Sicko type help, insurance won't pay for Lunesta

[Omaha Steve]

I have sleep apnea. I use a cpap machine each and every night. I only learned my insurance company won't pay for Lunesta last night AFTER customer service closed. I had a week for free. Then a month was paid for through my wife's insurance. We don't have it anymore. Long story. It works and I'm happy with it. So what is the big deal with Lunesta besides price? It runs about $150 per 30 days. Has anybody else had problems and know what I need to do?

[w8liftinglady]

1. ask your pulmonologist to intervene

he may be able to front you some more samples while you challenge the insurance company's decision.

[Warpy]

11. Or he might be able to steer you to an older medication

that will work for you that is in the insurance company "formulary."

Insurance companies consider it a "lifestyle drug." You know, like birth control pills.

[MichaelHarris]

2. Steve

my wife is a doctor and what she does for people who don't have insurance or can't afford something is to "scrounge" up every free sample she can and save it for them. Sometimes she even asks the reps for additional samples for them.

I don't know if it's illegal for her to do that but she feels it's the right thing to do. If it is illegal I'll deny I ever said it :)

Ask the doctor if that is something they would do for you.

[w8liftinglady]

4. a lot of docs I know do that.it's the right thing to do.

[ThatsMyBarack]

16. I say there's nothing illegal....

....about helping a sick person get well!

[napi21]

3. It seems there's a generic Lunesta. Seethis link.

http://www.drugs.com/mtm/lunesta.html

Check with your Dr. first and ask is you can take THAT, then either ask the Dr. to contact the Ins. Co. or you contact them and see if they'll cover that.

[Telly Savalas]

6. I don't think the generic is being manufactured

All drugs have generic names, but it's only once they go off-patent when the cheaper generics are actually manufactured by other companies. I don't see anything in that link suggesting Lunesta has gone off patent yet. (Not to say I might be overlooking something.)

[frazzled]

5. I'm not a doctor (by any means) ... but

Are you 100% sure you should be taking Lunesta with sleep apnea? It may help you to sleep better, but it is my understanding that it might not be advisable. According to the Columbia University page on apnea, it says "sleeping pills and tranquilizers should be avoided completely, as these agents can cause the throat tissues to sag and restrict breathing." I know Lunesta is a new breed, and a hypnotic, so maybe it doesn't apply. But I'd definitely ask your doctor and research it further.

Here's the Columbia page, fyi: http://www.entcolumbia.org/osa.htm

I should admit up front that I am someone who tries to avoid medication a lot and look for other solutions, so maybe I'm overstepping my bounds here. I have a great deal of sympathy for your problem ... but the underlying problem is the apnea, which Lunesta, of course, does not treat. That still leaves you with the problem of getting a good night's sleep. I guess your insurance company wouldn't be so keen to pay for alternate treatments or sleep therapy. It's always a bitch.

[LiberalEsto]

7. Have you tried Trazodone?

Much cheaper

[Ian David]

13. You beat me to it. Trazodone is a $5 co-pay. n/t

[cutlassmama]

14. I have sleep apnea

and also take Trazadone. It's wonderful

[LiberalEsto]

15. I have sleep apnea also

I underwent a sleep study earlier this year. They found that if I sleep on my back, it's pretty serious. When I sleep on my side, it pretty much disappears.

I've started training myself to sleep on my sides only and it's helped eliminate snoring. Some people find that stitching tennis balls to the back of their nightwear helps.

And the Trazodone is a Goddess-send. Until I started taking it several years ago, I woke up every morning around 3 a.m., and collapsed into bed by 7 p.m.

[ThatsMyBarack]

17. Welcome to DU, cutlassmama!

:hi: :patriot:

[MonkeyFunk]

19. yeah

trazodone rocks. And it's cheap!

[LiberalHeart]

8. The original version of Ambien is now available in generic...

All I take is 5mg per night; works great. My doc prescribes the 10mg pills, which I slice in half with a pill splitter. It costs me $8 for a two-month supply.

[hiaasenrocks]

20. I'll put in a good word for Ambien CR. n/t

[Coexist]

9. has your MD attempted to do an override for you?

usually the pharmacy will fax the rejection to the MD for this purpose?

Have you failed whatever med is on their sleep-aid list already? If not, have your MD give you a sample to try - many times you do need to fail their preferred first.

If not, and you can't get samples, you might want to see if you qualify for their assistance program:
http://www.lunesta.com/lunestaOverview/patient_assistance_program.html

Best of luck.

[w8liftinglady]

10. maybe try this link

http://ask.hrsa.gov/pc

[Ian David]

12. Talk to your doctor about using Trazodone as an off-label sleep aide.

I am not a doctor, I don't play one on TV, and I did not sleep in a Holiday Inn Express last night.

[dkofos]

18. Marry a pharmacist.

Don't vote for ANYONE that does not support HR 676.