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Celebrex - prior authorization

Laur en PainLLaur en Pain Posts: 47
edited 06/11/2012 - 8:40 AM in Pain Medications
I posted last month about trying some samples of Celebrex that was like a miracle drug. I had my doctor call me in an Rx for it but but was told by the pharmacy that my insurance doesn't cover it which was an issue with a few other spineys as well. Normally, if my insurance won't cover something because it needs a prior authorization from my doctor, the pharmacy specifies that when they call to tell me it's not covered. With the Celebrex, all they told me was that my insurance will not cover this medication period. I had to call my insurance company regarding another matter and mentioned this situation to them. I explained that the Celebrex helped me tremendously but that I couldn't afford $200/month for it since they didn't cover it. The representative told me that it's not that they didn't cover it, but that it required prior authorization and then would be reviewed. I had my doctor send in the paperwork for the prior auth and it did get approved. So now I just pay my normal co-pay for a name brand Rx which is still $35.00 but hey, that's a heck of a lot better than $200. I just wanted to let you all know b/c it may be the same situation for you where it's not clarified that it MIGHT be covered. It's at least worth a phone call to your insurance company to see if that is the issue or if they just won't cover it.


  • I was surprised my insurance covered it also as well as Cymbalta and it says they don't cover it. I guess it depends on the diagnosis why you need it. These drugs would be very expensive to pay for on your own. I'm glad you got through to your Insurance and get the drug that helps you. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • That's great news. Glad you were able to get that straightened out. I use Celebrex and it does wonders for me. Thanks for sharing this information so that others in similar situations may be able to get things worked out.

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