 40mg Prilosec OTC 20mg TWO tablets daily (up to 4 tablets daily) Aciphex 20mg Prilosec OTC 20mg TWO tablets daily Prilosec (Rx version) 20mg Prilosec OTC 20mg once daily Prilosec (Rx version) 40mg Prilosec OTC 20mg TWO tablets daily
Mar 08, 2009
kubicki5
Julie - I have three children. My youngest Katie is my refluxer. My first Ben was very colicy and is ADHD. My middle Jakob is pretty easy going. Katie had it bad as a baby no sleep for two years. She was on Nutramagin, Prevacid and Zantac. Thought we were through it but after age three it came back big time. After her scope she was put on Prevacid 45mg a day and mylanta as needed. Scope was in Sept. Showed damage in stomach and espophogus. It took about 7 months of medication and Reflux diet for her to start feeling better.
For my GI this was like breathing for them. They do it all the time and will do or say anything to get the kids on the right meds. Go with the GI.
Mar 08, 2009
slimfast13
This is our dd, Alessandra. Dx with GER 10/07. Ran the gamut with meds and now done with them (crossed fingers). Using magnesium, probiotics and prebiotic supplements. With the exception of teething and general sassy attitude, all is well now. They really CAN grow out of it!
We have BCBS, though our Rx is through ExpressScripts. We could not get Prevacid without documentation that we had tried both Zantac and Prilosec (which we had.) It took auth from our MD and faxed records. We were also on reconstituted Pepcid, which was a MAJOR fight to get them to cover it AND let us get it locally. The Prevacid we have to do mail-order.
Mar 08, 2009
jenrackley
PAGER Volunteer Services Coordinator
Nutritionist
Melina 7/24/02 now reflux free!!
TWINS:
Ella 5/3/05 GERD, asthma, hypotonia, food intolerances, esophagitis, IBS //
Ava 5/3/05 asthma, food allergies
Pic: My girls! They are getting so big!
Same here. My refluxer is on an adult dose of prevacid and they tried to deny this last time we tried to get it filled. Thankfully after a quick phone call it was straitened out and is now back to being covered.
Mar 08, 2009
isobel'smamma
Sara, Mom to Isobel 10/01/08 Dx Silent reflux @ 6 wks. Prevacid 22.5mg split in 2 doses. Pepcid .5ml twice a day. Diagnostically confirmed milk protein, egg and cat allergy. Suspected corn, pea and squash allergy. Trialed Alimentum and Elecare without success, currently on Isomil Advance RTF with moderate success. Barium Swallow and UGI 3/08 Pondering a ph probe and endoscopy.
LOL! I just opened my mail from yesterday and got the same letter!

The letter reads, "If omeprazole is not recommended for you, your doctor has been advised that authorization from us is needed in order to approve coverage of Prevacid Solutab"

A call or letter from the doctor will definitely solve the issue - no big deal, they do this all the time. Bring a copy of the letter to your GI, if the office staff is good they'll have it sorted out for you in a matter of minutes!

Check with your
doctor first!