I have been on sample of Horizant for a month instead of gabapentin and its been great. My insurance denied it and my doctor challenged United Healthcare and I just received their reply. They denied it again because the FDA has not approved the drug for use with Trigeminal Neuralgia. They though approved it for treating Poseherpetic Neuralgia this month. I hate insurance companies. I printed the recent FDA approval for PHN and will contact my doctor. It works in lieu of the gabapentin. I am so frustrated.
Many meds are used off label -- thousands of them!
Have the doc change diagnosis!
Insurance rules the whole game - beyond stupid!
I've had to fight hard to get my son the right meds -- took years when it should not have!
Good luck!
If you get the actual prescription I highly recommend getting it from Canada. I have had to do this with other meds and the prices are so much lower. It's not illegal and they are regulated just like the US. The state of Minnesota gets there meds from Canada for the state employees for this reason. I use CanadaDrugs.com. You can order and then fax or send them your script. I haven't checked if they have Horizant but it's worth trying if it's working for you. You can also go to the Minnesota state website and they have a list of companies that they recommend. Try this if your insurance still won't pay for it.
Kc dancer is right. I get Klonopin (anti anxiety) for pelvic pain. Tramadol (pain reliever) for depression, Prozac (anti-depressant) for symptoms of menopause and metformin (diabetes) for poly cystic ovarian syndrome. Your doc can also contact your insurance co and fight for you or indeed put down that you have this diagnosis as well.
Is your Insurance through your employer? If so, get your company’s insurance liaison involved! Don’t give up!!
Post Herpetic Neuralgia is what caused my TN. I talked to United Healthcare and they it’s a Tier drug so I would owe $100.00 a month. I’ll ask if they will cover it for PHN! Thank you for the info! I’ve had nonstop pain for nearly 2 years. It would be great if it helped.
Ive worked in health insurance for 25 years, specifically presription insurance for 15 and i can tell you it doesn’t work that way, the person you talk to at the insurance will have no medical info or diagnosis info. They pull up the name of the med and tell you the copay. Period. They won’t be able to tell you what its for for the most part and will refer you to a doctor or pharmacy.
A tier drug means it’s covered at a copay. There really aren’t any options to a covered drug,the price is the price. The manufacturer offers a discount card you might qualify for, there’s info on their site, just do a search by med name. Home delivery via UHC usually offers 1/3 copay discount when you purchase 90 days at a time, see if that’s part of your plan.
Horizant is basically extended releases gabapentin, I’m sure your plan prefers gabapentin at a lower copay. About the only thing you could do is appeal for a tier exception by proving therapeutic failure on immediate release gabapentin but be warned its a very long shot. Odds are good you’ll be told the med is covered at $100 copay because covered is covered, your copy is not up for debate.
Another thought – please be VERY careful ordering online. Unless you know exactly where the meds are being filled online ordering is risky. An estimated 12% of all international orders are bad drugs, bad meaning ineffective or not as advertised (I can’t find the link to the series of articles about it, I’ll post it when I find it again). Make sure you know where your meds are coming from, make sure it’s a industrial country like Canada, Ireland, or the UK and not India or China. Be very careful of anything produced by Dr. Reddy’s (https://cen.acs.org/articles/95/i32/Dr-Reddys-struggles-meet-FDA.html) as that company routinely fails FDA requirements and cheats on batch testing.