Neupogen (and Pharmacy Question)

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beachmama
LIF Adolescent

Member since 8/12

599 total posts

Name:
T

Neupogen (and Pharmacy Question)

I have to take Neupogen. Insurance covered it the first month but now won't.

I got it from Kraupner's the first time.

I called Kraupner's, and they said a month's supply is $2200.

Anyone have better suggestion re: pharmacy?

Thank you!

Posted 8/22/13 2:20 PM

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jessnbrian
Only God knows His plan for us

Member since 4/13

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Jessica

Re: Neupogen (and Pharmacy Question)

Posted by beachmama

I have to take Neupogen. Insurance covered it the first month but now won't.

I got it from Kraupner's the first time.

I called Kraupner's, and they said a month's supply is $2200.

Anyone have better suggestion re: pharmacy?

Thank you!

I would first find out WHY the insurance isn't paying for it when they did the first month. It MIGHT be as simple as your doctor getting a prior authorization for further treatment. It could even be a situation where they consider it a "maintenance" drug where you need to order it through their specialty pharmacy. I would dig a little deeper before just shelling out the money for it out of pocket, mainly because even if they do decide to pay for it later it will be extremely difficult to get it reimbursed.

Posted 8/22/13 2:40 PM

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beachmama
LIF Adolescent

Member since 8/12

599 total posts

Name:
T

Re: Neupogen (and Pharmacy Question)

Posted by jessnbrian

Posted by beachmama

I have to take Neupogen. Insurance covered it the first month but now won't.

I got it from Kraupner's the first time.

I called Kraupner's, and they said a month's supply is $2200.

Anyone have better suggestion re: pharmacy?

Thank you!

I would first find out WHY the insurance isn't paying for it when they did the first month. It MIGHT be as simple as your doctor getting a prior authorization for further treatment. It could even be a situation where they consider it a "maintenance" drug where you need to order it through their specialty pharmacy. I would dig a little deeper before just shelling out the money for it out of pocket, mainly because even if they do decide to pay for it later it will be extremely difficult to get it reimbursed.

Thanks. I've been up and down this issue for the past month. They mistakenly covered it the first month, but are not seeing reimbursement.

Neupogen is really a drug for cancer patients. It is being used "off label" for fertility. My diagnosis code does not match any of the approved diagnosis codes (all relating to cancer, which thank God I don't have). My doctor's office said this is fairly common and I am lucky I got it covered the first month.

Posted 8/22/13 2:44 PM

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