Epi-pen & HMO\'s

Posted on: Sun, 12/05/1999 - 5:10am
Gabesmom's picture
Joined: 11/03/1999 - 09:00


Our wonderful pediatrician prescribed the first epi-pen for our 13 month old son. I was shocked to discover that our insurance does not cover the cost ($47 a pop, with a 6 month shelflife). According to my policy, the company does not cover any injectible drugs besides insulin. Of course, I plan to fight this one, but I was curious what others have experienced.
Anyone with an HMO that covered the cost with no problem? Anyone fight the battle and win?

Posted on: Sun, 12/05/1999 - 6:25am
Donnamarie's picture
Joined: 11/16/1999 - 09:00

Our HMO is Optimum Choice (MAMSI). They do pay for the epi-pen, and we have not experienced any problems with that. I certainly think you could fight this one easily, as this is a life-saving medicine. Keep us up-to-date on your experiences with them. BTW, who is your insurance carrier? Good luck.

Posted on: Sun, 12/05/1999 - 7:49am
Angela's picture
Joined: 10/04/1999 - 09:00

Our HMO is Health Pledge and we haven't had any problem getting this prescrption so far. Who is your HMO? Good luck and stay safe.

Posted on: Sun, 12/05/1999 - 9:37am
dhumphries's picture
Joined: 02/02/1999 - 09:00

Good luck with your battle with your HMO, as I have been fighting this one for almost two years. My HMO also does not pay for the epi, and I carry three at all times. So, that is roughly $140.00 a year. If you have any luck with your HMO, please let me know what tactic you use.
Stay Safe, Debbie

Posted on: Sun, 12/05/1999 - 11:18am
Carrieann's picture
Joined: 11/12/1999 - 09:00

Our HMO is Harvard Pilgrim Health Care and they covered the epi-pen at generic cost - which means I paid $5. They have a certain number that I can pick up at a time...I, myself, use a albuterol inhaler that I like to carry an extra of and in bad months I can't get. Otherwise I have had no problem.

Posted on: Sun, 12/05/1999 - 11:37am
MaryLynn's picture
Joined: 06/25/1999 - 09:00

Are you sure about the shelf life? I have gotten EpPen Jr. that have had exp. dates a year after getting them.
My insurance co does not cover them either and it's not an HMO.

Posted on: Sun, 12/05/1999 - 12:10pm
Gabesmom's picture
Joined: 11/03/1999 - 09:00

Hmmm...I hope I'm wrong about the shelflife. This one was 6 months; maybe it was already old? My husband picked it up and said he talked to the pharmacist about shelf-life. I'll have to look into it more and get back to you.
My HMO is Ohio HealthChoice, a rinky-dink HMO. My employer (Oberlin College) just switched providers from UnitedHealth (which we loved) to this smaller less-cost-to-them HMO.
Let you know what happens!

Posted on: Sun, 12/05/1999 - 12:25pm
bakermom's picture
Joined: 11/30/1999 - 09:00

My HMO is NYLcare. It covers the cost at just 10.00. They're a pain in the butt in other areas though. The shelflife is one year on mine. I don't know if there is a limit to how many I can have in a year, but so far I have gotten 3. Good Luck.

Posted on: Sun, 12/05/1999 - 12:53pm
Mary Kay's picture
Joined: 01/25/1999 - 09:00

With our HMO we have to pay $50 per prescription, so I have them write the RX for 4 at a time, that way it is $50 for 4 of them. Also, I call around to pharmacies to see who has the epi-pens with the longest shelf life. I won't accept any under 1 year, some even have a year and a half. Check your insurance booklet for whether it is per prescription or per epi pen.
Mary Kay

Posted on: Sun, 12/05/1999 - 1:12pm
PattyR's picture
Joined: 04/12/2002 - 09:00

I always ask the pharmacist to order fresh epipens for me. I have never been told "No". I have to wait a few days but then always get prescriptions that are good for 18 mos.

Posted on: Sun, 12/05/1999 - 4:26pm
Chris PeanutAllergy Com's picture
Joined: 04/25/2001 - 09:00

Tufts Health Plan is also going to stop paying for them soon (Massachusetts,USA has sent out a letter)! Stock up now while they are still allowing you to get them! We just got a prescription for 4 this week. Check with Tufts to see when the deadline is.
I think we should fight this (with all HMO's etc.) as it causes us to carry and have less on hand, which may put someone in a dangerous position if a situation where more than one is needed comes up! I don't want to get the call where someone tells me they lost their
loved one because they only had one pen and were a half an hour away from medical attention, but their health insurance only gave them one (or none) and they could not afford another. We have a lot of single moms who are just barely getting by!
I am glad you started this thread and are showing so much interest on this issue, this was something I was going to bring up this week.
Let me know what you think!
Post and E mail me also!
Stay Safe,


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