Prevacid and the Perils of Pauline

This is what is happening to my friend Pauline in the US, in her own words. That makes it the first guest post!

AHHH...the insurance debacle.

I got a  call today from the CareSource guy who manages my case and he said they denied the Prevacid again.  Well, I lost it, for me anyway, then felt guilty afterwards. 

Why did they deny it?  Did they get the doctors letter?  Did they read it?

Step Program from woodworkingdownunder.com/freedollhouseplans

The reasons they state for not approving Prevacid are that the generic is the same drug as the brand name and a step program of trying other drugs is needed. Now I am on the 90 day trial of the 2nd manufacturer, but it upset my stomach on day one, so am not taking anything for my acid reflux. I'm just sitting till my waiting period has expired and so I am wasting money by not taking the same medication that I tried in 2007 when it did not work.

This is what I need to do again:
I need to use drugs from two different generic manufacturers again.
The Doctor needs to send the chart and history (he has done that).
He has written a letter. All the things they need, we've done.  I asked, doesn't Caresource read anything?  They're sending me the same denial letter over and over again!  The two other med manufacturers are Dr Ruddy and Sandcrest.  Does the insurance company read anything or do they just deny and put everyone off?  I think they don't care about the people - just about making money.  This will be my third letter stating the same reasons!

Sometimes it's like a merry-go-round

The rep said well, I wouldn't say they just worry about the cost not the people.  I said "Well, what does this look like?  I don't mean to take it out on you but this has been ongoing for about 9 months or more. I'm not taking any acid reflux meds and probably developing ulcers because of the stress".   

They just want us to give up on getting this med and I'm sure the majority of patients do.  And if the generic made me feel okay, I'd take it but....my tummy says no way.
 

My CareSource Navigator said that if I get this approved, make sure that the Dr pre authorizes it..because prevacid and nexium are the two hardest to get.  They're the most expensive. 

The pulmonologist said we (patients) should all rally against this.  How do you do that?  There's so much to rally against...what do you start with?  Doctors that drop you, meds they prescribe for you that are denied, moving your scheduled appointments to another later date, going to only the poorer hospital, switching your generic meds constantly...with different manufacturers?  Is that safe? 

Not a drug rally. This was environmental

So, what do I do now?  He said to call the doctor's office: they got a copy of this denial letter and have them call the Peer to Peer group in the CVS Pharmacy.  HMMMM..can I call the Peer to Peer group myself?  Nope.  Lucky for them.  He said they aren't even allowed to call them anymore.  Sherry at Dr X's office has to call so I called and left her a message.  No hurry..wonder when she will start blocking my caller id.  LOL 

I feel bad being kind of nasty with the rep but it rubbed me the wrong way.  Even Dr X said,  this letter is all we can do..the last step.  I hope it works. Anyone need some nails cause I've been spitting them out since 10 am? 

I think (KNOW) now that I am fighting for principle.  I could easily change to something else but I know prevacid doesn't upset the stomach like the others...so why try number 3, 4 and 5? 

Really, I thought..according to the insurance and medical companies, that the generics are all made the same as the name brand.  So???

Generic is not the same .. I don't care what they say. Its a nightmare here to get your name brand meds.  I don't think the generics are made to match the name brand. For sure the fillers and delivery system may be different and probably made in factories with poorer quality control. Look at the Ranbaxy settlement for one example of substandard drugs.

It's stupid.  My care source navigator told me that she tells her patients if they get do get approval on nexium or prevacid...never let it drop cause it's like gold.  What a waste of time, paperwork, medication and my health. My husband used to call this "thinning the herd".

I have 2 friends who have had success on this name brand drug and no luck with the generics. I wonder if they are the only ones? It's too bad that so many with RA need to take additional drugs to protect their stomachs from damage by NSAIDS.

Patient Stories About Generic Drugs

Like almost everyone else who uses medicines to improve or maintain their health, I take a large percentage of  generic drugs. Up until the last few weeks I have not noticed any difference in the effects of brand name vs generics.

                                           Generic drugs 

Unfortunately that is not the same for everyone, and now I am joining their ranks. One of the drugs I take recently just became a generic and I noticed a real difference quite quickly.

With most medication you judge the efficacy by a gradual change in the way you feel or by lab tests that indicate how well they are working in your body.  So many drugs that we take are preventive or work slowly on changing your system. With those you are unlikely to notice a difference. This new generic (Pilocarpine, brand name Salagen) is the only one I take that takes effect quickly and has a noticeable physical effect.

                                   Non-generic - see markings
My doctor wrote me a note and a new prescription that says "no substitutions". The insurance company says fine, if the doctor says I need the brand name they'll pay (and so will I of course) so that is lucky for me.

Neither the doctor nor the pharmacy mentioned reporting an adverse effect for this new generic. I was able to access the 32 page monograph that the new manufacturer supplied to Health Canada. They listed every paper about the drug from the past and talked about how the drug worked in trials compared to the brand name drug. They only tested the effects on 5 women. I guess I'm not like them.

Patty's Story:

"I am taking the generic Prevacid and I don't like the effects.  It upsets my stomach.  I stopped taking it.  I don't know which one would be easier on my digestion.  I don't think I ever got the brand name Prevacid though I do hear the acid reducers are hard of the gastro tract. 

I haven't been able to get Prevacid..still jumping thru hoops for that.  I'm not taking anything....just sort of po'd.  And not doing a thing about it.  I'm trying out the 2nd manufacturer but really not.   The pharmacist says if the Dr pre authorizes it, I can get it but he already did pre authorize it and I still was denied.  I am still waiting for approval on the Reclast....  I think they hope I break my hip or leg first. Then they'll approve it. 

                                                 Patty is angry in a non-threatening way

I'm just so mad....I don't know when the patient had to be their own doctor, secretary and insurance company to make sure you get the things you need."    

Julie's Story

"I am going to add my experience with the generic of Prevacid to Patty's reply.

I have Barrett's esophagus - thanks to use of NSAID's.  This is a pre-cancerous condition.  The doctor put me on Prevacid and it really helped.  At a follow-up endoscopy, he could barely see anything in my esophagus.

Well, my insurance company switched me to the generic of Prevacid - Lansoprazole.  I tried that for about a month and started having GERD symptoms.  After much confusion and doctor's visits, my insurance company agreed to pay for the Prevacid.  I started back on the Prevacid and things returned back to normal.  So no one can tell me that the generic works like the Brand name drug.  I had to get special permission from the Insurance Company to get them to pay for the Prevacid.  I told them that if they would rather pay for treatments for esophageal cancer instead of the correct medication, then that was their choice.  I have to get approved every year.

                                   Please approve my brand name drug

The Prevacid is EXPENSIVE!.  I don't quite understand why.  Another thing is that Prevacid is sold OTC - but the strength is 1/2 of that of the prescription medication.  I take 30 mg and the OTC is 15 mg.

Insurance companies are really getting screwy with what they will allow their patients to have."

Julie

Patty continued...
My Caresource insurance lady was telling me about Exact Care where you get your meds in an easy tear off pouch all tightly wrapped and inside a little cardboard box.  All your meds for the month are there...just tear them off as the day goes along...am pills, lunchtime,  afternoon, PM and evening, bedtime.  She asked would you be interested in that? Its so convenient.  I said no way....they're already substituting my meds when I pick them up at the pharmacy. Or switching manufacturers on me.  I want to see what I'm getting and I don't want a month of a med or two that they've subbed that may make me sick or is totally different than what I am used to.   

Ronny's Story:

"I guess you are proving my point.  The move is towards saving money first and finding healthy resolutions second. 

Many years ago it was predicted that this time would come.  Health would be the big commodity and everyone began positioning themselves to make out like bandits.  The health center I worked for had big meetings to discuss how they could position themselves to take advantage of the health boom and also baby boomer aging.  They got in early.

Now we have to fight to keep what little Social Security we have.  I was hoping I could afford more fruits and vegetables.  Guess that's not happening!"

                       AmusingPlanet.com Harrowgate Flower Show. Fruit&veg for Ronny

Here's another story about generics from CNNMoney - Are Generic Drugs Really The Same as Branded Drugs? . This story points out that although generics compared to the brand name they are not compared to one another so the relative usefulness is unknown.

This is the link to the original post called Generics: Not Just an Image Problem