Denied !

Donald, sorry that your day is officially in the toilet...not surprised at the insurance company's denial as my husband can't get Viagara either (without paying through the nose). Many prescription plans now cover only "preventative" medicines but, even more important, they don't seem to recognize the "other" use for ED drugs (rehab after prostatectomy). Go out and enjoy your dinner tonight - tomorrow is another day and hopefully will be alot better than today.

DonaldJ email me about viable options. There are some. I have left over Viagra I really never use anymore that you can have. In fact I have 22 still in the blister packs. BTW it's normal to be turned down by insurance companies. Your urologist should've known and warned you.

Sorry, Don, last thing you needed to hear. Hope you can find a way round it.

david

Maybe some sort of help plan? A prescription drug assistance program?

Don,

Some thoughts -

1) You have not had your surgery yet. That is probably why the claim does not qualify. The way I got the insurance company to cover a minimal number of pills (8 per month, regardless of type/size) and later Trimix, was to wait until after the surgery. Go to the surgeon, who can then diagnose you as having ED due to the surgery. That is the important part, you had to be functional without them before surgery. Most insurance pays little or nothing for pills for generic ED. My Surgeon and pharmacist pushed it through as required for ED due to a surgery that was covered by my insurance. So it was caused by something they paid for. They didn't like it, but they agreed.

2) Beg for samples. I never leave either my uro or GP's office without asking for whatever they might have to offer, even if it isn't one I can use. Horse-trading happens.

3) Shop prices. As mentioned, they vary. If you have a Sam's or Costco, check there as well. Even if you had to pay a membership, it might pay back over a year. Some wholesale clubs don't require membership at the pharmacies (state laws, I think).

4) For your first prescription, get a month pack of 5mg Cialis written. Go on line to the Cialis website, and download their free offer coupon. Take that to the pharmacy (make friends with your pharmacist if you have not already, as they will have to go out of their way on some of these things for you). You get the free prescription filled on Cialis' dime, then, if the price is too high the next month, don't get the first fill on the doctor's prescription. Do the monthly deal, as the 20mg deal only gives you 3 pills. Most good pharmacists know the drill.

Same boat as most of us find ourselves in. I was furious when it happened to me. I had friends pick them up in India for me from a pharmacy and I picked them up when I go over for work. They work just as well.

Coverage here is getting ridiculous.

Many of us have run into this problem, and yet the public perception seems to be that Viagra, Cialis, and Levitra are "covered" items.  CNN.com recently ran a story marking the anniversary of the introduction of Viagra, and many commenters remarked that while many important drugs are not covered, they all were certain that these ED drugs are covered.  I don't know where they get this impression.

No one seemed aware of the role these drugs play in trying to assist men who have been treated for prostate cancer in recovering their ability to be intimate with their wives.  There were a lot of fairly disgusting comments about these drugs, and about men who feel they need them to bolster ther sex llife, but mostly a whole lot of ignorance.

Until the public becomes more enlightened about the legitimate medical uses for these drugs, it's hard to envision the insurance companies changing their existing policies.

 

I see the subject as assisting Don to sort out the mess he has with his provider as best we can within the rules of the site.

The morality or practices of the insurance companies won't be influenced by our comments here, and those comments just stir up another ugly thread.

Don,

You might want to put an email in your profile. The guys who could make some off-board suggestions can get to you that way.

Don,

The office and on-line Cialis offers are the same. You can get one fill per patient per 12 months, so I do that at each annual prescription renewal.

I faced a similar problem after my da Vinci. I don't know if any of the other posts have suggested this, but you should contact the manufacturer of Cialis. They have (or at least did) a program where they will give you one month's worth of 5 mg pills for FREE. Kind of a trial sample thing.

Good luck!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-firm erections now happening 14 months post-op & slowly getting a bit stronger.

Yeah, tried that, no luck.