Aetna not covering Rowasa or generic

Your Dr's office can call the ins company and explain its necessity. Mr Dr's office did it for me.

Carlie

I have Humana PPO

Her nurse called them this morning and couldn't get it. We've always had amazing coverage with everyone else, I can't believe this is happening. Even BCBS covered Rowasa.

That's really strange. I would try calling yourself and maybe even ask to speak to a supervisor. It doesn't make sense they'd cover Lialda and not Rowasa.

This is absolutely unconscionable. Your husband's employer should have considered possibilities of this kind when making the change to Aetna. I would be willing to bet dollars to donuts that the insurance broker responsible for bringing about the change of carriers promised your husband's employer that the change would entail no reduction of benefits whatsoever. If that's the case, then I would stick that promise right in their ear and there are two ways you can do that: (1) Hold the agent responsible if such representations were made, (2) demand that the company self-insure the uncovered amounts which they won't want to do, of course, but their refusal to do so would go over like a turd in the punch bowl with the rest of the company's employees. I'd be absolutely unmerciful in my pursuit of these ******s. Most important, first determine what promises were made to your husband's employer by the so-called "broker of record", and if I'm right in what I've guessed at here, demand that either the broker or the company make good on the promise. Your chance of getting anything from Aetna are zilch.

beatUC,

I've always liked that imagery.

cupcakespinkgal might have hit on the answer......
Is there someone in Human Resources at your husband's company who deals with questions regarding health/drug coverage? They may be happy to run interference for you.
Aetna might cover the generic version.
I used to work for an insurance company and had to switch to the generic version of Colazal (balsalazide) under my health/drug plan and use mail order for a 90-day supply.
The one time I tried to order through a pharmacy resulted in a lot of complications.

Thank you for your replies. I called them myself 3 times and on the third try I really laid into them and got them to cover the generic. That will at least tie me over while I work on getting Rowasa petitioned by my doctor. The guy I spoke to from Aetna said since I'm new with them, they don't have my medical history so it's up to my doctor's office to push for what I need. I don't think my doctor's nurse is very good at that, but hopefully we'll get it done. My husband spoke to HR too and they said they could make some phone calls if they needed to.