ptsd How To Get A Non-formulary Prescription?

[RockyA1911]

I was diagnosed with Barrett's esophagus since 1999 and have been on medication ever since along with annual endoscopy performed by my private gastroenterologist. My gastro guy even furnished the VA with a diagnosis letter and the length of time I have had Barrett's.

Anyway, my first medication for the Barrett's began in 1999 where I was prescribed Prevacid. After a couple years of taking it I experienced some severe side effects, some of which are know to be common side effects such as abdominal pain, diarreha, headaches, etc. along with chest pains, throat restrictions, unusual amount of mucus discharge, coughing, and severe IBS triggers. I switched to Prilosec in 2004 and experienced the same to say the least undesirable and painfully uncomfortable physical side effects also.

My gastro guy seemed to think I should continue taking it. So I decided the burning esophagus was less severe than the side effects I experienced while taking Prevacid and Prilosec. So I went for a whole year without medication, taking Tums, Mylanta, etc. I told my gastro of that when I had this latest endoscopy and he declared that I must be on medication. I again told him I could not take anymore of the Prevacid or Prilosec and he offered an alternative PPI medication called Aciphex.

I have been taking Aciphex since last August and I have not experienced any side effects at all, it is like a miracle for me. I checked the internet sites and discovered that Prevacid, Prilosec, Nexium, and Protonix all share the same adverse side effects. However, there are no reported side effects for the Aciphex.

So now I finally have a medication that controls my Barrett's and burning esophagus but without any side effects what so ever.

I had my annual visit with my VA primary care doctor and he submitted a request for me to get Aciphex. He told me the VA only has Prilosec in the formulary, but when I told him all the adverse reactions I had with Prilosec and Prevacid, he filled out the special request whatever it is and forwarded it. The rest of my prescriptions were filled. Three days later I received a call from the VA clinic telling me that the request for the Aciphex was disapproved and I would have to take Prilosec or continue to purchase it on my own.

This is the kind of crap that triggers my PTSD. One would think DAAAHHHHH!!!!!! Why would a VA patient have to contend with all the side effects and continue taking what they dish out even though it hurts him? I checked and the Aciphex is also like $30 cheaper than the Prilosec.

How did we ever end up in this mess where one medication fits all scenario, no exceptions?

Does anyone here know what I can do to resolve this and get the VA to furnish my much needed correct medication Aciphex?

Thanks,

[Scott D]

I find the exact same problem with my insurance providers. I started aciphex while in service but had no luck, so the Doctor switched me to Nexium which was a godsend. Since seperating and dropping Tricare my new insurance carrier, Group Health, doesnt carry Nexium on the formulary so they have been prescribing Omeprazole. I was pretty pissed since Nexium had proven effective with little side affects.

My best advice would be to contact customer service and explain the circumstances and have your PCP make the same request via his/her department head.

Good Luck!

From VA FAQ page:

Q. If I am eligible for this benefit, can I get all medicines prescribed by my non-VA providers through the VA Pharmacy?

A. Medicines on the VA Formulary (including insulin and syringes) will be supplied to you if you are eligible for this benefit. These medicines do NOT include controlled substances, supply items, or over-the-counter drugs. Medicines that are given in the vein or that must be given by a medical professional will NOT be provided. If a medicine is not on the VA Formulary, it will be supplied only after your VA provider has discussed the need for the medicine with your non-VA provider and has decided that the medicine is necessary for your medical care.

[Pete53]

I used to get acidiflex which worked perfect and now it is the omeprezaloe which makes me burt and leaves a salty tase. I would love to get back on the acidoflex but was warned that bitching about a med could jepordize my fee service.

If you get a Doctor to write it is medically necessary and take it to the head of pharmacy you can get what you need. Good Luck.

[RockyA1911]

Omeprazole is Prilosec,

The VA doctor did submit a request for the Aciphex, but it was disapproved. I wrote a letter to my gastroenterologist and asked him to contact the VA doctor and find out exactly what it is needed from him in order for the VA to buy the Aciphex for me. It must be lunacy is all I can think of if the VA expects a veteran to unnecessarily suffer adverse side effects of medication just because it is in the formulary. The VA apparantly has cost savings and their promotion of the best health care priorities confused. Anywhere else the patient would be given the medication that produces the least side effects and at this time for me it is Aciphex. I haven't experienced any side effects with the Aciphex.

I would think by letting the VA doctor know of the adverse side effects and him requesting the proper medication for you should be enough to justify the VA going out and purchasing it.

They have to be crazy to think that one size fits all when it comes to meds.

[Scott D]

For me the biggest worry with the whole PPI chain of medication, was the potential for adverse reactions with other medication. My GI doctor said that esomeprazole (Nexium) had proven to have fewer dug interactions than omeprazole, although both are chemically very similar. This may be a fact only because Astra Zenica spent more money to show that Nexium was better than omeprazole simply becasue their 17 year patent had expired.

But besides the similarities I was extremly confident and comfortable with the nexium, which should be the biggest factor in not altering treatment, and saw no reason to switch precriptions.

Continuing care that is proven should be a high priority for any medical system, be it the VA, HMO's, or private care.

GAO Report on VA Formulary