I was a clinical physician (an MD) for over fourty years..So please don't try to educate me on prescribing drugs...Yes if the drug plan does not cover the drug. Then the patient has to pay for it out of pocket..Hopefully nobody including non md clinicians on this board has trouble undertanding that.
I would not be surprised if a number of drug plans think fishoil capsules are just as good as Vascepa...That is something the company understands..Prior approval simply means the insurance plan wants to know the premise. Vascepa is a new drug..new to everybody the company, the drug plans and the patients...No surprise that there are bumps in the road...The drug plans have a vested interest in studying what the drug will be used for....They have the label..but that is not enough...I do not see any flashing red lights..The important thing is the drug plans are lowering the tier for Vascepa...That means the patient with PA (and not all of them will be challenged0 because it does cost the drug company money to go through every script...
The tiers determine the out of pocket cost of the drug...In Vascepa's case Tier 4 is around $180 a month..Tier 2 could be less than $15 a month...So if you have a script and its Tier 4 you might not be able to afford it...
"There's at least one insurance company recommending fish oil as an alternative. Maybe they don't know what they're talking about, since there are differences between the 2" ...MAYBE???...SMH
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