DMPS insurance coverage

[Guest guest]

Hi,

I am trying to fill out my insurance company's paperwork for

reimbursement for Falls Pharmacy compounded DMPS. Falls refused to

submit it or the nystatin they compounded for my daughter (despite

saying they'd do the latter) because " insurance companies never pay

for DMPS and almost never for anything compounded " . I have Medco

coverage and the form has explicit instructions for what to do with

compounded presriptions, which implies there must be coverage for them

in at least some cases.

Falls is being less than helpful in supplying all the info I need to

submit the claim. (The insurance company wants all ingredients listed

on the receipt. Falls has given me just a handwritten note with no

signature listing active ingredients only. I'd like to know what the

fillers are for my own sake, but I haven't gotten that yet.) The

total bill is $455, so I'd at least like to try.

Is this just a waste of my time and theirs? says some

people have been able to get coverage, but not many.

Thanks,

W.

P.S. I suspect the DMPS filler is FOS. Does anyone know if that is a

bad idea with a Citrobacter infection?

[Guest guest]

,

I also have Medco coverage and started with Falls as my supplier of

compounded DMPS. I found them helpful in the sense that my script

specified exactly what to fill it with as pecified by Andy and they

complied. Medco DID pay for DMPS from them, but not for ALA which is

over the counter except I needed very small dosages.

But then I shopped around and found The Compounder in the midwest

U.S., a very reputable firm that beat the Falls price by about a

third. I gave Falls the option of matching the price but they could

not and I switched pharmacies. Medco needs an 11 digit # (I forget

right now what it is called)for any compounded med. Once they got

that which the pharmacy provided, they were very happy and payed 100%

minus my co-pay of $15.

Also, Medco offers a direct ordering service from them especially if

you have a recurring order. They will provide 90 day supplies

overriding the 30 day max. you usually get. So I gave them my typical

script for DMPS to see if they could fill it for cheaper, and their

pharmacists could NOT fill it so I continued to use the Compounder.

(So if they encourage that, tell Medco someone else inquired and it's

a non-starter). Compounder's # is . Their site is

http://www.thecompounder.com/

Good luck with the Falls - sounds like Medco should cover if you can

get Falls to comply with their rules. Really not sure why they are

not listing the filler - that's their business. Let me know how you do.

--Jeff

>

> Hi,

>

> I am trying to fill out my insurance company's paperwork for

> reimbursement for Falls Pharmacy compounded DMPS. Falls refused to

> submit it or the nystatin they compounded for my daughter (despite

> saying they'd do the latter) because " insurance companies never pay

> for DMPS and almost never for anything compounded " . I have Medco

> coverage and the form has explicit instructions for what to do with

> compounded presriptions, which implies there must be coverage for them

> in at least some cases.

>

> Falls is being less than helpful in supplying all the info I need to

> submit the claim. (The insurance company wants all ingredients listed

> on the receipt. Falls has given me just a handwritten note with no

> signature listing active ingredients only. I'd like to know what the

> fillers are for my own sake, but I haven't gotten that yet.) The

> total bill is $455, so I'd at least like to try.

>

> Is this just a waste of my time and theirs? says some

> people have been able to get coverage, but not many.

>

> Thanks,

>

> W.

>

> P.S. I suspect the DMPS filler is FOS. Does anyone know if that is a

> bad idea with a Citrobacter infection?

>