My "case" was turned over to their PHARMACIST for review on Friday. As yet I have heard nothing.
I continue to down the pepto and use lomotil and keep my fingers crossed that the PHARMACIST decides that everything I sent them is valid. I'm still flummoxed that a pharmacist (and no offense intended to the profession...how sad I have to put that in there) is deciding what drugs to use to treat disease when a board certified physician with knowledge in the field should be doing that.
If this doesn't go, I'll be searching for the pharmacy information for entocort in India. Do you send the prescription to them and they mail it, or is a prescription even needed?
Insurance refusing Entocort, says not FDA approved
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
That pharmacist will have an opportunity to demonstrate how much (or how little) she or he knows about treating MC.
Prescriptions are worthless across borders (because doctors are not licensed to practice across borders) so no prescription is needed when ordering from India. For some reason or other, Canadian pharmacies require prescriptions from U. S. customers, but that's apparently just a feelgood gesture.
Good luck with the pharmacist's review
Tex
Prescriptions are worthless across borders (because doctors are not licensed to practice across borders) so no prescription is needed when ordering from India. For some reason or other, Canadian pharmacies require prescriptions from U. S. customers, but that's apparently just a feelgood gesture.
Good luck with the pharmacist's review
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I'm pretty sure that Gabes is referring to this section: http://www.perskyfarms.com/phpBB2/viewforum.php?f=73
but you've already posted in that discussion (about the booklet by the German GI specialist).
Tex
but you've already posted in that discussion (about the booklet by the German GI specialist).
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I'll start by saying it took me a while, but I won!
I am glad I won, just not for myself, but also for anyone who comes along behind me that will need this drug as well.
Entocort was approved by my insurance and I'll now get 3 months for $15!
The part(s) that irritate me most are these:
I submitted my appeal to denial on October 8, and got verification of its receipt. One week later I get a letter stating that it is determined it is not an urgent case (apparently they've never been hospitalized for dehydration or spent the night on the toilet) and that they were going to take 15 days to review it (they being the PHARMACIST that this insurance company uses to determine their drug formulary).
In the meantime , I'm downing lomotil and pepto like they're tic tacs and pepsi cola. I'm up in the early a.m. (3:00 a.m.) with the "got to go's" every night and not resting well.
I went to my scleroderma doc yesterday and realized...wait, it has been a lot longer than 15 days....what is the answer. My sclero doc even spent some time looking into how to get me the drug compounded or perhaps ordered somewhere else (I had to explain you all had provided me with scads of info on that).
I got to work today and got angry. I called them and was told this...hold on to your hats...
MY APPROVAL CAME THROUGH ON OCTOBER 9!
No one there informed either me, my docs, my pharmacy. I could have been going forward, minus the bismuth headache, for a month and no one there deemed to inform me. Sigh...yes, negligent and wrong.
In the meantime, since going gluten free, less bloating, so that is good. Here's hoping this entocort helps, even a little.
I am glad I won, just not for myself, but also for anyone who comes along behind me that will need this drug as well.
Entocort was approved by my insurance and I'll now get 3 months for $15!
The part(s) that irritate me most are these:
I submitted my appeal to denial on October 8, and got verification of its receipt. One week later I get a letter stating that it is determined it is not an urgent case (apparently they've never been hospitalized for dehydration or spent the night on the toilet) and that they were going to take 15 days to review it (they being the PHARMACIST that this insurance company uses to determine their drug formulary).
In the meantime , I'm downing lomotil and pepto like they're tic tacs and pepsi cola. I'm up in the early a.m. (3:00 a.m.) with the "got to go's" every night and not resting well.
I went to my scleroderma doc yesterday and realized...wait, it has been a lot longer than 15 days....what is the answer. My sclero doc even spent some time looking into how to get me the drug compounded or perhaps ordered somewhere else (I had to explain you all had provided me with scads of info on that).
I got to work today and got angry. I called them and was told this...hold on to your hats...
MY APPROVAL CAME THROUGH ON OCTOBER 9!
No one there informed either me, my docs, my pharmacy. I could have been going forward, minus the bismuth headache, for a month and no one there deemed to inform me. Sigh...yes, negligent and wrong.
In the meantime, since going gluten free, less bloating, so that is good. Here's hoping this entocort helps, even a little.
Hmmm. One would think that the pharmacy at least, and probably your docs (if they were writing letters or filing forms on your behalf), would have been notified. I'm guessing that your pharmacy may have dropped the ball, but maybe they didn't have your email address. It does seem strange that communication would be so difficult in this day and age.
But at least it was an approval, so I reckon it could have been worse.
Tex
But at least it was an approval, so I reckon it could have been worse.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Tex,tex wrote:Hmmm. One would think that the pharmacy at least, and probably your docs (if they were writing letters or filing forms on your behalf), would have been notified. I'm guessing that your pharmacy may have dropped the ball, but maybe they didn't have your email address. It does seem strange that communication would be so difficult in this day and age.
But at least it was an approval, so I reckon it could have been worse.
Tex
I checked into it with both pharmacy and physician and they got nothing, so I called the insurance company back and they checked their records..they sent nothing, it was a "glitch." Hmmm.
DJ, thank you for the thoughtful reply, I truly appreciate it.DJ wrote:Hi Karen, Maybe your doctor should describe your illness in a way the insurance company understands..... Inflammatory bowel disease? Or, another term he/she feels the insurance company will understand. This is disturbing.
We went the inflammatory bowel disease route, my scleroderma doc even called in and gave her thoughts, sending some back up studies and information on the drug and what it does for inflammatory bowel disease.
Because no specific FDA study had been done on entocort and MC, they felt they didn't have to cover it. Once two docs, myself, my congressman all sent them back up information, once I went to my HR Department and Benefits Coordinator about this and they talked to them, it changed.
I am an assistant to the president of a well known university in my area, and I feel (and this bugs me) that that also helped bring this to the fore.
Took my first three pills this morning. Tex is taking three-3 mg tabs each a.m. the norm?
Karen,
Perhaps you already have this information, if not I have included a link.
In case you might have to provide any further research regarding the use of Entocort for MC, Dr Pardi from the Mayo Clinic has done the research on this topic. I have included a link to his information, you can find article on MC under his publications. In one of the abstracts, #15 on the page, he states budesonide has been well studied in randomized clinical trials.
Glad everything worked out for you.
http://www.mayo.edu/research/faculty/pa ... o-00086058
Perhaps you already have this information, if not I have included a link.
In case you might have to provide any further research regarding the use of Entocort for MC, Dr Pardi from the Mayo Clinic has done the research on this topic. I have included a link to his information, you can find article on MC under his publications. In one of the abstracts, #15 on the page, he states budesonide has been well studied in randomized clinical trials.
Glad everything worked out for you.
http://www.mayo.edu/research/faculty/pa ... o-00086058
Donna
Diagnosed with CC August 2011
Diagnosed with CC August 2011
Yes. That's the labeled dose and the most effective way to take budesonide.Karen wrote:Tex is taking three-3 mg tabs each a.m. the norm?
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.