Nexium and insurance

[Samtex]

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?

 

[Leonidas]

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.

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.

 

[FinallyRetired]

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.

 

[innova]

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.

 

[Rich_by_the_Bay]

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.

 

[smileydog]

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.

 

[TeeRuh]

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.

 

[Rich_by_the_Bay]

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."

 

[Leonidas]

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?

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.

 

[FinallyRetired]

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.

 

[Rich_by_the_Bay]

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.

 

[FinallyRetired]

0%.

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

So if you include the marketing guys would that be 0.0001%?

 

[Leonidas]

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.

 

[Rich_by_the_Bay]

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.

 

[innova]

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.

 

[meekie]

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.

 

[Budman]

Barretts

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.

 

[FinallyRetired]

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.