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hi! I am going to call the doctor to see if he has samples yet of Zelmac. I have read a few posts speculating on insurance not paying for Zelmac. Does anyone really know it will not be covered? I thought all drugs that require a script were covered.
 

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Patsy,Ah, the joys of medical insurance. Depending on your plan (and who pays for the insurance coverage - e.g., an employer, yourself, etc.), there is usually a formulary. This formulary is made up of the medications that the insurance carrier will cover and at what cost to you. Generally, the formulary excludes as much as it can. It is highly unlikely that your formulary will include Zelnorm in near future. This means that you will probably have to pay the full retail price. The only way to know is to call the insurance company. It is probably too soon for them to have added Zelnorm to the formulary, but they are the only ones who can tell you.Steven
 

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Insurers have different requirements. Some may require documentation that all other options have been tried before reimbursing. Your doctor will likely have to fill out a new drug "prior authorization" form. They often do this with new medications to discourage their usage. Generally, within a few months they will review the medication to determine if and how they will reimburse for the drug. It is very likely they will require this prior authorization to ensure the person is a woman. Since the drug is indicated to be used in woman they very well may exclude men from reimbursement.
 

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Hi there everyone,I can speak for my situation with this med in Canada....It is NOT covered, nor is it even recognized in my company's tables of allowed meds (this is Blue Cross). Alberta Health doesn't have it listed either, and they told me they are waiting for info from the company to review it.Blue Cross won't cover it or even partially reimburse me until Alberta Health reviews the data and this won't happen until at least Oct. In Canada it cost $148 per month, completely uncovered by any insurance and this is our version of public health care!!! I am also upset that my private insurer is not as forthcoming with the information regarding the drug's status. The cost is worth it, but I'm not so sure what I'm paying for insurance coverage for then especially when we in Canada are supposed to have "publically funded and supported" health care!!!
 

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I just wanted to tell you that there are some drug plans in Canada that do cover Zelnorm. My employer's plan is with Great West Life. The drug has been approved - which is a great releif for me as I am not sure I could even afford to try it otherwise. I do have a very generous healthcare plan however (covers all drugs legally requiring an rx). Company formularies are always very specific as to what drugs are covered (some may only cover what the province covers, hence Blue Cross wouldn't cover something not approved by the AB gov't). Some plans also state that they will not cover "brand name" drugs. Since there is no generic Zelnorm, you would also be out of luck.I would suggest looking into your prescription drug formulary in order to understand why it is not approved, or speak with your plan administrator (if you feel comfortable) as they can work with the insurance company to make exceptions. It is better for the insurance company to have you well and at work than unwell and on disability.Good luck!
 

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I have blue cross HMO and they do cover Zelnorm 6mg,but my co pay is $35.00 for this particular drug.Unfortunately ,my doctor won't give me a prescription since it is so new and he feels that he doesn't know enough about it.-WENDI-
 

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this is an odd note, but I called the VA here today and they say they aren't going to get zelnorm but they will have lexapro! This means I'll have to pirchase insurance to get it paid for. Since I'm unisurable because I have IBS it looks like I'll have to wait until I'm 65 and then I'll only get a 13% discount under Bush's wonderful drug plan.tom
 

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My insurance covers it. Its called Starmark, and its through my father's employer, I don't think many people have it? They cover everything our family has ever gotten, which is a very wide variety of stuff, with the exception of Optical Rx's. Co-pay is 10$/20$ for generic/Brand name.
 

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My insurance company is Liberty Life and they informed me tht they would not cover Zelnorm because there is a mixed consensus of opinion. I am a retired teacher in Canada and have been using Zelnorm for 6 weeks. It has helped tremendousley. But can I continue to afford it or how do I convince my insurance co. to cover it. Help!
 

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Peckibs--My insurance company (Health New England) covered it the first month; but when I went back for a second month's supply, they refused to cover it. I requested my gastro doc to write a "letter of medical necessity" to HNE. They gave me some samples to hold me over, and they turned the matter over to the drug representative to hash out with HNE. I expect to hear more in the next week or so as to who wins this battle. As I understand it, if one's doctor writes a letter of necessity, stating that the patient MUST have a particular drug, after others have failed to help, then often the health insurance company will reconsider and make an exception for that patient. Check out the small print in your insurance policy coverage info. Good luck to you!
 
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