Horizant, Insurance Woes

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Posts: 59
Joined: Fri Oct 22, 2010 8:54 pm
Location: Los Angeles

Horizant, Insurance Woes

Post by fraujoolie »

Hi Everyone! It's been awhile since I last posted, I hope you're all doing well. I have been on Horizant 1200 mg for about three months now, and it is a nice complement to the Methadone. I've been having so much trouble with my insurance, however. I have gone through three denials, written letters, Dr. Buchfuhrer has written letters on my behalf, I've sent in studies about Horizant and how it's profile/metabolism is different than gaba, and had a phone interview with the appeals team (in which Dr. Buchfuhrer sat in and ripped them a new one). They had NO questions for either of us, and the whole thing took 10 minutes. In the end, United Health Care has flatly denied to pay for Horizant, saying that it's main ingredient is the same as Gabapentin, so I can just take that, instead. This drug is costing me about $300/month.
I'm appealing to the state, which is my very last option. The crux of my argument: UHC is practicing medicine by ordering me to take a different drug. The drug they are telling me to substitute with is not the same, even though they have some of the same ingredients, gabapentin and gabapentin enacarbil are chemically different. Horizant is also the last and final FDA-approved drug that I can take, as I have failed on all others.
I don't quite qualify for Glaxo's under-insured program because we don't fall that low with income. I don't know what else to do. Has anyone else had this problem with their insurance?

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Location: Los Angeles

Re: Horizant, Insurance Woes

Post by ViewsAskew »

That's awful, Julie. I have heard of this happening (with other drugs) but haven't been through it myself. I can't believe they can be so idiotic - well, I can - it's all about money and since they are for profit, their profits come before your health.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Polar Bear
Posts: 7844
Joined: Tue Dec 26, 2006 4:34 pm
Location: N. Ireland

Re: Horizant, Insurance Woes

Post by Polar Bear »

It's awful to hear of you battling for the one drug that is giving you relief from symptoms.
Here in UK we don't have to same problem - it possibly could arise that a doc may not wish to prescribe a certain medication because of cost and because he has a budget
but hasn't happened yet to me or to anyone that I know,

Can't understand how the support of Dr B didn't get through the insurance red tape.

$300 is a lot to be regularly dropping out of a bank account because of the beurocrats who don't understand and are blinkered.
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

Posts: 36
Joined: Mon Oct 15, 2012 8:38 pm

Re: Horizant, Insurance Woes

Post by Newlydiagnosed331 »

I just got this drug filled for the first time today. My insurance DID cover it. From what you're telling me I am surprised they did agree to fill it. Because, I've had issues with other drugs with them and being denied and having to have letters by a doctor to get approval (migraine meds). The insurance companies SHOULD NOT be telling US what is best for us. Drives me crazy! Since when did they become MDs??? I'm sorry you're going through this. I know how frustrating it can be.

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Re: Horizant, Insurance Woes

Post by badnights »

Julie, I'm so sad for you but I must admit I'm also very grateful that you're finding the energy to fight this battle. Other people will hopefully benefit. I don't see how you can't win - but I wouldn't have seen it getting to this point either. I can't believe how obtuse and - well, cruel - people can be.
Beth - Wishing you a restful sleep tonight
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

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