Tuesday, March 22, 2011

17p/insurance info

I have been waiting to hear back from my OB's office regarding the 17p for my pregnancy. I know what my OB told me at my last visit, but his PA was waiting on official word from him before she put in the order for anything. He was out of town at the end of last week, so she called me first thing Monday morning to tell me we are doing exactly what we did last time, with the exception of the terb pump.

With Zoe, it was a one stop shop with a home health group. They provided my contraction monitor and monitoring service, the terb pump/med, the 17p and a weekly visit from an RN to give me the shot and look me over. My 17p never went through my prescription plan, it was included in the services from the home group group, who I am assuming has their own compounding pharmacy. It seems that will be the same this time around. Soon after I spoke to my OB office I received a call from the home health group verifying all my personal information. They were then going to forward all requests to my insurance to verify benefits.

Today (you still with me?) my insurance company called. All patients prescribed 17p are considered high risk and are assigned an RN who works the case. They check in periodically and are available to the patient for whatever assistance they may need. When I spoke to my insurance RN today (she incidentally is the same one who I had with Zoe) I asked her about the coverage given all the new developments with the drug. According to her, she was told last week that my insurance and the home health group are still in agreement in terms of coverage and all things will remain the same as it was previously. She did not tell me specifically that I was going to be receiving a compounded version, but that is what it sounded like to me. And if that is the case, I suppose there may be some truth to the claim regarding compounding pharmacies still being able to provide the drug if ordered by the doctor.

Anyway, just thought I'd share this information in case it could be beneficial to someone else. The home health route is more expensive because you pay for a weekly nurse visit and the drug, but I am pretty darn sure it would still be cheaper than $1,500 a pop to pay for a nurse visit and compounded 17p if this is in fact allowed. Had I only needed 17p I am unsure whether my OB was have ordered it from the home health group, because I know several of my friends got the drug via their prescription plan and then gave the shot to themselves. I'll post again once I get some clarification on things.

No comments: