Epi-pen & HMO\'s

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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? Thanks, Jennifer

On Dec 5, 1999

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.

On Dec 5, 1999

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.

On Dec 5, 1999

Hi,

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

On Dec 5, 1999

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.

On Dec 5, 1999

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.

On Dec 5, 1999

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!

On Dec 5, 1999

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.

On Dec 5, 1999

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

On Dec 5, 1999

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.

On Dec 5, 1999

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,

[email]"Chris@PeanutAllergy.Com"[/email]

On Dec 7, 1999

I would think that the epi-pens you recieved had been on the shelf awhile. I too always request 'fresh' ones. My daughter's first epi-pen expires this month and we just replaced it...the expiry date on the new pen is June/2001. Also, just in case the Y2K computer bug affects our pharmacist's supply we got a couple extra to have on hand in case there are any problems getting them in the new year (paranoid I know...but I would rather not take any chances!) Since her epi-pen is expiring soon, my husband and I are getting our first chance to actually dispense one (we will use an orange). We have an epi-trainer but have been waiting for a chance to get the feel of a real one. Epi-pens are covered under medicare here in Canada and there is no restriction on how many you can have/use at one time.

On Dec 7, 1999

My HMO is lifegurad. We are allowed 1 epi pen per 30 days. My son's prescription was changed from 4 pens (I needed extras for daycare and granny's house) to 1 pen + 3 refills. I called over the phone to "customer service" and they released 1 additional pen. I pled "minor child", "school regulations", "medical need as per pediatrician". My pediatrician backed me on this issue.

I pay a prescription cost of $10.00 per pen. If they are purchased "off plan" they are $56 at our pharmacy. My previous insurance plan filled a prescription of 2 at $5.00 per pen. The injectable drug thing is a common restriction, often used to discriminate against diabetics like my nephew.

Thanks very much for shelf life info. I will definitely ask for "fresh" ones the next go round.

On Jan 1, 2000

We have never had a problem with coverage of epi-pens but with a nebulizer that is concidered durable medical equipment. I called the insurance company and verified that office visits and er visits were covered. Then told them that since we could not afford the full purchase price of the nebulizer (350.00) that we would be taking our son to the Dr's office 2 x's daily and to the er every evening for a month until we would have the $ for the nebulizer. they agreed to pay 80% of purchase price :-) I know that you can not wait until the dr has an appointment but you may try informing the insurance company of the cost of admitting a child with a severe reaction to the hospital for treatment against the cost of the epi-pen. Good luck.

On Jan 4, 2000

my insurance carrier, Fallon, covers the epi-pen with a co-payment. fyi some insurance companies use the terms "compassionate use" when referring to drugs not on their pharmacy formulary. with my insurance i would call the customer service number and request a form to file for "compassionate use" of the drug i needed.

On Jan 5, 2000

I have seen alot of talk about the Epi-Pens being left oin the car. I live in MAssachusetts and have left them in the car overnight. I have looked at them the next day and the soulution was not discolored which is what the telltale sign of a bad or unusuable epi-pen is supposed to be. Has anyone actually talked to one of the reps that has given them any actual information about this (freezing, discolered)???

On Jan 5, 2000

I was told by my allergist that when the pen gets to cold the needle will not eject. Only heat makes the liquid discolor. Hope this helps.

On Jan 5, 2000

I was told the same thing. Cold makes the mechanism in the pen malfunction.What can happen is the needle will not pop out. I also was told only heat will discolor the medication.

On Jan 6, 2000

well, I got them to cover it, but not without jumping through hoops (note from the doctor, only supplied through mail order, etc). I'm still ticked off though since they are covering us as an exception. The college I work for is unionized. The union is working to make coverage standard for any union member who needs epinephrine. I was suprised that there are several other folks this effects (mostly people who need it for bee sting reactions).

Jennifer

On Jan 6, 2000

Hi, I guess I have a different perspective living in Canada. My husbands health care plan at work covers most of the cost od the epi-pen jr. we pay $16.00 per pen. If we did not have a health care plan the cost would be $80.00. It seems to be a huge difference in price compared to the US prices. I too phone around to different pharmacies to get the best "shelf life" possible although the best I have found was just shy of one year. Seems to me if they are selling you pens that have a shorter shelf life it should be reflected in the price. Good luck!

Katiee

On Jan 6, 2000

One more data point. We were with Kaiser Permanente in Georgia. Through them, Epi-pens only cost $5 each. Also, when you get them, insist that the expiration date is at least a year away. If they don't have any, go to another pharmacy!

On Jan 6, 2000

Anyone who has Tufts Health Plan please contact me. (See my post above)

------------------ Stay Safe,

[email]"Chris@PeanutAllergy.Com"[/email]

On Jan 8, 2000

Chris , I have GIC the old Hancock plan and they are great I go through CVS they give me as many as I can convince the Dr for (five today)

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