A little background - I just graduated from college (or will officially on May 1, but I’m done school). For the last four years, I’ve been getting birth control free through my school’s health center (yay!). In addition to using is as a contraceptive, I’m also prescribed the pill for incredibly heinous cramps that caused me to miss work several days a month. I do beleive that when you can’t walk from one end of a studio apartment to the other without sitting in the hallway curled into a ball, this deems the pill “medically necessary”. However, my insurance company does not think so. I’m fighting them, but at the moment, I’m paying $35 a month out of pocket. Now, I don’t think that I’ll have a big problem getting them to pay for it, and paying me back for what I paid. My problem is that I discovered my insurance company covers Viagra, no questions asked.
So, I have to “prove” that I need the pill, but Viagra is fine? If there’s some medical use for Viagra, besides being able to get an erection, that I’m not aware of, then fine. But really, does that make any sense?
Does your insurance company cover generic or synthetic forms of the pill that you’re on?
Many insurance companies won’t cover the big brand names of certain drugs but will cover their generic counterparts, which according to the FDA have to have exactly the same ingredients.
It sucks that they’re giving you such a hard time, though.
None that I know of, but there have been some studies (sorry, no link, i’ll have to come back later) that the generics of some drugs should not be substituted, some birth controls too. Since I’m using it as a contraceptive, also, this isn’t something that I want to play around with. Anyway, I really dont’ think I’ll have a problem getting money for them, it’s really the whole Viagra thing that bothers me.
“Here, have a hard on, on us! What’s that? You want to not get prengant and not miss work?! Sorry, you’ll need a doctor’s note for that”
I would also think that it costs far less to just pay for birth control than it would if I had gotten pregnant, and needed an abortion or prenatal care (don’t actually know what I would do if that happened, so I’m not assuming anything).
Insurance plans vary. Some plans cover contraception, some don’t. Work with your plan and see what can be done.
Second, impotence is a medical condition. Viagra is a drug that treats it. Insurance generally pays for drugs that treat medical conditions.
I realize your circumstances suck, but do you realize how silly it is to turn this into a male-bashing rant, instead of an insurance-bashing rant? Do you especially want to target those men unfortunate enough to suffer from impotence to make your little political point? How about their wives or partners? They suffer as well.
99 out of 100 times, it isn’t your “insurance company” that doesn’t cover the medication, it is your benefit office (the job or school or group who provides your insurance to you). We all tend to think of it as the insurance company, when it really is the group that we belong to who chooses what items are covered and what items are not. The exception to this are those who are self insured.
Many groups do cover Viagra but about 6 pills a month for their copay. Still, I totally understand where you’re coming from. Considering how cheap the generic forms of birth control are, each group should cover them whether medically needed or not.
You can find studies that state (usually sponsored by drug manufacturers who produce the pills) that the generics aren’t as good. You can find studies that state they ARE just as good. You can also shop around and insist on “AA” grade generics which are the best ones (ask you pharmacist). Honestly, with the rising cost of prescriptions, it would be impossible for insurance companies & benefit offices to give everyone brand name medication when there is a generic available.
I’d say there’s some logic to paying for Viagra, which treats a dysfunction, and not birth control (which in general does not treat a dysfunction). If the pills are needed to treat excessive cramps, though, that sounds like as much a dysfunction as impotence, and should be paid for IMHO.
I agree this sucks and is fundamentally unfair. However, until you get this straightened out, is there a Planned Parenthood near you? They will treat you on a sliding-scale basis, including prescriptions.
This does make sense. I actually don’t have a real problem with birth control not being paid for if it’s only used as birth control. But since birth control is used to treat a number of different things (cramps, regulating periods, etc), it’s often harder to “prove” to an insurance company that it’s really needed than some other drugs.
Anyway, thanks to you, and the others who gave civil, helpful replies!
Slight hijack, but that does not necessarily mean that they are the same drugs. My girlfriend, for example, can’t take generic ritalin. For her it’s like taking nothing at all. Turns out that all the ingredients are the same, but the binders are different, and that makes all the difference.
Erections are obviously far more important. The world as we know it was built on mighty erections! Had some silly woman not provided her “bits” to the mighty ejection we would never have got out of the cave.
You think the saying “Rome wasn’t built in a day” is important??? Civilisation was not built without a hard one, young lady!
Without the mighty erect penis we were all just wishful thinking and a twinkling in our horny yet non-erect fathers eyes!
Why yes it is that time of the month…why do you ask?
you know, when groups of women live together, their menstrual cycles often start to coincide with one another. Do you think this is true of women who post together?
I must have missed the male-bashing and the little political points.
Second, “birth control drugs” don’t just prevent pregnancy. They are actually used for several medical conditions. Like you mentioned, insurance generally pays for drugs that treat medical conditions. Just as there are many plans that do not cover Viagra at all, there are insurance plans that do not cover “birth control drugs” at all for any reason.
Back to the OP, be sure to use your ERISA (Employee Retirement Income Security Act) rights to make a formal appeal to your insurance company. Often, if your doctor gives the medically necessary reason, an authorization can be placed on file to allow your medication to be covered. Just call and ask “How do I file an ERISA appeal of your denial of coverage for _________ (insert drug name).”
Women whose insurance will pay for hormonal IUDs get to rant without bleeding. Have I mentioned I love my insurance, high copays and all?
While I have no problem buying the whole “dysfunction” argument, menstrual pain is something that’s really hard to quantify. It’s one of those things that it’s pretty easy for someone who doesn’t feel like there’s a Garden Weasel in their guts to poo-poo. You’re just being melodramatic. It can’t possibly be that bad. It’s all in your head. Take some Advil and suck it up. As such, it’s pretty easy for insurance companies to argue that you really don’t need bcp to control your cramps and dysphoria, and so they’re not covering it. End of story.
And yes, it’s pretty damned ridiculous that they’ll cover something as expensive as Viagra without a single scrap of documentation that the patient actually suffers from erectile dysfunction, but they’ll make somebody else spend months jumping through hoops documenting that they’re suffering debilitating pain that a fairly cheap prescription can correct.
Of course, I’ve always though birth control, in a variety of forms, ought to be covered under the preventive medicine umbrella. It’s a lot cheaper for my insurance to spring $800 every five years for me to have an IUD than for them to cover prenatal care and birth, or to cover an abortion. Hell, it’s a lot cheaper for them to spring $400 every year than to cover either of those options. It just doesn’t make ecomonic sense to me not to cover it.
Subtle male bashing here. It’s an implication that men with a genuine medical condition somehow don’t deserve treatment for it.
I really don’t understand this attitude. It’s as if men with impotence are just big jokes. This is seen all the time in the media and in conversation.
Turning the tables is a useful exercise in detecting bias. Let’s see if it works here.
**My problem is that I discovered my insurance company covers Replens, no questions asked.
So, I have to “prove” that I need the Viagra, but Replens is fine? If there’s some medical use for Replens, besides being able to get wet, that I’m not aware of, then fine. But really, does that make any sense?**
If I were to say such a rediculous thing, I would be a social pariah. And yet, it is somehow acceptable for tamaraqueenofgoths to make the statement she made, which is identical in every way but the products mentioned.
As a wee hijack…I am a major fan of the IUD but mine (oh thank the mighty gods…NOT) still give me periods. What IUD eliminates periods? Pleeeeeeeeeease tell me.
As far as viagra goes, after knowing a viagra man, I say do the planet a favour. Knock off the drugs and call him retired (ok, ok JUST that one man then!).
