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Old 04-14-2005, 03:58 PM   #1
zuzu8
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Join Date: Jan 2003
Location: California, U.S.A.
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Zyrtec- Not covered by insurance????

Hi-

I haven't had to deal with seasonal allegies for some years, but this year am having problems.

My ENT just prescribed Zyrtec and my pharmacy informs me that neither Blue Cross NOR Blue Shield covers this drug anymore. Nor do they cover Allegra.

I'm in California.

Is this true nationwide??
Does ANY insurance carrier cover these two drugs now?

zuzu xx
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Old 04-14-2005, 05:12 PM   #2
katkat
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Location: indiana usa
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Re: Zyrtec- Not covered by insurance????

many insurance companies are now more or less telling the docs what they can prescribe and what they can't.......it sucks but what can you do? Call your insurance company and ask which kind they cover, then tell your doc to prescribe that one. Good luck.
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Old 04-14-2005, 10:25 PM   #3
USCGirl
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Location: Greenville, SC
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Re: Zyrtec- Not covered by insurance????

I have Blue Cross/Blue Shield (but it's in South Carolina) and they cover my Allegra. I guess it just differs according to state and the insurance your employer elects for your company.
I was still having bad allergies on Allegra and Flonase so they just added Singulair, too. I'm not sure how well it works by itself, but my allergy symptoms have gotten better since adding that. You might want to check into that one and see if that is covered since it's apparently also supposed to help with allergies. If not, have you tried looking into that over the counter Claritin? It didn't do anything for me, but maybe you would have better luck with it. There are also some other sprays that I think are for allergies, but the only one I have ever been on was Flonase (except for getting some sample of one other one-that one didn't do too well for me, can't even remember its name).
Hope you find something that works for you that your insurance will cover.
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Old 04-14-2005, 11:32 PM   #4
zuzu8
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Location: California, U.S.A.
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Re: Zyrtec- Not covered by insurance????

Thanks to you both...
USCGirl- I was covered for years with a group plan thru my employer ( they used Blue Cross).

Became unexpectedly unemployed and exhausted COBRA so now have to have an Individual Plan. Signed up with Blue Shield. Double checked with both Blue Shield and Blue Cross of California (they are separate entities and not affiliated in California) and NEITHER has Allegra or Zyrtec on their formulary for INDIVIDUAL plans! Maybe they do for Group, I'm not sure.

An insurance broker told me today that when Claritin went OTC, a lot of insurers dropped Zyrtec and Allegra. The oral antihistamines that Blue Shield of CAlif. DOES cover are Periactin and Vistaril (Atarax), both of which are not quite as popular (can you spell l-e-s-s e-f-f-e-c-t-i-v-e?) as Allegra or Zyrtec. (Actually Atarax IS popular but isn't it mainly for dematologic allergy??)

Anyway, bottom line is--- less demand. Therefore less pay-out $$ to the insured. No-brainer!


Fortunately this Blue Shield individual plan I got will cover Nasarel and Flonase steroid sprays which work for me depending on the allergen in question.

Am planning to soon get back to work with my old employer and my benefits will then kick in again.
Until then, I'm going to stick with Nasarel which helps... and try Claritin as you suggest.

Fingers crossed.

zuzu xx

Last edited by zuzu8; 04-14-2005 at 11:43 PM.
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Old 04-15-2005, 01:04 AM   #5
jazzy_girl
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Join Date: Apr 2005
Posts: 29
Re: Zyrtec- Not covered by insurance????

The insurance plan my employer offers only covers Zyrtec, I can't take it because it snows me. I almost fell asleep driving to work when I took it. I have had my alllergy DR fill out paperwork with the insurance company so they will cover my AllegraD. It is at the non formulary cost, but much better than full price. I have also started imunotherapy and have felt really well since then, but I hear that effect wears off.

jazzy
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