I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Pre-Dialysis => Topic started by: Deanne on March 09, 2011, 07:16:04 AM
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My neph wants me on Sensipar, but my insurance company is refusing to cover it. :thumbdown; Any suggestions?
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Stupid insurance companies know better then our doctors.
Have your Neph write them a note stating you need this drug.
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Ask your social worker for a coupon. Reduces the cost to a few dollars. :2thumbsup;
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I don't have a social worker yet. My neph gave me a Sensipar pharmacy card to use (is that the coupon you mean?), but apparently it's use still requires my insurance company's approval and they refused it. I have a call in to my neph. I'm hoping I can just keep using calcitrol instead.
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I don't have a social worker yet. My neph gave me a Sensipar pharmacy card to use (is that the coupon you mean?), but apparently it's use still requires my insurance company's approval and they refused it. I have a call in to my neph. I'm hoping I can just keep using calcitrol instead.
ARGH!!! :banghead; :banghead; :banghead;
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All I can say is I HATE HATE HATE HATE HATE being sick in the USA....
:rant;
Sorry to hear this Deanne. Like we need this kind of stress! :grouphug;
KarenInWA
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I get frustrated with all of it. But, my expenses for surgery and all that went with it, comes close to $200,000. We have had to pay a few hundred. I can't complain because I know others have it so much worse. I had top ranked surgeons, private room, 1 day in ICU, chemo, and on and on. This isn't a cheap disease and the anti rejection meds are very expensive. My doctors insist on brand names for Cellcept and Prograf. I am ok with that. The surgeon sent a note to insurance company and pharmacy stated that brand name is "medically necessary". See if yours will do that. It might help. I'm sorry. None of us need this extra stress and worry. :cuddle;
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Might try Zemplar too, some times they cover one but not another...different pharm company's I guess.
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Might try Zemplar too, some times they cover one but not another...different pharm company's I guess.
You are so right!
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My neph wants me on Sensipar, but my insurance company is refusing to cover it. :thumbdown; Any suggestions?
I am sorry to hear about your situation. Could you explain your condition a little more and why your nephrologist is prescribing Sensipar. Sensipar is not a wonder drug and it is not generally indicated for someone not on dialysis.
"Sensipar is NOT approved (nor does Amgen support its use) for patients who are not on kidney dialysis"
BTW, it appears that even in Canada, you may have problem getting Sensipar under some circumstances:
http://www.dialysis-do-or-die.com/2010/12/unafordable-sensipar-for-dialysis.html
Amgen Sensipar pharmacy card (http://www.amgen.com/amgenassist/copay_sensipar.html) to reduce copay. This still requires the insurance company to pay up to $5000 per year per patient, it only reduces the copay for the patient for up to $3000. Sensipar just costs too much.
Generic Sensipar has been denied in the US until at least 2016:
http://www.bloomberg.com/news/2011-01-07/amgen-wins-ruling-against-teva-in-generic-sensipar-fight.html
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i too was denied the sensipar, and it led to me getting a parathyroidectomy. My insurance covered it, then when i switched to a new pharmacy, they said it wasnt covered, called dr ,but he never did a damn thing about it, now ive switched to yet another pharmacy, and half the meds i was told were denied, are accepted here! so u may check another pharmacy... good luck!
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I checked with Medco directly - my prescription coverage. Their website states up-front that they won't cover it, so I don't think the issue is with the pharmacy.
My neph wants me on Sensipar because, although I'm not on dialysis yet, my PTH is still very high. I don't remember the exact number, but she wasn't pleased. I left a message asking her if I can just make do with Calcitrol for now and see what happens after I start vitamin D (just got a prescription for it).
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Have you talked to your insurance and asked them about it? I would talk to them directly to seek out their reasoning.
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I think greg may be right. I'd ask your neph about the difference between Sensipar and Zemplar. Hyperparathyroidism can be treated with a vitamin D analog (Zemplar) and may be safer than Sensipar. This may be a blessing in disguise and may be why the ins co denied coverage for Sensipar, ie, you are not a dialysis patient.