I’ve been taking Oxtellar XR for at least 5 years and so far it has management my TN better than any other med… I went to the Dr this month and the cost had gone from $30 to $2,412. Crazy I have 5 pills left and now i’m in the middle of a battle between my Neurologist and the insurance co. Looks like the insurance company will when.
Has anyone else experienced this? I have Blue Cross Blue Shield
I ran into this problem when I started taking the extended release version of gabapentin (Gralise) which is a name brand drug, which insurance does not like to pay for. My doctor filled out a form to my insurance explaining the medical necessity of this drug and I didn’t have any trouble getting it. However, my insurance is Tricare so things may be different for you.
I’m sure you have, but have you tried trileptal, the generic version of this drug?
thanks for the information… My doctor is appealing now. I had a problem with tegretol so if this isn’t cleared up in a week he will prescribe Trileptal.
Oxtellar has a discount card program, search by the drug name and it should come up.
I work for a prescription benefits manager. What’s happening is, basically, price fixing by the manufacturer. A drug comes off patent so the manufacturer add a coating to make it delayed or extended release, refile the patent, and jack the price. Or they simply jack the price to fundamentally extort money from insurance companies. They figure the end user (us) will pay a copay so they charge thousands for the med with the idea big business insurance will absorb the price. Insurance is refusing to be extorted any longer because of greedy attempts like the price change you mentioned. There is no product in the world that legit pricing goes from a few hundred to a few thousand!
As a prescription benefits manager my company now monitors price increases. The cost goes up too much (I don’t know the percentage or calculation for it) and we threaten to advise insurance companies to not cover it. After all, if the insurance refuses to pay for an unsupported price jump of 500% it’s not like consumers will either – or be able to afford it.
If insurance companies simply absorb price fixing it will not only damage their business model, which will damage all if us with insurance, but it drives premiums, deductibles, and copays through the roof. No one can afford price increases that are extortion level. There have and are numerous law suits about what prescription manufacturers and patent holders are trying to do to pricing.
Unfortunately patients are getting caught in the battle. You can’t afford $2400 but neither can your insurance company and stay in business. 99.5% of the time this price war is over a brand name, usually extended release, and there is a non-extended releases or generic version available that is covered at non-extortion pricing. You might want to look into those options.
You can also do either a prior authorization or an appeal for coverage through your insurance. Be aware that you will have to medically prove the other forms of the medication did not work.
At the end of the day by refusing to accept random price hikes your insurance company is protecting you from price gouging. You can equate price hikes to what happened with sub prime mortgages. Its an unsupportable money grab that will bring down the market. It has to be stopped. Unfortunately stopping it tends to catch patients in the middle, putting them between a rock and a hard place.
Put the blame in the right place. Manufacturer pricing!
Thanks the discount card is limited to $250.
Completely understand supply and demand:(
Since this AM I found out that the meds I take when my TN is out of remission are also no longer covered. SPRIX and CAMBIA …SMH starting another appeals process
Wish Insurance company would notify customers. THANKS for the info
Found CAMBIA coupon for $20 …less than I was paying with Insurance!
Cambia is another bullshit brand name issue. All it is is diflonac, which has been around as a tablet for decades are costs pennies per dose. Someone stopped making the tablet, poured the powder into a bag, and called it new.
There’s diflonac sodium and diflonac potassium available as generic tablets readily available for not much money. Odds are you can crush the tablets at home and make your own “cambia” or just take the pill.
BS is right… more research coupon covers $20 of $615. SHM
I just looked up sprix, more BS.
Sprix is a nasal spray that costs $1000 per bottle. Or you can get the active NSAID ingredient Ketorolac in tablet form for pennies on the Sprix dollar.
This is a perfect example if why meds are no longer being covered! Suspending an active ingredient in a nasal spray shouldn’t increase the price by $800 or $900, it makes no sense… Unless you start looking at it as fraud…
Thank you for the information. Is there a website or database the consumer can use to find out about a particular medicine? Maybe just google? This is a real eye opener for me!
When you google the name of a drug the top hits are typically the manufacturer site, Wikipedia, and WebMD. Those should give you everything you need.
The generic name of a medication is actually the chemical name of the active ingredient. When you see a brand name it’s usually followed by a name in parens, this is the generic name and you can then search for that to see what’s available.
For example: Imitrex (sumatriptan)
By law the active ingredient must be identical in all forms of a medication. What changes are the inactive ingredients such as gel cap cases, coloring, and binders.
I’ve been taking the generic oxcarbapezine for over 2 years and it works great. Take it once in AM and once in PM. Try the generic before subcumbing to the drug extortionists. It’s about $30 per month for 600 mg per day