Topomax

Posted by marygrace1028 @marygrace1028, May 24 7:40am

I have been taking this brand medication for almost 20 years, but just recently began applying for Medicare and have found that they seem to be denying it in every ‘category’, approving only the generic Does anyone have any suggestions or experience with this or other options?

@marygrace
My first question is why are you taking it? If it's for seizures it is recommended not to switch from brand to generic or vs verse and not to switch manufacturers.
Your doctor can specify “Do not substitute” or “Dispense as written”
My insurance company refused my brand also but my doctor did the above and they pay for it, reluctantly I'm sure.
Good luck,
Jake

REPLY
@jakedduck1

@marygrace
My first question is why are you taking it? If it's for seizures it is recommended not to switch from brand to generic or vs verse and not to switch manufacturers.
Your doctor can specify “Do not substitute” or “Dispense as written”
My insurance company refused my brand also but my doctor did the above and they pay for it, reluctantly I'm sure.
Good luck,
Jake

Jump to this post

Hi Jake. I’m taking it for petit mal seizures. And my neurologist will recommend it, but in looking at all of the Medicare information, that doesn’t necessarily seem to be ‘enough’. Perhaps I do not understand everything quite yet. And I will do this. But still investigating all of what is needed. Thank you.

REPLY

Has your doctor sent a letter stating why you need this? Usually it will be approved if the doctor sends this letter. Good luck with it! 🙂

REPLY
@beccahp

Has your doctor sent a letter stating why you need this? Usually it will be approved if the doctor sends this letter. Good luck with it! 🙂

Jump to this post

Thank you. I actually spoke with someone in my neurologist’s office yesterday who seemed to know a bit more about Medicare than the doctor. So, I’m hoping this will advance the effort.
When I was working through private insurance, there was a similar situation handled by the pharmaceutical side of the company, but ultimately I was able to get approval.

REPLY

@marygrace
I recently changed my drug plan and I received a notice yesterday that my brand-name drug would no longer be covered so I called them and they’re going to send a form to the doctor and once he fills it out all will be good again.
Take care,
Jake

REPLY

Hello @marygrace1028 and welcome to Mayo Clinic Connect. Hearing the news that your medication may not be covered is certainly scary, so I am glad you joined Connect and reached out to others who have been there and/or understand.

It sounds like you have found a great resource in your neurologist's office who may be able to help move this along. Will you come back and share an update on what you ultimately hear back?

REPLY
@amandajro

Hello @marygrace1028 and welcome to Mayo Clinic Connect. Hearing the news that your medication may not be covered is certainly scary, so I am glad you joined Connect and reached out to others who have been there and/or understand.

It sounds like you have found a great resource in your neurologist's office who may be able to help move this along. Will you come back and share an update on what you ultimately hear back?

Jump to this post

Hello Amanda. Yes, I will be happy to share the outcome. And I’m very glad to have found this resource.

REPLY
Please sign in or register to post a reply.