Join Early Retirement Today
Reply
 
Thread Tools Search this Thread Display Modes
Nexium and insurance
Old 08-31-2009, 09:40 PM   #1
Dryer sheet wannabe
 
Join Date: Aug 2009
Posts: 21
Nexium and insurance

My wife's insurance company (Blue Cross) won't cover Nexium. Other products don't seem to work as well or have other issues. We have heard from other people that even additional letters from doctors don't seem to help.

Anyone else been through this?
__________________

__________________
Samtex is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 08-31-2009, 11:25 PM   #2
Thinks s/he gets paid by the post
Leonidas's Avatar
 
Join Date: May 2006
Location: Where the stars at night are big and bright
Posts: 2,847
My first thought was that I had a scrip years ago for Prilosec and BCBS covered that without a problem. It was a temporary thing and I stopped using it before it went OTC. Why wouldn't they cover Nexium? I guess I listened to too many "purple pill" commercials.

Then I read that maybe Prilosec and Nexium are not so different. It's the same molecule, but sort of "flipped" (best easy explanation I can come up with) so Nexium does the same thing as Prilosec but in a mirror opposite way. It allowed Astra Zeneca to patent Nexium when Prilosec went OTC. I thought Prilosec was a better product, but apparently (according to wiki) some people don't metabolize that version of the molecule very well, but the Nexium version is not a problem.

Sorry to go on, but I was helping my son study chemistry tonight and the "mirror image" molecule got me interested. I was in a chemistry thinking mode.

Anyway, there seems to be skepticism about there being much difference between the two drugs. But I saw a lot of patients' comments that made it clear they thought there was a big difference. Interestingly, some were pro-Nexium comments and others were very anti. Perhaps there is a difference. But it seems that BCBS (and many other insurers) are in the "no difference" camp and are not covering the scrip because they think Nexium is just Astra Zenca being greedy profit centered.

What I learned is that many insurance companies won't pay for Nexium. Astra Zeneca is aware of this and has a program that helps, a little.
Quote:
The Purple Plus program offers savings on your prescription, as well as access to online tools. If you have prescription coverage and your copay is more than $25, you may receive up to $50 in savings on each refill for NEXIUM (up to 12 refills). If you do not have prescription coverage, AstraZeneca will cover the first $50 of the cost for each refill for NEXIUM (up to 12 refills).
About NEXIUM—Cost of NEXIUM and Tools & Resources

The only other suggestion I could offer is have you asked the doctor to write the insurance company? That worked for me recently with BCBS on a non-pharma issue.
__________________

__________________
There is no pleasure in having nothing to do; the fun is having lots to do and not doing it. - Andrew Jackson
Leonidas is offline   Reply With Quote
Old 09-01-2009, 08:11 AM   #3
Thinks s/he gets paid by the post
 
Join Date: Aug 2002
Posts: 1,322
I was put on Prilosec for GERD by my PCP, twice a day. Later I went to a GI doctor and he said Nexium would be better for me, once a day. No problem with my insurance. I find Nexium works better but maybe that's because I only have to take it once a day.
__________________
FinallyRetired is offline   Reply With Quote
Old 09-01-2009, 08:19 AM   #4
Recycles dryer sheets
 
Join Date: Jun 2007
Posts: 183
Ahh the power of commercials. If you believe it works better (hint hint) it must be working better. "I trust my heart to lipitor", for example.

Here's the deal. Prilosec is made from a mixed enantiomer - that is to say it contains mirror image molecules, right and left handed. Not identical but mirror image. The left hand molecule is responsible for the antiacid effects, whereas the right has less or no activity.

So what did the drug company do?

Came out with just the left-handed molecule, called it something else, and continued to rake in the cash. God bless your insurance company for not covering a drug that offers no advance in treatment other than the minor convenience of taking 1x per day versus 2. Any other perceived benefit is just that - perception.
__________________
innova is offline   Reply With Quote
Old 09-01-2009, 08:39 AM   #5
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Esomeprazole = omeprazole, therapeutically. There are always individual issues that can override that generality but realistically they are equivalent when used according to appropriate direction.

Omeprazole = OTC, cheap(er) - buy generic.

Check with her doctor about that - problem solved.
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
Rich_by_the_Bay is offline   Reply With Quote
Old 09-01-2009, 08:39 AM   #6
Recycles dryer sheets
smileydog's Avatar
 
Join Date: Feb 2007
Posts: 193
I ran into the same situation several years ago when I was on BC&BS and went through several brands before landing on protonix which works pretty well for me. When I was on Kaiser they encouraged me to get on an over the counter product but after trying several the doc made a special request and they put me back on name brand. I would love to get of the pills totally but can never seem to ween off.
__________________
Oh Look, a squirrel!
smileydog is offline   Reply With Quote
Old 09-01-2009, 09:04 AM   #7
Recycles dryer sheets
TeeRuh's Avatar
 
Join Date: Oct 2007
Posts: 248
As usual I am impressed with the knowledge on this board! Not to highjack this thread, but: I have a self developed approach of a daily Prilosec (supper time) and if I've been "bad" (often am) I also take a 150 Zantec as I go to bed. This usually lets me get through the night (only time I really suffer is night). Does this make medical/chemical sense to anyone?

t.r.
__________________
Life is a Holiday!
TeeRuh is online now   Reply With Quote
Old 09-01-2009, 10:00 AM   #8
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Quote:
Originally Posted by TeeRuh View Post
As usual I am impressed with the knowledge on this board! Not to highjack this thread, but: I have a self developed approach of a daily Prilosec (supper time) and if I've been "bad" (often am) I also take a 150 Zantec as I go to bed. This usually lets me get through the night (only time I really suffer is night). Does this make medical/chemical sense to anyone?
Bear in mind that the "proton pump inhibitors" like omeprazole take a few days to work optimally; they are not as good at treating or preventing heartburn in the short term, but are better at it in the long term. Ranitidine and others start working within an hour or less, but aren't quite as effective over weeks or months.

For OTC use, I think generic ranitidine or similar is a good choice. If that doesn't help, it's time to see your doctor in any case. And, for the record, don't assume that upper abdominal pain or chest pain is just heartburn unless you have it checked out at least once. Heart attack can masquerade as "reflux" or "heartburn."
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
Rich_by_the_Bay is offline   Reply With Quote
Old 09-01-2009, 10:01 AM   #9
Thinks s/he gets paid by the post
Leonidas's Avatar
 
Join Date: May 2006
Location: Where the stars at night are big and bright
Posts: 2,847
Quote:
Originally Posted by Rich_in_Tampa View Post
Esomeprazole = omeprazole, therapeutically. There are always individual issues that can override that generality ...
Just out of curiosity, what rough percentage would you say would find Prilosec doesn't take care of the problem but Nexium would?

Like most everybody else who has commented, my first thought was AZ is just trying to keep the big bucks coming in with the Nexium molecule. I would just grab some OTC Prilosec and rock on. But I ran across forums with zillions of comments from people who expressed a very clear preference for one drug, because the other "sucked" (pardon the technical phrase). OP said that nothing else was working for his DW.

Or are there that many people out there that are just totally confused on the meds?

Quote:
Originally Posted by TeeRuh View Post
As usual I am impressed with the knowledge on this board! Not to highjack this thread, but: I have a self developed approach of a daily Prilosec (supper time) and if I've been "bad" (often am) I also take a 150 Zantec as I go to bed. This usually lets me get through the night (only time I really suffer is night). Does this make medical/chemical sense to anyone?
I don't know. But I had a serious GERD incident when I was in my 30's (thought I was having a heart attack and drove to the ER) that I briefly used Prilosec for. There are triggers for GERD that can be avoided, I found that not eating late, not over indulging in rich foods, coffee, alcohol and cigarettes did wonders. I would take an occasional Zantec if I had hit on too many triggers, but I mostly resolved the GERD problem with diet and lifestyle modification.

When I was in my 40's, I found, by accident, that a low-carb diet completely eliminated any digestive problems. No GERD, no indigestion, no problems at all.

Since I ER'ed I've turned into a carbaholic and I've recently developed symptoms again. I bought some Prilosec a couple of months ago. Currently, I'm girding (hah, a pun) myself to go back to eating low carb. Not Atkins, but less refined foods, sugars, and definitely no/reduced "white" stuff (potatoes, rice and bread). It's going to be tough, wife and kids can all eat anything they want without gaining an ounce or having any problems, and all three of them would eat pasta at every meal. I am tempted too often by pasta, rice and potatoes that wind up on the dinner table.
__________________
There is no pleasure in having nothing to do; the fun is having lots to do and not doing it. - Andrew Jackson
Leonidas is offline   Reply With Quote
Old 09-01-2009, 10:18 AM   #10
Thinks s/he gets paid by the post
 
Join Date: Aug 2002
Posts: 1,322
On thing that does not work for GERD, in fact makes it worse, are antacid pills like Rolaids and Tums. I was treating my own GERD with these pills for years, then found I was taking more and more of them. I would wake up with acid reflux in the middle of the night and just reach for a Tums by my bedside, then two, then three.

I don't know what the medical process is, and these antacid pills might work for an occasional problem after a big meal, but not for a chronic problem. It wasn't until I got on Prilosec and Nexium that my GERD came under control. Unfortunately, by that time I had developed what they call Barrett's esophagous.
__________________
FinallyRetired is offline   Reply With Quote
Old 09-01-2009, 10:48 AM   #11
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Quote:
Originally Posted by Leonidas View Post
Just out of curiosity, what rough percentage would you say would find Prilosec doesn't take care of the problem but Nexium would?
0%.

If you don't count the marketing department at AstraZeneca.
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
Rich_by_the_Bay is offline   Reply With Quote
Old 09-01-2009, 10:54 AM   #12
Thinks s/he gets paid by the post
 
Join Date: Aug 2002
Posts: 1,322
Quote:
Originally Posted by Rich_in_Tampa View Post
0%.

If you don't count the marketing department at AstraZeneca.
So if you include the marketing guys would that be 0.0001%?
__________________
FinallyRetired is offline   Reply With Quote
Old 09-01-2009, 11:17 AM   #13
Thinks s/he gets paid by the post
Leonidas's Avatar
 
Join Date: May 2006
Location: Where the stars at night are big and bright
Posts: 2,847
Quote:
Originally Posted by Rich_in_Tampa View Post
0%.

If you don't count the marketing department at AstraZeneca.

No ambiguity in that statement!

After reading the Nexium/Prilosec comments I read somewhere, and coupling it with your judgment (which I'm sure is widely held), then I have more sympathy for you medicos over what you have to deal with in some patients.
__________________
There is no pleasure in having nothing to do; the fun is having lots to do and not doing it. - Andrew Jackson
Leonidas is offline   Reply With Quote
Old 09-01-2009, 11:48 AM   #14
Moderator Emeritus
Rich_by_the_Bay's Avatar
 
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
Quote:
Originally Posted by Leonidas View Post
After reading the Nexium/Prilosec comments I read somewhere, and coupling it with your judgment (which I'm sure is widely held), then I have more sympathy for you medicos over what you have to deal with in some patients.
It's usually not the poor patient who creates the confusion. It's the direct-to-consumer ad that tells them "talk to your doctor about..." or the HMO that changes supplier contracts every 6 months so you get lots of calls from patients who "have to" switch from one drug to a copy-cat drug, etc.

A personal favorite was the woman who got ahold of some obesity drug for which the ad cautioned about "oily diarrhea" and wanted me to prescribe -- just in case -- some Lomotil which she could get OTC for about a nickel, but whose insurance would only cover it with a doc's prescription. Every trade has its stories.
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
Rich_by_the_Bay is offline   Reply With Quote
Old 09-01-2009, 02:07 PM   #15
Recycles dryer sheets
 
Join Date: Jun 2007
Posts: 183
One other thing came to mind,

Do not ignore the overwhelming influence of so-called 'free' samples the reps leave at the physician offices. I can cite numerous studies showing the influence that samples exert, and I can say from personal experience that the Nexium reps are taking full advantage.
__________________
innova is offline   Reply With Quote
Old 09-01-2009, 04:46 PM   #16
Recycles dryer sheets
 
Join Date: Oct 2007
Location: San Diego
Posts: 283
Quote:
Originally Posted by TeeRuh View Post
As usual I am impressed with the knowledge on this board! Not to highjack this thread, but: I have a self developed approach of a daily Prilosec (supper time) and if I've been "bad" (often am) I also take a 150 Zantec as I go to bed. This usually lets me get through the night (only time I really suffer is night). Does this make medical/chemical sense to anyone?

t.r.
This is exactly what DH's doctor prescribed for him. He's on the generic OTC for both and it seems to work well.
Dr. also recommended to use a liquid antacid like Maalox when he has a flare up, especially at night. It helps soooo much more than tums, and helps right away. It really knocks it down and keeps it from damaging his esophagus and being sore for weeks.
__________________
meekie is offline   Reply With Quote
Barretts
Old 09-02-2009, 04:59 AM   #17
Recycles dryer sheets
Budman's Avatar
 
Join Date: Feb 2007
Posts: 120
Barretts

Quote:
Originally Posted by FinallyRetired View Post
On thing that does not work for GERD, in fact makes it worse, are antacid pills like Rolaids and Tums. I was treating my own GERD with these pills for years, then found I was taking more and more of them. I would wake up with acid reflux in the middle of the night and just reach for a Tums by my bedside, then two, then three.

I don't know what the medical process is, and these antacid pills might work for an occasional problem after a big meal, but not for a chronic problem. It wasn't until I got on Prilosec and Nexium that my GERD came under control. Unfortunately, by that time I had developed what they call Barrett's esophagous.
I have had Barretts for 7 years and have been on Nexium. No displasia. Scopings every other year. I'm 60 now. My brother who is 12 years older than me developed esphageal cancer and had to has esophegaus removed 7 years ago. He's cancer free today.
__________________
My beer has a hole in it!
Budman is offline   Reply With Quote
Old 09-02-2009, 08:22 AM   #18
Thinks s/he gets paid by the post
 
Join Date: Aug 2002
Posts: 1,322
Quote:
Originally Posted by Budman View Post
I have had Barretts for 7 years and have been on Nexium. No displasia. Scopings every other year. I'm 60 now. My brother who is 12 years older than me developed esphageal cancer and had to has esophegaus removed 7 years ago. He's cancer free today.
I'm glad the nexium works for you, and glad your brother is cancer free, though I've heard that's a pretty serious operation. I don't have displasia either, and the doc told me with Barrett's I have a 1% chance per year of developing esophagal cancer. Higher than normal, but I put 1% in the "get hit by a truck" category. But I need another scope next year, I get them every three years.
__________________

__________________
FinallyRetired is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Insurance for getting health insurance REWahoo Health and Early Retirement 13 12-04-2008 11:36 AM
Insurance Agent can't collect on her insurance wabmester Other topics 14 08-24-2005 09:25 PM
Insurance TomJoMO Life after FIRE 12 02-18-2005 05:49 PM

 

 
All times are GMT -6. The time now is 11:04 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.