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Need help with Zithromax and insurance!!

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Posted 2/25/2015 12:15 AM (GMT 0)
My insurance will only cover 3 days of Zithromax. I called to argue today, but they said it is that way because Zithromax comes in packets of 3. So, I would have to make LLMD call and try to override their 3 pill limit.

Does everybody on Zithromax have to do this? I noticed quite a few people on here do take it now or have taken it in the past. Why is it so difficult to get Zithromax?

I checked my email and LLMD said for ME to call insurance. If they gave me a hard time to take Biaxin instead. This is to go along with my mepron for babesia. Is Biaxin good to take with mepron?

I'm so frustrated! Is Zithromax better? What should I do?
Posted 2/25/2015 1:29 AM (GMT 0)
Facing similar issue with my mom's zithro. The pharmacy only gave 6. However, I noticed on the label that it said I had 2+ refills, 84 tabs remaining. So I wonder what will happen next. will keep you posted
Posted 2/25/2015 2:20 AM (GMT 0)
utahgal - there is always something that can be done from the pharmacist's standpoint. your pharmacist should be able to help you out - if not, I will. What insurance do you have?? you live in NY right? shoot me an email and provide me with your insurance info, I will make the calls to your insurance for you if you would like me to!!

if the Dr wants you on Zithromax, then stick with it - we will figure it out, I was on zithro, and it did wonders for me. I personally don't like biaxin - it kills my stomach to no end!
Posted 2/25/2015 4:24 AM (GMT 0)

Chapelle said...
utahgal - there is always something that can be done from the pharmacist's standpoint. your pharmacist should be able to help you out - if not, I will. What insurance do you have?? you live in NY right? shoot me an email and provide me with your insurance info, I will make the calls to your insurance for you if you would like me to!!

if the Dr wants you on Zithromax, then stick with it - we will figure it out, I was on zithro, and it did wonders for me. I personally don't like biaxin - it kills my stomach to no end!



^^^^^Just wanna say real quick....Chapelle is Da BOMB!! So kind of you to put your personal professional knowledge to use & extend a helping hand to Utahgal! turn yeah smilewinkgrin


-Courtney
Posted 2/25/2015 12:33 PM (GMT 0)
You can provide them with literature that shows longer treatment is required for some conditions. Failure on their part to approve treatment that is recorded in the literature is risky from a litigation standpoint. These references are reaching and you will need to be convincing. I've successfully done this before with Mepron and they could not beat me. They ended up beating my physician, but they couldn't beat me because of the literature.

http://sti.bmj.com/content/84/1/72.short
http://www.sciencedirect.com/science/article/pii/000293439190401I
http://jama.jamanetwork.com/article.aspx?articleid=197393
http://ard.bmj.com/content/63/9/1113.short
Posted 2/25/2015 1:10 PM (GMT 0)
Thank you so much, Chapelle, for the offer. I may take you up on that. I didn't get anywhere when I called the insurance. You are so kind to help out.

GH.....thanks for the helpful links. That's a good idea to provide studies to back me up. My problem is I tested CDC negative for Lyme and babesia. That might be an issue.
Posted 2/25/2015 1:17 PM (GMT 0)
Courtney - you are so funny, and sweet!! =)

anytime utahgal - i will look out for an email from you!!
Posted 2/25/2015 3:05 PM (GMT 0)

Utahgal said...
Thank you so much, Chapelle, for the offer. I may take you up on that. I didn't get anywhere when I called the insurance. You are so kind to help out.

GH.....thanks for the helpful links. That's a good idea to provide studies to back me up. My problem is I tested CDC negative for Lyme and babesia. That might be an issue.

A clinical diagnosis maybe enough. Heck, a positive band 41 should be enough. Sad-sad.
Posted 2/25/2015 8:13 PM (GMT 0)
Georgia - its all about getting prior authorizations - believe me, the people working at the insurance end have absolutely no clue about band 41! They just need a "diagnosis" - which does not need to be proven by any bloodwork, it can be a clinical diagnosis by the Dr, which is a plus for the patient!
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