HealingWell
Search Close Search
☰

Mepron issues with insurance

Support Forums
>
Lyme Disease
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 2/18/2017 11:47 PM (GMT 0)
Who has had problems with insurance covering Mepron? I just went to the pharmacy and they told me that Atovaquone (not even sure what that is...they said it is the generic) would cost $1,121.99 for a 750mg/5ml supply and that Mepron would be over $1,700. I've seen people posting that theirs cost $400..but this is way more than I would have ever imagined. I don't know what to do...I am supposed to start the protocol on Monday.

Post Edited (Brainzap545) : 2/18/2017 6:17:01 PM (GMT-7)

Posted 2/19/2017 12:05 AM (GMT 0)
Mine would not cover mepron.

They would cover malerone but out of pocket still was 400$ a month. Insurance co are all different
Posted 2/19/2017 12:21 AM (GMT 0)
Yes, all insurers are different...and depending on your coverage level even the same insurer's coverage will vary. I have excellent insurance but they would only approve 100ml, a 10 day supply. My lldo wants me to take it for 10 days then pulse off for 60. I'm going to back it up with herbals.
Posted 2/19/2017 12:59 AM (GMT 0)

OldSalty said...
Yes, all insurers are different...and depending on your coverage level even the same insurer's coverage will vary. I have excellent insurance but they would only approve 100ml, a 10 day supply. My lldo wants me to take it for 10 days then pulse off for 60. I'm going to back it up with herbals.

OldSalty - that's taking it for 10 days and then 60 days off (or did you mean 6 days off)

60 seems like an awful long time...what was the reason?
Posted 2/19/2017 1:16 AM (GMT 0)
Has anyone had success with online coupons? The pharmacist said it covers "11 days." Im guessing she means 11 doses as I doubt she took into consideration pulsing?
Posted 2/19/2017 2:29 AM (GMT 0)
Ask your LLMD for coupons. Mine has been able to really help out
Posted 2/19/2017 2:52 AM (GMT 0)
Mine said something about getting a Walgreen's card or something, then being able to get it for $40. Not sure about that, though. I may be recalling incorrectly. There was also some organization that will send a six month supply. Though, the trouble of getting a positive test result makes that difficult. Keep in mind, I've fact-checked nothing. I'm still working on getting back on insurance, after Medicaid decided I was making too much money, then booting me off.

Anyway, really sad situation, because I think I have a big problem with Babesia or BLO, and I have tried a lot of the natural things. I'm thinking my essential oils have hit all they're capable of hitting. I've been flaring terribly about every week. I have many things I need to work on that could be playing a part though.

You hear about how difficult Babs can be to treat too.

All, or most of, the meds cost so much.

Always a money issue, at some point. sad

Keep keepin' on, y'all! Life's a garden, dig it! Just keep swimming (watched Finding Dory last night)!

MWAH MWAH *kisses*
Posted 2/19/2017 3:54 AM (GMT 0)
I am not sure about all this because its all new to me, but I was just prescribed mepron and azithromax and they were both $0 copay for 30 days. My LLMD also takes insurance so idk if that has something to do with it? She doesnt take my insurance, but she does deal with insurance.
Posted 2/19/2017 11:55 AM (GMT 0)
Most insurances will pay for Atovaquone with a prior authorization. This can be a tricky process where the insurance asks questions about the diagnosis and then denies your claim. Always ask "why" the PA was denied. Once they deny your claim, you have to present them with the scientific literature that proves you to be correct. Sometimes your physician alone is enough to get it paid, but they will often deny subsequent months. I was able to get my paid each month for 3 months and would have continued to get it paid had they not scared my physician so bad that he wouldn't write any more Rx's for me and basically dropped me as a patient. The 2nd month, they had a physician get on the phone to question me and he could not deny my claim because I presented evidence proving my stance. It can be done but is not easy.
Posted 2/19/2017 1:01 PM (GMT 0)
My insurance cost of the generic Atovaquone was $1150 for a month or $1750 for Mepron. They told me they would not cover it at all. Completely denied. I decided to go with generic Malarone and the cost was $22.00 for a month.

There is no way I could pay for any form of just Mepron especially if I was on it for an extended period.

I tried different coupons and the pharmacy would not accept them.

I am doing fine with Malarone.
Posted 2/20/2017 6:10 PM (GMT 0)
Girlie: 10 days on, two months off. I don't quite follow it either, which is why the crypto and other tinctures are supposed to arrive today. I'll start them as soon as they get here. Since Dr. J got run out of the state on a rail by the NCMB, anything that relates to a vector borne disease is treated very cautiously. Which also drags out treatment...which means more visits...which means more revenue. I AM making slow progress, much of which I don't realize until I look back at how I was. I don't get lost in my shop any more, less "here after" syndrome, I walk rather than shuffle or stumble, vertigo episodes are fewer, LD tinnitis more sporadic. Brain fog only comes on after I get tired, though I still get tired easily. I still feel like I'm wearing clown shoes, but my arches collapsed shortly before infection and that made my feet longer, so I can't tell if that is part of the condition or not. Air hunger is still there. Hopefully I can get more exercise to reverse that as well.
Posted 2/20/2017 7:06 PM (GMT 0)

OldSalty said...
Girlie: 10 days on, two months off. I don't quite follow it either, which is why the crypto and other tinctures are supposed to arrive today. I'll start them as soon as they get here. Since Dr. J got run out of the state on a rail by the NCMB, anything that relates to a vector borne disease is treated very cautiously. Which also drags out treatment...which means more visits...which means more revenue. I AM making slow progress, much of which I don't realize until I look back at how I was. I don't get lost in my shop any more, less "here after" syndrome, I walk rather than shuffle or stumble, vertigo episodes are fewer, LD tinnitis more sporadic. Brain fog only comes on after I get tired, though I still get tired easily. I still feel like I'm wearing clown shoes, but my arches collapsed shortly before infection and that made my feet longer, so I can't tell if that is part of the condition or not. Air hunger is still there. Hopefully I can get more exercise to reverse that as well.

So, it is LLMD you are seeing? But, he can't prescribe it for more than 10 days on...because of the threat of investigation?
Posted 2/20/2017 11:00 PM (GMT 0)
She is a llDO. "Conventional therapy" indicates that 10 days is "sufficient", just like 30 days of doxy will cure borrelliosis. I've had two positive tests, so there is at least a basis for treatment. But I had difficulty getting my family dr to prescribe even the first 14 day course of doxy. Which was a waste of time and abx. Most physicians in this state seem threatened by doing anything perceived as controversial that pertains to Lyme. Which is why there was no problem getting 30 days of doxy for rosacea. It doesn't count.
Posted 2/20/2017 11:25 PM (GMT 0)

OldSalty said...
She is a llDO. "Conventional therapy" indicates that 10 days is "sufficient", just like 30 days of doxy will cure borrelliosis. I've had two positive tests, so there is at least a basis for treatment. But I had difficulty getting my family dr to prescribe even the first 14 day course of doxy. Which was a waste of time and abx. Most physicians in this state seem threatened by doing anything perceived as controversial that pertains to Lyme. Which is why there was no problem getting 30 days of doxy for rosacea. It doesn't count.

Well, even if she is lyme literate then...but is not following ILADS guidelines - then it's really not going to help you.

So, if CT Dr.'s aren't wanting to prescribe what's necessary(because of threat of investigation)...is it possible for you to travel to another state? Or is that not feasible?
Posted 2/21/2017 3:23 AM (GMT 0)
I'm too far from a llmd in another state. I'll keep supplementing with herbs. I am making progress.
✚ New Topic ✚ Reply