I'm new to this and I have Health America HMO. Just being dx with PCOS and will go on Metformin in August at my next visit. Is it common for insurance to deny coverage of Met to PCOS pts or do they do it with out much complaint? Just wondering. If it isn't covered, how much is it out of pocket?
If you have prescription coverage, and your doctor prescribes it, insurance normally covers it unless it is a very expensive or experimental drug. Sometimes drugs are not in the insurance's formulary, which means you will pay a higher price for it. Most insurances have a website where you can check out how much a drug will cost. Met is one of those very old generics. Most people don't pay more than $5 - $20 per month. Wal-mart and several other large pharmacies have it on their $5 list, so anybody can get it at that price with or without insurance. It is $12 per quarter under my Medco coverage.
If you have prescription coverage, and your doctor prescribes it, insurance normally covers it unless it is a very expensive or experimental drug. Sometimes drugs are not in the insurance's formulary, which means you will pay a higher price for it. Most insurances have a website where you can check out how much a drug will cost. Met is one of those very old generics. Most people don't pay more than $5 - $20 per month. Wal-mart and several other large pharmacies have it on their $5 list, so anybody can get it at that price with or without insurance. It is $12 per quarter under my Medco coverage.
That is great news! Thank you so much!!! That puts my heart at ease! I do have coverage! Now I just have to learn to eat properly so the side effects are not my undoing!
I just got my rx refilled yesterday, I'm Canada. So my prescription without coverage would have been $33.04 for 180 tabs of the regular metformin. The cost $24.07, filling fee $8.97. My co-pay was $10.94. As my year goes on, once I hit a set $ amount, my cost goes to $0. I use the Walmart for my rx. Since I am to take 2 tabs a day, this prescription will last 3 months.
What should I expect from my insurance? 
Thank you so much!!! That puts my heart at ease! I do have coverage! Now I just have to learn to eat properly so the side effects are not my undoing!
