@chinasmom My last post made me curious about the differences since I had forgotten. Apparently Plan G is not as good as F, it has more deductibles. This is what I read "Medicare Supplement Insurance Plan F, "the most comprehensive plan offered". I told my husband when I signed up for F that it was a gift for him. Unfortunately I was right. I can't help but wonder what people without good coverage do. My son works for a small company and as is typical the coverage is pretty basic. My daughter is a free-lancer so she has some form of ACA. I have no idea what that covers. A few years back when she worked for a small company she had a TIA and was in the hospital overnight. She really got hit with bills. She managed to work something out with the hospital, paying over time I believe.
JK

Hi Becky, what about that thing they insert into your back that sends out
electonic pulses? I have a friend with that implant and she swears by it. I am
so sorry that you have had to endure pain for so long. I can't even imagine
living like that. Big Hug, Terri M.
 
 

You can also have your dr fight for you too. He can send a letter
explaining why this is the only thing that will work for you.
 

Medicare pays 80% of my toby through Walgreen's. I got a scholarship for
the rest. Maybe Mayo Pharmacy is not an approved pharmacy through Medicare or
whoever you have insurance through.
 

Hi all,
I forwarded your conversation about coverage for tobramycin to a Mayo Clinic pharmacist to see if she could shed light on the topic. This is what she replied:

"Health insurers have to balance care and cost and they do that by putting drugs in categories based on how they feel they can best service the bulk of their patients. The problem is that not every patient fits into that bulk group. In those cases patients can seek prior authorization, exception, appeal and/or write or have written a letter of medical necessity.

As an example, here is a link and information from Blue Cross Blue Shield with reasons they require prior authorization for certain medications. http://bit.ly/2sfMttz. The article states:

What kinds of drugs need prior authorization?
* Drugs that have dangerous side effects
* Drugs that are harmful when combined with other drugs
* Drugs that you should use only for certain health conditions
* Drugs that are often misused or abused
* Drugs that a doctor prescribes when less expensive drugs might work better

"There is evidence of efficacy for tobramycin in bronchopulmonary infections like MAC but it is not FDA approved for this indication. Because the medication is very costly, the insurance company wants to ensure that patient-specific factors and antimicrobial susceptibility data are being considered. Every plan has different requirements on what is covered and what exceptions can be made. Prior authorization, appeal if denied and submitting a letter explaining medical necessity or having your care provider send one to the insurance company are some things you can try to get claims covered. In some cases, this process can be more efficient to process restricted or excluded drugs when the pharmacy and the prescriber operate within the same network (ie Mayo Clinic)."

Colleen, thank you SO much for this information .. I am sure Members will find it helpful! I am adding it to my File Cabinet! Katherine

@chinasmom & @windwalker, Hi Becky & Terri M., I have a friend with chronic pain
In her back & she went through the surgery to implant a device to deliver electric impulses to help the pain & it did not work. She's back on aim meds. The same thing happened to my grandmother. I'm not trying to say that it does or does not actually work...I'm just passing along that I would do a lot of research on it...which I'm sure you would do! I was actually in the OR with the surgeon (I'm a previous OR nurse/RN) that implanted the device for my grandmother. It's not anything to take lightly...the surgery wasn't horrific but it is much more involved than I had previously realized...of course new technology brings about all sorts of new procedures these days!

~Jen 🙂

@jentaylor,
Jen, when it comes to medical treatment, everyone reacts differently. My
friend had her implant for several years and it worked for her. The device
finally gave out and she had a new one put in two weeks ago. It is still
working for her. She has been off of the oxycontin for years now. Thank
God.
 

@colleenyoung Thanks for the link, Colleen. My hepatologist had to go to bat for me to get my xifaxan paid for. Lactulose is around $5 a bottle. Over the course of a month that comes to about $40 or $50. Zifaxan costs over $2000. Thankfully they did pay for it so I was left with paying about $700 to $800 a month for it. Not cheap but in the long run it was worth it. It kept the HE episodes away for almost a year until my cirrhosis got worse and then I had to take both. No one wants to take lactulose. It has very unpleasant effects. When I was in some pain following my transplant my husband kept reminding me "NO MORE LACTULOSE".
JK

Hi. I don't know how my Tobramycin got authorized, but I am grateful that
it was. I had a pseudomonas infection and that is when I got put on the toby.
Mysteriously, the toby cleared up issues I had been suffering from for 15 yrs! I
believe it also kills off the MAC too, but do not know that as a fact. All I
know is, I do not cough any longer and breathe clearly.