Nutramigen-Any luck getting it covered by insurance?

Has anyone had any luck getting the insurance company to pay for Enfamil's Nutramigen? My boys have reflux and we have tried 4 different formulas now. Nutramigen is so expensive--especially since we have to fill the bottles higher because one of my boys dribbles out at least an ounce or more per feeding.

 

One of mine is on Alimentum (which is the same as Nutramigen, just Similac's brand instead) .. I hear you on the cost and the increased use - we have to concentrate ours up to 24 cals/oz. Pricey.

But YES, we did get it covered by our insurance. They give us 7 cans per month for a single copay. Our pediatrician just wrote the script and sent it over to CVS, and they filled it and it miraculously went through. I think the prescription said it was for "severe GERD and milk protein intolerance", and she wrote it for 32 oz/day (at normal 20 cal strength), which pretty well works out for us.

It's worth a TRY anyways. The worst that happens is they'll reject the claim, right? Assuming your pediatrician is fully behind you on the issue of your boys NEEDING it, the pediatrician can help fight the insurance company, if need be. I didn't think ours would cover - our policy actually specifically said that formula wasn't covered except under a few very strict (and seemingly rare) conditions. But I guess since we NEED to feed him this, they'll cover it.

Good luck!

 

We were able to get the twins neosure covered the same as stated above. The Pedi just sent it to the pharmacy and I went to pick it up. We got 12 cans a month, 6 for each kid. My pedi used sever prematurity and it was a health issue they had to have it.

I've also heard of people applying for WIC to get it. I don't qualify for WIC in anyway but it may be worth looking into.

Andrea

 

I was just going to suggest that WIC might cover it if you qualify.

 

Not for us, sadly. One of my daughters has severe GERD and a milk protein intolerance, but infant formula is specifically excluded by our insurance (Blue Cross Blue Shield).

 

Funny timing, as we're dealing with this right now too! My old insurance (Tufts) gave us Neosure for the babies -- 15 cans EACH for two months, so we got 60 cans free! We then switched to my husband's insurance (United Healthcare), and they are not so accomodating. My son now needs Neocate for reflux, but United apparently doesn't cover infant formula as a general rule, so my doc's office really needs to push the medical necessity of the Neocate. Doc is also trying to push for Neosure still for DS, but I care less if that one goes through since she really could go on regular formula at this stage. The Neocate though is *expensive*!!

 

QUOTE(alankford @ May 8 2008, 08:24 AM) [snapback]762396[/snapback]
We were able to get the twins neosure covered the same as stated above. The Pedi just sent it to the pharmacy and I went to pick it up. We got 12 cans a month, 6 for each kid. My pedi used sever prematurity and it was a health issue they had to have it.

i have new premature twins and was also prescribed neosure. i'm having a hard time finding places that will fill the prescription. cvs sells it over the counter, but they made some confusing statement about their supplier dropping it or something so they couldn't fill the prescription.

has anyone had a prescription filled for neosure lately and if so, can you tell me what pharmacy?

thanks,

 

My pedi wrote a precrip for Nutramigen but sadly the insurance did not cover. Luckily they were only on it for 4 months. My mom always bought the girls stuff so sometimes instead of clothes she'd buy a few cans of formula so that was very helpful to us.

I wanted to add that even though the cost was a lot more I would not change anything - the Nutramigen made a huge difference with the girls.

 

We have BCBS and they do cover it. It used to not have a co-pay, but now does, since our plan changed. We do it through the mail and get a 3-month supply for the price of 2.

 

We used Nutramigen for our daughter and while, it was expensive, it was worth it. I never even thought to try and get insurance to pay for it. Good luck with that.

If you can't get insurance to pay for it, our ped contacted his formula rep and the rep sent us about 20 $5 off coupons in the mail. Every little bit helps. I believe I also called Enfamil and they sent me a couple of free cans.

 

We didn't try to get ours covered. I had no idea insurance coverage for formula was even possible. We did buy ours online by the case (DS1 was on it for 9 months) and that saved money. The site I bought from is not there anymore, but there are others and most are free shipping over $100. It was expensive, but those baby smiles were worth all the money. Good luck with the insurance company.

 

All this seems to be a mixed bag. It really depends on your insurance policy and how they classify special formulas. If you've got a prescription from the pediatrician, that might help your case with the insurance company. For people who stuck in insurance limbo, dialing the 1st central contact number could shed some light on your situation. Advocating for your child's needs is super important, so don't give up!