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Nexium, Prilosec, GERD: HMOs Don't Pay

By Stephen Joltin, published Oct 09, 2007
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I had a terrible case of Gastric Acid Reflux Disease (GERD). This is caused when acid from the stomach flows backward up the esophagus and burns your sensitive upper digestive tract from your mouth to your diaphragm. Often the acid reaches your teeth and starts to eat them away. In addition, since this happens more often when you are in lying flat trying to go to sleep, GERD interferes with a restful night's sleep.

Here is the good news. GERD can easily be controlled by a type of medicine called acid pump blockers. These medicines stop the acid from being pumped into your stomach to a degree where not only your heartburn and GERD symptoms disappear but also previous damage to your esophagus is given a chance to heal. Here is even better news. Prescription strength Nexium by Astra Zenica Corporation is a tiny single pill that only has to be taken once a day.

My problems disappeared thanks to Nexium. For the next two years I had no GERD or even heartburn related problems at all. That was until my HMO, CIGNA Health Care, took Nexium off its list of approved pharmaceuticals it would pay for. I was forced to use Prilosec, which was the predecessor to Nexium. For a while this worked but not quit as well as Nexium. I had to avoid some foods before bed. Othewise it was worth it. Apparently everyone else on my CIGNA HMO switched also.

CIGNA then decided that Prilosec, was too expensive for their pharmaceutical plan as well. I received a letter that Prilosec would no longer be covered. They included a free coupon for a free 14 pill pack of Prilosec OTC and suggested I use that from now on. Very generous, Prilosec OTC is only half the strength of the prescription dose. I found out through painful experience that it took two Priolosec OTC pills to stop GERD. It cost about $30 for a 48 pill pack of Prilosec OTC. This is a 24 day supply.

Takeaways
  • GERD is a common and painful disease and is also known as Gastric Acid Reflux Disease
  • Nexium and Prilosec are effective acid pump blockers which reduce GERD
  • HMOs decided not to cover these prescriptions any longer
Did You Know?
HMOs Don't Pay
Resources
  • HMOs Don't Pay
Comments
Showing Comments 1 - 15 of 15
 
 
Yeah, Wolcott, guess what? The author can delete your comments if he wants! And sick of it is right - it's not just the drug companies, not just the insurance companies -- the whole system is broken. I can't get a prescription anti-histamine/decongestant that works unless I first prove that 3 different OTC drugs don't work after a month of using each - by which time my allergy season is pretty much over, and I've been sick through it all. I hate it when expensive insurance does this - Melissa is right!

Posted on 11/27/2007 at 3:11:00 PM

 
Certainly makes you wonder about things. Thanks for sharing your experience.

Posted on 11/02/2007 at 8:11:00 AM

 
good reporting

Posted on 10/30/2007 at 11:10:00 AM

 
Insurance companies make me furious when it comes to things like this. My husband and I pay over $500/month for standard (not HMO) coverage through his job for just the two of us. My doctor prescribed Advair for my asthma, but insurance won't cover it. It costs $180 for just one months worth, and we cannot afford that. I have insurance but can't afford the medicine I need. It's ridiculous.

Posted on 10/28/2007 at 5:10:00 PM

 
nice article!

Posted on 10/19/2007 at 2:10:00 PM

 
:-)

Posted on 10/16/2007 at 9:10:00 PM

 
Amerihealth65 covers Prilosec .

Posted on 10/15/2007 at 6:10:00 AM

 
"There is just something wrong with a Health Insurance Company that that is more interested in making huge profits than providing the best heath care for its participants." - There is something wrong with a country that backs that up...

Posted on 10/15/2007 at 1:10:00 AM

 
In this country there is no reason that anyone should go without the medication they need!

Posted on 10/12/2007 at 8:10:00 PM

 
Indeed, what does happen to those people who can't afford or dont have insurance. We don't and currently my DH takes 2 BP meds and one for cholesteral one is available generic. I take two allergy medicines every day, no generic available. Our cost per month? $493.00

Posted on 10/12/2007 at 9:10:00 AM

 
Well, Steve, my Nexium isn't a tiny pill, it's a large-ish capsule! But I do know what you mean, and it sucks. My insurance won't cover the only migraine med that works for me, but will let me have 6 pills per month of a med that helps a little bit but which I have to take 2 of to get any relief. And sorry, but I usually have more than three headaches a month. They don't care. They're in it for the money, so they get to tell us what we can take, and ignore what our doctors, who know us and understand out health care needs, say we should have. Totally sucks, and there doesn't seem to be a darn thing we can do!

Posted on 10/11/2007 at 5:10:00 PM

 
:)

Posted on 10/10/2007 at 6:10:00 PM

 
I have had a similar issue with my insurance company. My 13 yr old son has suffered with this for many yrs and dealing with the insurance companies can be so frustrating.

Posted on 10/10/2007 at 9:10:00 AM

 
:-)

Posted on 10/09/2007 at 5:10:00 PM

 
This is ridiculous. I agree with your last sentence. There is something wrong with putting greed before human welfare.

Posted on 10/09/2007 at 4:10:00 PM

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