Saving...

During chemo I have nausea. Zofran & Compazine haven't worked. Emend helped but is expensive. How can I negotiate with my insurance company to pay for Emend?

Cancel

Topics (Tags):

Financial Emend Zofran Financial Assistance Health Insurance Insurance Nausea Compazine Chemotherapy

Topics:

Financial X Emend X Zofran X Financial Assistance X Health Insurance X Insurance X Nausea X Compazine X Chemotherapy X

Done

Diseases:

Done

Answer Summary

Cancel

Answers (2)

member9844 (Friend) - 07 / 25 / 2011

First you need to ask your doc if there is anything that is a generic that's comparable to Emend. The price of Emend may be a function of its place on your Pharmacy plan's Formulary, and, as such may be in a Tiered Plan situation where certain inexpensive drugs are made more accessible, and as the complexity and expense of the drugs go up so may your co-pay. If there is no comparable drug to Emend, and if this is truly the only med to work for you, then you'd get a letter of medical necessity from your doc over to the PBM/Managed Care Org. with a request to keep the patient expense to a minimum. In the interim, I would call the Managed Care Org. and ask to speak to the CEO's office ("I'd like Joe Smithers office please.") Then you explain your situation to the assistant and ask for a remedy as it's an expensive drug. Also, I'd contact your company's HR/Benefits people to see if they can suggest a remedy for you as they took part in purchasing the plan. Use as much emotional leverage as you can here. I wish you luck.

First you need to ask your doc if there is anything that is a generic that's comparable to Emend.  The price of Emend may be a function of its place on your Pharmacy plan's Formulary, and, as such may be in a Tiered Plan situation where certain inexpensive drugs are made more accessible, and as the complexity and expense of the drugs go up so may your co-pay.  If there is no comparable drug to Emend, and if this is truly the only med to work for you, then you'd get a letter of medical necessity from your doc over to the PBM/Managed Care Org. with a request to keep the patient expense to a minimum.  In the interim, I would call the Managed Care Org. and ask to speak to the CEO's office ("I'd like Joe Smithers office please.") Then you explain your situation to the assistant and ask for a remedy as it's an expensive drug.  Also, I'd contact your company's HR/Benefits people to see if they can suggest a remedy for you as they took part in purchasing the plan.  Use as much emotional leverage as you can here.  I wish you luck.

Cancel

member5693 (Survivor (2 - 5 years)) - 07 / 25 / 2011

My insurance wouldn't pay either, but Merck had a program to furnish it to patients in those circumstances. Don't think we ever had to buy a single dose - they mailed them to me before each scheduled chemo. Your doc should contact them for you an arrange that.

Cancel

Note: Usernames have been made anonymous and profile images are not shown to protect the privacy of our members.

Note: All content on this site is informational and not a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with questions regarding your health.

Flag Content

Please expain why you are flagging this content. Thank you.

Cancel

Thank you for flagging this content. We will look into it right away.

Give a 'Thank you' to

Cancel

Add Answer

Question:

Optional: What context or background information is relevant to this request?

Notes:
The more clear and thorough your request, the more likely you will receive support.
Many of our members are learning from this information or english might not be their first language. Please use standard english and spell out all words. For example, use 'you' instead of 'u'.

Submit

Thank you for sharing your question.

We will notify other members of your question. Responses will be sent to your email account as well as viewable at the following link:

We are finding other members now to join the chat.

Click here to start the chat.

Cancer questions and answers.

Personalized, helpful, and accurate health answers.

Join Via Facebook

Join Via Twitter

Question Statistics

Latest Activity: 07 / 25 / 2011
Views: 734
Followed By: 3 members