songlady's advice on how to get VSL#3 DS covered by insurance

Hi All - I think this is worth breaking out into a separate thread.

As many of you know, when 'VSL#3 Double Strength' first came out, it was prescription only. You couldn't buy it over the counter, you could only buy the regular VSL#3 (not Double Strength) over the counter at the time. While this was the case, I had zero problems getting the VSL#3 Double Strength with a prescription from my doctor.

After a while, VSL#3 Double Strength began to be offered over the counter. So the prescription only feature was taken away. When this happened, my insurance company no longer covered VSL#3 Double Strength. Since I was taking 3 packets per day, the cost for me skyrocketed.

Songlady has figured out a way to get VSL#3 Double Strength covered by her insurance company. Here's how:

songlady had tried getting the VSL#3 DS a few times by prescription, and she was rejected both times. Her doctor had written the prescription as "VSL#3 DS packets of 30". After being rejected a few times with that, songlady had her doctor write "VSL#3 DS packets of 20" instead. Switching from 'packets of 30' to 'packets of 20' worked, and her insurance company covered it!

Has anyone else tried this method with success? This might be a major breakthrough for me, because the VSL#3 DS over the counter is very expensive for the dosing I need ($18/day). Thank you songlady for uncovering this strategy!!

My insurance just changed from Blue Cross to Blue Shield in Jan 2011 --I was getting Rx VSL #3DS from Blue Cross , (although copay was $50)all last year 2 packets a day and it (along with Humira) was keeping me in remission for severe UC and C-Diff after 5 hospitalizations in the past year and a half!! Now Blue Shield says it is not on their list of Rx drugs and they will not cover any of it for a cost now of $300 for the same amount--I was having so much success with it that I am afraid to try anything else!! Any suggestions on how to get them to consider covering part like I had done in the past and also is there a good substitute?  (there are so many probiotics out there and some have given me gas in the past)  The new insurance company also gave me a hassle trying to get Humira because it is being used off-label for UC for me--it took over a month for them to approve it after many appeals--even though I have been in remission with it for almost a year (I had allergic reactions to Asacol, Lialda and Remicade--serum sickness hospitalization)  Just some info for anyone who has a problem like this with insurance--I requested a case manager (who is usually an RN with good medical background) to help deal with the nonmedical beauracrats and was approved for Humira in a day!!!!!!!!!!  ALWAYS, ALWAYS request a case manager who will be on your side--many people don't know they can do this!! I have been trying to get the case manager's help with VSL #3 DS, but with no luck so far because it is not even on "the list"!! Thanks for any help or suggestions!!

Does anyone have a copy of that letter?  I don't have UC, but Sarcoidosis, and the VSL#3 was clearing up the lesions on my face, as well has curing the IBS-related asthma, before the insurance co. cut me off.  I was taking 4 DS per day.  I suppose I could threaten with one of the anti-inflammatories they've been trying to get me to take too, Humira, Methotrexate, Plaquinil, etc.

thanks!!!!

 

I'm reading through all threads about VSL#3 DS and Aetna. I have been on VSL#3 DS for 2 years with BCBS. I pay $150 for 80 sachets (closest thing to 90 day supply) with BCBS, and it is covered. My insurance company is changing next year to Aetna. I'm trying to figure out how much I should set aside for Flexible Medical Spending Account in 2015. I was disappointed to learn that Aetna doesn't cover it at all. I called them and they said it's not covered. Is there anything to get around this? My doctor prescribed this, and my UC has been stable for the last 2 years post-FT and I truly believe VSL helps! There are days when I go more frequently, so I will take 2 sachets and the next day is better. I really don't want to change by meds up only for insurance. But I was quoted $462 for VSL#3 DS without insurance.

I see on Amazon that there is VSL#3 (regular strength) would taking 2 packets a day be the same mix of probiotics. The Amazon price is $52 + $6 shipping for 60 sachets which would be only a 30 day supply. Would this be eligible for the Flexible Medical Spending if my doctor would complete proper paperwork? I know OTC meds are no longer part of Flex plan, but I thought I remember if it's doctor approved there may be exception.

I did look at the wrong Amazon product. I was looking at the capsules which are a lot less. They do have sachets with 450 billion (1/2 the amount of the DS). If I took 2 sachets a day, my cost + shipping would be $180 per month.

I just talked to my healthcare provider and the pharmacy. I think I've done all the research I can. Either I spend $2107 to get the DS version at my local pharmacy and take 1 sachet per day for maintenance therapy. Or $1938 per year to take the over the counter version 2 sachets per day to get the same amount of bacteria. The 2 sachets per day will sure take up a lot more room in the refrigerator if I want to order a 3 month supply at a time to save on shipping.

I'm just so bummed. My UC has been doing so good, and I wish I just didn't have to get another reminder of how my health "costs" my family.

You can also order it directly from VSL.