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Extended release medications and insurance

Hey guys! My PM doctor wanted to prescribe me Zohydro (ER hydrocodone) along with IR "for break through pain", but he thought my insurance wouldn't cover it, so he just decided to stick with the IR PRN.
I know we all have different insurance plans, but I was wondering if any of you have been prescribed this (or other ER narcotic) and had a problem with your insurance covering it. Do you think I can call my insurance and inquire about coverage of this medication?
He said ER would be more beneficial for going to work/school since it releases throughout the day, and I would only need ~2 pills per day. And from my perspective, it's less acetaminophen on my liver.


  • dilaurodilauro ConnecticutPosts: 9,842
    The ER medications I took. (OxyContin and Opana ER)
    My insurance carrier covered them like any of my other medications

    I would call your insurance to find out what ER they do cover
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Me too. I was on ER Oxy and my insurance covered it along with IR Percocet. You can call and ask them.
  • I've been on Norco (hydrocodone/APAP) prior to starting pain management (from my PCP/Neurosurgeon). The PM doc continued that prescription. I'm guessing he wanted to put me on ER hydrocodone because I'm already on IR hydro. Should I ask him about trying a different form of ER medication (that my insurance covers)?
  • Motor1MMotor1 Pittsburgh, PaPosts: 552
    edited 08/10/2015 - 1:58 AM
    I was on Zohydro & my insurance covered it. But, i m being treated through work comp, so I don't know if that makes a difference?
    I did have a problem finding a pharmacy that could dispense it. My local cvs was unable to get it for me.
  • My insurance company will only pay for this particular med to be taken twice a day. My doctor prescribed it three times daily so they are appealing the insurance company decision. I would call and ask your insurance company just to be sure.
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