Today my new primary Dr gave me sample pack of Viibryd. I told her that my insurance wouldn't pay for drug but she said well you've tried many of the others so it should. My B/C medicare plan only pays for generic. Any ideas or do I call tomorrow and get different drug. In the past I've taken Cybalta, Lexapro, venlafaxine and Prozac. I am down in the dumbs as it is taking so long to get diagnosis for lungs. They told me in June the CT showed interstitial lung (PF). The second scan showed it was somewhat clearing,O2 70% at night(based on night O2 study) and was 92 during day. So I'm still waiting on sleep study which is Sunday. I have had severe chest pains for 6 months. Pretty much ruled out heart from echo. I have a number of other serious issues going on but I can't take the wait anymore. Anybody have any suggestions on a drug that might work sooner. I don't like pain pills but she did give me muscle relaxers-haven't tried today. Thanks Peggy
How do you get insurance to pay for expensive drug Viibryd?
Question posted by braydensnana on 16 Oct 2013
Last updated on 5 August 2015
5 Answers
I take two medications that are not covered. My doctor sends a prior auth request with the history of things tried and my condition. They pay for it. I Also have secondary insurance which further reduces the cost.
It is up to the doctor to request payment for your treatment.
Karen maybe she has plans for that. I only started with her in July but she has my records
Excellent. I do hope thi works out for you. :-)
Viibryd still has a discount card available. See if your doctor has one or contact them.Their contact info in on this site. It does not last forever, but it is better than nothing. With insurance it still cost me $75/month.
RonMan
Peggy, Viibryd is an SSRI as are the Prozac and Lexapro which you have already tried. I would ask your doctor what is so special about Viibryd as opposed to other SSRIs such as Celexa (generic: Citalopram) and Zoloft (Sertraline) which do come in generic. Just because the doctor gets some free samples doesn't mean that Viibryd is the one for you to take. Doctors tend to promote the drugs that they get free samples of. Also I take about 40 mg of Baclofen (a muscle relaxant) which I've had no side effects from. And I have a very long list of meds that I am allergic to. The Baclofen has taken away severe pain that I had in my mouth and face. Good luck to you.
That is the muscle relaxer she gave me but so far not working on chest pain but I only took 10mg each afternoon so tomorrow I will try higher dose .Thanks for advise. My daughter in law is drug rep so I understand what they do and laughed about the Viibryd samples to her. I will call tomorrow about changing..One reason she did the Viibryd she said didn't cause weight gain. Not being able to exercise due to all the health and joint issue I have gained 15 pounds. I'm just overweight not obese. Do you think Citalopram or Sertraline would cause weight gain?. Need all the help I can get right now.
I don't know anything about them. An extra 15 lbs doesn't sound like that much, but I know it is a problem for you. Hopefully EndlessPred's suggestions will help you get the Viibryd. And 10 mg a day is very little of the Baclofen. My doctor even increased it to the top dose of 80 mg a day for my severely clenched up toes, which was too much--made me drowsy. It didn't help at all, since it is most likely spasticity from my stroke. Hoping that the Botox will help that. Really wish you relief just as soon as possible. Sara
And also Ron's suggestion could also help you.
Thanks everyone. I think I will just stay with it as so far no side effects and I sleep was ok (only on 3 days). I just started it. Ron I will get the discount card when I go back to her on the 31st. Maybe I wont have to be on the drug long. I think once I get lung diagnosis and get treatment I will be better. Also need my right kidney out so lots on my plate in addition to that. If anyone has any other things to add please do. I have been helped by a few members like Karen and Sara. Feels better than family.
Peggy, I was on Citalopram but my Doc had me switch to Viibryd recently due to one uncommon side effect - Nocturnal Bruxism aka jaw clenching. I would find myself clenching my jaw a lot, but during the day or while in bed before actually being asleep, I would realize I was doing it and just open my mouth, but apparently it was happening during sleep too because I would wake up with sore muscles in my jaw. It became sort of annoying to eat because my jaw muscles felt too tired to chew, and it even extended toward whatever muscles help you swallow... it became hard to swallow sometimes. Hence, the switch to Viibryd, which is supremely unfortunate because of the cost.
But while I was on Citalopram, aside from the jaw thing, I also experienced little to no libido, which I think is a pretty common side effect. It came back as soon as I started weaning off of it, so no long term effects from that. Other than those, I had no weight gain, no mood switch, no headaches, nausea, none of the "normal" side effects. I think I MAY have had some fatigue from it, but I always took it at night before bed so I'm not sure if that was making me tired, or I was just tired because it was bedtime. Either way, I was just going to sleep anyway so it didn't matter.
I just realized this post was from 2013! I hope all is well and that everything worked out for you. =)
I keep trying to answer you and its not posting. If you google forest pharmaceuticals you will find an assistance site. You can apply for help, and get more samples from the dr meanwhile.
My part D won't pay for anything but generics either
thanks. Have you ever tried to get expensive drug reduced by your insurance? I had to pay for Cymbalta. Thanks. Peggy
With part D you pick your plan, you need to be aware what it will pay when you do. I know that mine won't pay for those because I haven't needed them, so I am using one that has no copay for all the generics I take. If I ever need one that isn't covered, I can change it. Open season is coming and the plan can be changed if its not adequate.
thanks. I've been doing pretty good with just the generic. I think sometime the Dr just wants to give you expensive drug for the drug rep. I noticed in the new coverage for B/C they moved lots of drugs to different tiers or at least my plan.
I had some shifting around too. Its inevitable, I think they like to keep you guessing, lolol.
The best thing to do is get out the insurance card that pays for your medications and call the customer service line and find out why it isnt covered. Sometimes it is because they want you to try other less expensive medications first (and your Dr needs to document what was tried and why it failed), sometimes it is just a matter of getting prior authorization in which your Dr has to contact the company and answer questions or whatever they require, then ask them what you can do to get this medication covered. There is usually an appeal process that you can try to see if they can make some kind of exception for you since you have tried so many other drugs. You may need to get your Drs help in the appeal process but first things first is to call your insurance company. As a case manager for a health insurance company, I do this sort of thing all the time.
Every insurance company is different in what they cover and dont cover and they each have different appeal processes but very little is ever written in stone and exceptions can be made but you may have to do some leg work to get it done. If your insurance company offers a case manager, get into contact with him/her and they can help you. many companies have a CM assigned to cases. In getting exception, you cn expect to pay the highest copay that your company has. Sometimes they will even make exceptions on that. It never hurts to call your insurance company and ask questions, always about many things. Dont just except no for an answer because many times these exceptions can be made if a person is willing to do the leg work. The insurance company counts on the fact that most people dont like the hassle and bother of getting the most out of their coverage because that saves them money! Best of Luck! :-)
Thank you for your help. Yesterday RN from B/C called about my health and at the end she wanted me to get on meds. So I got in with DR today so maybe they will go for it. The drug might not work but I wanted to call her soon if not possible to get price down. It will cost $95 month and more next year. Maybe my Dr was prepared to get it paid. Thanks again
Related topics
depression, insurance, viibryd, medicare
Further information
- Viibryd uses and safety info
- Viibryd prescribing info & package insert (for Health Professionals)
- Side effects of Viibryd (detailed)
Similar questions
Search for questions
Still looking for answers? Try searching for what you seek or ask your own question.
