Frontpage Discussions General ZYTIGA VS ABIRATERONE

Viewing 4 posts - 1 through 4 (of 4 total)
  • Author
    Posts
  • #8029
    Marsha
    Participant

    Hey there all! After talking with Humana Part D plan for a patient for over 40 minutes, I wanted to share some information with the group that I found out.

    All of the insurance plans that I have dealt with prefer that the patient try and fail the generic form of a medication first before trying the brand name. Sound about right?

    I have found out that today, 04/03/2019, Humana Part D formulary only includes the BRAND name Zytiga. So what does this mean? This means that I am letting you know not to waste your time (like I did) submitting a prior authorization for the generic Abiraterone. Humana will not recognize this medication and in the prior auth questions, it will clearly state (yes, even on covermymeds.com) that the Brand name Zytiga is the preferred medication and your prior auth will be submitted, but not completed. You will then have to call on Humana PA line, talk to a rep and have a PA done for the Brand name and hope that the rep understands the issue.

    I have no issue giving the patient the brand name, but this definitely was BACKWARDS when it comes to any other medication that has a generic available.

    Now, if only the insurances would do that for GLEEVEC, I definitely know I wouldn’t be the only happy person on the planet!

    Let me know if any questions!

    Thanks,

    Marsha Sneller CPhT

    #8071
    Marsha
    Participant

    One of my patients is restarting their Imbruvica, and Humana is at it again! The patient was previously on the tablet form, and I went for a Prior Auth for tablet form since the dose changed and patient has been off medication for about 6 months. Humana has taken the tablet form off of their formulary and are demanding patients to use the capsule form of the medication. **INSERT EYE ROLL HERE**. Is there any way around this with Humana?

     

     

    #8077
    Carol
    Participant

    Hi Marsha,

    We are experiencing this issue with Tricare and have been able to express that by using the capsule form, it creates a pill burden for the patient.  This has been effective in getting approval for the tablet form.  Hope this helps.

    Carol

     

    #8089
    Marsha
    Participant

    Thanks Carol! I will try that next time!

Viewing 4 posts - 1 through 4 (of 4 total)
  • You must be logged in to reply to this topic.