Aetna drops coverage for VSL#3DS

Sorry to hear it, I hope you're able to find a way to get it covered.

AETNA refused me also but I thought it was because I haven't met this year's deductible yet. Guess I need to shop around for new insurance.

My insurance won't cover "medical foods" which means probiotics.

Also won't cover LDN.....fortunately it's reasonably priced.
The big drug companies haven't gotten their greedy claws on it ...yet.

There is a PAP program listed in the resources thread. A few members have gotten into the program but others have said that it's a lot of paperwork and they ask for your private financial details which many felt uncomfortable with.

Sounds like nobody is covering it anymore.

Honestly I don't even know if it is any better than other OTC probiotics, but having gotten into remission after a long painful struggle, I don't want to take any chances by switching to something cheaper.

I wonder if the manufacturer will stop making the DS version now as virtually no one will buy it out of pocket.

Funny Aetna would pay tens of thousands for ongoing remicade infusions, but they won't pay for a much less expensive clinically proven "non-drug" treatment. Makes you wonder what the bean counters at the insurance companies are thinking. No wonder our rates keep going up.

Honestly I don't even know if it is any better than other OTC probiotics, but having gotten into remission after a long painful struggle, I don't want to take any chances by switching to something cheaper.

I feel the same way. I did a cost analysis and VSL#3 is less expensive per billion of probiotics. Other probiotics may be less cost per pill but they have waaaay less probiotics in them and that is the important part, billions and billions is important. If you took as many pills of cheaper stuff to equal VSL it would be very expensive, more expensive than VSL. But many people just look at the price instead of what they are (not) getting for the money.

My insurance is covering VSL#3 DS. My co-pay is $50. Doctor wrote the prescription for 1 sachet per day. The pharmacy tells me that a box comes 20 sachets to a box, and they are not allowed to break a box. Therefore, I have to pay $50 for a 20 day supply. Anyone have ideas on how to get a full 30 day supply?? I called my insurance mail-order pharmacy, and they say it's not available through them -- only retail pharmacies. My doctor wrote me a prescription where I can fill 100 sachets at a time, for basically a 90 day supply, but they will only give me 80 sachets again because of the breaking the box. The pharmacy checked and my co-pay would be $150. Better for me to get the 80 sachets, but I've only been taking about 2 weeks so I'm still trying to see if I want to be on this long term. I don't notice much difference yet.

I called an Aetna representative to ascertain exactly what is going on. He said that Aetna will continue to pay some of the cost for VSL#3DS just like last year. However your doctor must first call the Aetna pharmacy at 800 414 2386 to get the prescription "precertified".

I bought those probiotics twice already this year for several hundred dollars but because they were not precertified by my doctor I had to pay full price. And the money spent so far on non-precertified prescriptions will not count for my deductible this year. So my deductible is still zero dollars for 2012. But the good news is that I know what can be done for next year.

As BabeintheWoods said, just because your insurance says they don't cover it doesn't mean they actually don't cover it. When insurance denies a drug claim, the pharmacy is supposed to send the rejection to your dr via fax or phone. Your dr (well, usually an administrative assistant) has to call the insurance company to get the appropriate precertification/prior authorization form. Your dr (well, usually a nurse) fills out this form, explaining why the medication is medically necessary and sends it back to the insurance company. Someone from the insurance company will read the form and determine if you meet their criteria for coverage. The decision is sent to your dr's office and to the pharmacy. If you have failed the covered medications and/or have been taking the drug for a while, it is usually approved. However, as Judy2 said, meds available over the counter are rarely covered by insurance. The turnaround time is, on average, 7-10 business days (though it took 3 weeks for my Remicade treatment to be approved). Many insurance companies will reimburse the patient for the cost of the medication that they bought during the prior authorization process. If the prior authorization is rejected, you can appeal but it's unlikely that they will change their mind.

At a well-organized clinic, this is done automatically for you (sometimes without your knowledge). If your pharmacy didn't notify your dr of the rejection or if your dr did nothing to help you get it covered, you should take your business elsewhere.

Whenever your insurance company denies something, you NEED to call them to find out why. The whole prior authorization process is just a way to make things difficult so drs will prescribe the less expensive medications, whether or not they think those medications are best for you.