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In answer to zoph3388 re: Cialis, etc.

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Posted 10/18/2011 7:29 PM (GMT 0)
Insurance can be made to see the light if your doctor presents a proper argument. Dr. Charles Myers and Dr. Mark Scholz have form letters they send to insurance companies with appropriate references to studies. The coverage is specifically for a low daily dose of Cialis to guard against atrophy.

My insurance company adamantly refused to fill this prescription, but when Dr. Scholz presented his justification, my insurance company obliged me. I have not seen the letter, but I know it worked, and Dr. Myers claims that he routinely handles this issue.

This may not be what you are referring to, but I thought it would be helpful to mention it.

Nellie
Posted 10/18/2011 7:56 PM (GMT 0)
The insurance companies are tough on this, because they can be, I guess. I filed an appeal, got letters from the right doctors, and they still refused it. Appealed that, and lost again. Since I was trying to accomplish the 5mg daily dose, and the limit for my insurance is 8 pills monthly (counted, not by dose), we shuffled the prescription to be for the maximum 8 pills of 20mg, and I cut them up.

I do beg samples from any doctor I see - both my uro and GP have them in unpredictable brands, doses, and quantities, so I've been known to take what I can get.

It is interesting, and I think someone else mentioned, that Federal law requires insurance companies to pay for reconstructive surgery for the ladies with BC. Won't go any farther with that, and don't anyone reply to it lest we go off the political cliff.

Good luck.

Posted 10/18/2011 9:05 PM (GMT 0)
my insurance allows eight viagra and/or six cialis but of course i have a huge co-pay.  it's about $60 for the viagra and $70 for cialis.  i'm not sure if i can get both.  i cut the cialis in half so i get 12 doses for $70.  for me that's about a month's worth.

ed

 

Posted 10/18/2011 10:46 PM (GMT 0)
Tricare also approved Michael to get 30 Levitra per month. We had to go though the pre-authorizaton process. It was denied the first time because the Nurse who called it in didn't use the proper wording, it is all semantics and your DR office need to know what key words to say to get the approval. At least that is what we found with Tricare.
Posted 10/19/2011 2:53 AM (GMT 0)
When I appealed my "8" limit, the ins. co. produced the agreement with my company as to what is and is not covered in extraordinary detail. As we have been talking about HT, I discovered that they do not cover the RT  to prevent male breast enlargement. I learned at the time that the ins. co. offers a coverage at a price, then they negotiate, literally picking off coverages to get the price the buying company wants. The only things fixed are those required by law.

And no, mine, at least, will not honor parallel ED pill prescriptions. I have to clear 30 days from the last refill before they will honor the new one. I can buy them out of pocket, but that is at retail ($169.00 for 8 x 20mg Cialis), and no credit against deductible.

Posted 10/19/2011 2:59 PM (GMT 0)
I had the same problem with BCBS of AL. Even if I could have convinced them to cover my ED drug needs, the co-pays would have been $75 for 8 pills. The good news is next February Viagra will go generic in the US and I think you will see all prices for ED drugs drop dramatically to compete with generic Viagra. I have been taking Lipitor for several years with a $75 per month copay for my high cholesterol. It will go generic by the end of this year and I received from Lipitor a $50 per month Copay coverage card from them back in January in an attempt to keep me on the non generic. My insurance will require that I take the generic version once it is available.
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