It’s about time I have another fight with my medical insurance company, Athem Blue Cross Blue Shield. I received a letter from them at the end of December letting me know that my plan is no longer covering omeprazole (the generic of Prilosec) in 40mg doses. I am taking the 20mg pills but had my doctor spend weeks getting them to authorize a quantity of two a day, bringing the total dose to 40mg.
I called Anthem today, finally, to discuss this change in my coverage and how it’ll affect me. Using their handy [sarcasm – it sucks] drug coverage & pricing tool online, I won’t be covered. Previous experience has shown me that this tool doesn’t take into account authorizations on file and relatively has a mind of its own. It’s useless. Anyway, I got a very pleasant customer service representative to understand my dilema.
Nexium works the best for me, but it costs $65 a month or more. I’ve tried EVERYTHING else and nothing works except Prilosec or its generic in a higher dose. Prilosec is chemically similar to Nexium and actually contains about 20% of the active material of Nexium. Fun fact for the day.
The CS rep took the time to talk with a pharmacy specialist, placing me on hold for a good ten minutes. She said that because my doctor has completed the prior authorization form and they approved it, they’ll cover the prescription. My renewal for the pills comes up at the end of the month, so I’m crossing my fingers I won’t have WWIII to contend with. In the end, I could ask my doctor for 90 days of samples, but since I have insurance I might as well make them pay for it.