My insurance will only pay for 28 pills of 4mg of Zofran in a 30 day period and my doctor has prescribed 4 mg 3 times a day. Wondering if my doctor wrote the script for 8mg and I used a pill splitter, I could at least get the medicine two times per day covered.
Can Zofran pills be split?
Question posted by Roxy2326 on 9 Dec 2013
Last updated on 9 December 2013
Answers
DzooBaby
9 Dec 2013
If he prescribes 4mg 3 times a day and writes for 8mg tabs, it is likely they will only pay for 15 tabs then. What you need to do is contact your insurance company's medicine management team or just the customer service dept by calling the number on your insurance card. Talk to them and explain your situation and see if there is any way to file for an exception and what all needs to be done to get the exception. You may have to enlist your Drs help-he may have to send documentation as to why you need more than the allotted formulary amount. Many insurance companies will allow certain exceptions but you have to ask, they dont do it unless you ask specially and probably provide a little extra information from your Dr. If you have a Case Manager assigned to you at your insurance company, this is something he/she may be able to help you with. I work for an insurance company and we do stuff like this all the time so dont think it cant be done. The squeaky wheel gets greased so call them up and ask! Good Luck!
DzooBaby
9 Dec 2013
You cant just call and ask if it is covered-you have to tell them your situation and ask for an exception. They will sometimes cover drugs not on their formulary, you can ask them to waive coverage restrictions or limits on certain drugs (this is the one your request will fall under), or you can ask that they cover drugs on a lower tier (or copayment). They generally will approve an exception if alternative drugs or utilization restrictions would not be as effective in treating your condition or would cause you to have harmful medical effects. They usually require some kind of documentation from your Dr so ask what it is they need then talk to your Dr about sending the documentation to your insurance company. Get a fax number and the persons name to address it to.
kaismama
9 Dec 2013
You can split them, better be sure the insurance will give you the same amount of 8 mg ones. I looked at my formulary and I actually have the limit in number of mgs a month.
kaismama
9 Dec 2013
And I checked the price of the generic 4 and 8 mg and the 8 is hugely more then the 4.
Related topics
zofran, doctor, insurance, prescription, period
Further information
- Zofran uses and safety info
- Zofran prescribing info & package insert (for Health Professionals)
- Side effects of Zofran (detailed)
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