Insurance denied Viagra use

I had robotic surgery on May 4.  As part of the penile rehabiliation, I received a prescription for Viagra, 50mg every day.  My insurance (Blue Cross Blue Shield of NJ) has denied my request for medical necessity.  Nomal plan only allows four pills per month.  Use of Viagra or other ED drugs "in erectile rehabilitions after prostatectomy is considered investigaional."

I suspect this is just the company line.  Has anybody been successful appealing a denial for such medicine?  Also, does anybody have a plan that provides coverage?

Good news, cancer was contained in prostate.  I'm 53.

Hi Greg,
Welcome to the forum. Our Blue Cross Rx Insurance has a rider not covering impotence drugs also. My sister-in-law is a nurse and she said it should be covered for medical necessity. I called Blue Cross and pressed the issue but they wouldn't budge. We too are looking for a solution to this.

Greg,

I have the Federal Blue Cross/Blue Shield plan and they would not cover me either.  I was told I could write an appeal to the "board", but I feel that would probably be a waste of my time.  I ended up paying $113 for ten 100mg and I cut them in half for a 50mg dose.  That's 20 doses at 3 times a week...  or $17.00 a week.   I guess I used to pay that much for Starbuck's coffee each week and which I am not drinking now (makes you pee more!), so I guess it washes out.  It was still run thru my health plan, so I wonder if it will be included in my $4,000 yearly maximum catastophic limit, after which everything is free.  I am only about a thousand away from that limit with all the health issues year including my operation. 

I figured I would try the regular offical US prescription once (for six+ weeks), see how it was working and then maybe try to find a cheaper alternative.  I am near wrapping up my first 4 pills (8 doses) that were free with a coupon from the doctor.   They do seem to make a difference...  I am getting about a 20-25% erection at the 50mg and I had surgery 4/24 and just started the Viagra routine (3 times a week) 2 weeks ago.

 

Post Edited By Moderator (Admin) : 5/24/2007 10:37:09 AM (GMT-6)

I offered this same complaint awhile back. I found it insulting to be treated this way. I am on Medicare and they pay nothing. If your plan D does pay a portion it will be assessed at full cost against your "DONUT HOLE'. For those of you who don't know about this insidous Medicare Rx loophole, it was pushed through by Bushy and his cohorts to help bankrupt senior citizens. Hopefully the damage will be repaired in the future.

Actually you can buy some of these drugs online in generic form, but be sure to check out your source. I bought 100mg Viagra from Drugstore.com for about $10 each. This was direct and does not go against my "Donut Hole", sometimes called the GAP. Good Luck

Hey Kitt There was no illegal activity discussed, that I saw. Please don't over react, know your facts.

To Everyone:

Warning!  Buying ED prescription drugs in the US is very costly as we well know.  It is truly a sad situation when many insurers will not cover the cost of ED prescription drugs for PCa patients.  We face the same situation for many other miracle prescription drugs that are prohibitively expensive (especially if not covered by insurance), which may be needed for survival. This has forced many of us to seek the purchase of needed prescription drugs outside of the US at substantially lower cost, principally over the internet. The US government has been unable to readily police such purchases over the internet and is trying to rectify this situation for the future, hopefully to our benefit. In the meantime, there is a great concern about the quality of any generic drugs manufactured and sold outside of the US, and the possibility that they could be detrimental to your health, especially if they are counterfeit drugs.  Proceed with great caution! 

The following link indicates the FDA's current policy on importation of drugs.

 http://www.fda.gov/ora/import/traveler_alert.htm

You might be interested in reading this link relating to proposed "Regulation of Internet Pharmacies".

http://gregg.senate.gov/public/index.cfm?FuseAction=PressRoom.FloorStatements&ContentRecord_id=52fb8b9d-802a-23ad-4e3e-18cb9037e019&Region_id=&Issue_id=

Dave

BC/BS Federal plan does not cover the prescription either. we opted to use alldaychemist.com. I think in the future they will, but not now.

Sounds familiar Greg,

Paul's surgeon went to bat at a hearing that involved several of his patients. He gets a cookie and an A+ for his effort however, the insurance company stood my its opinion that there are no long term studeis on any post operative treatment involving PDE5 drugs currently available. They would not approve eating the cost of pills that cost 12-15 dollars each. Bottom line..... Approval of PDE5 drugs for men with a PCa hx is a patent expiration away in other words :>) Viagra is due to expire and Levitra right behind it..or is it Cialis that came 3rd? Anyway, it will happen in the not too distant future. Has anyone notice the major cost cutting moves Pfizer has made in anticipation of Lipitor and Viarga patent expirations? They haven't exactly been shy about why they have cut thousands of jobs. Tisk tisk tisk......

Ha...maybe it takes a long time to move!

There is a huge research complex here that is closing its doors and moving to various parts of the U.S / world.
Every month when I go there, the crowd gets smaller and smaller. Between the news and being on site once a month, this is the scoop I've heard. Will the last one out of Michigan please turn out the lights!!!!

Swim :>)

pcdave said... To Everyone: Warning!  Buying ED prescript ion drugs in the US is very costly as we well know.  It is truly a sad situation when many insurers will not cover the cost of ED prescript ion drugs for PCa patients.  We face the same situation for many other miracle prescript ion drugs that are prohibitively expensive (especially if not covered by insurance), which may be needed for survival. This has forced many of us to seek the purchase of needed prescript ion drugs outside of the US at substantially lower cost, principally over the internet. The US government has been unable to readily police such purchases over the internet and is trying to rectify this situation for the future, hopefully to our benefit. In the meantime, there is a great concern about the quality of any generic drugs manufactured and sold outside of the US, and the possibility that they could be detrimental to your health, especially if they are counterfeit drugs.  Proceed with great caution!  We got some "viagra" from India, but B has found that it is different than the Pfizer issue, not consistently potent and sometimes there is no effect at all.