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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by raisinb on October 5, 2008, at 10:32:07
A friend of mine was prescribed Lexapro after trying a few other meds that didn't work, or had difficult side effects. Her insurance company told her they wouldn't cover it until she'd tried two other SSRIs for a month apiece--including Celexa.
I can't see why they'd do this unless they have some kind of deal with the drug companies. And if so, how can that be legal?
Posted by Phillipa on October 5, 2008, at 10:47:40
In reply to is this legal?, posted by raisinb on October 5, 2008, at 10:32:07
Not sure but since celexa is the generic of lexapro they probably won't pay for it until she or he tries the generic. In my opinion it's not right. Phillipa
Posted by bleauberry on October 5, 2008, at 11:22:20
In reply to is this legal?, posted by raisinb on October 5, 2008, at 10:32:07
Your friend would have to look through the fine print of the insurance coverage details. There might be a clause or sentence in their that gives them the right to do this. As long as it is within the law, they can do about anything they want as long as the patient signed the insurance agreement, which obviously they did.
If there is nothing in the insurance agreement about specific protocols for treating depression, like for example the protocol you mentioned here, then they are overstepping their bounds. The likely reason would be that the other two antidepressants they want to try, one being celexa, are generic, and thus way cheaper for them to pay for than Lexapro. Sounds to me like the greediness of profit is dictating care. But, the doctor really is the one with that authority, so I do not think the insurance company has any business making drug decisions. That is, unless the insurance agreement the patient signed gives them that power. Gotta read the fine print.
A quicker more effective route would be to have the doctor write or call the insurance company stating that Lexapro is deemed a higher priority at this time than the other drugs. For factual support of this, metastudies have shown Lexapro to have better and faster response rates than other antidepressants, in generally accepted statistical terms.
Doesn't sound to me like there is any deal with pharm companies here. The insurance company just wants to get out of their obligation in the cheapest manner possible, which means trying two generic drugs first, in hopes than one will work and the very expensive Lexapro can be avoided.
> A friend of mine was prescribed Lexapro after trying a few other meds that didn't work, or had difficult side effects. Her insurance company told her they wouldn't cover it until she'd tried two other SSRIs for a month apiece--including Celexa.
>
> I can't see why they'd do this unless they have some kind of deal with the drug companies. And if so, how can that be legal?
Posted by Phil on October 5, 2008, at 16:23:54
In reply to Re: is this legal? » raisinb, posted by Phillipa on October 5, 2008, at 10:47:40
Celexa and Lexapro are two different drugs from the same manufacturer. Celexa came out first, Lexapro second. Both are brand, not generic.
Posted by Phil on October 5, 2008, at 16:34:36
In reply to is this legal?, posted by raisinb on October 5, 2008, at 10:32:07
God, that has to be bs. Number 1, a month isn't even enough time to give many antidepressants.
Say the doc wanted to try an older drug like Amitryptiline, $5.00 for a month supply, dirt cheap vs. an SSRI.
They have to be getting kickbacks.
Posted by Merge on October 5, 2008, at 17:35:51
In reply to is this legal?, posted by raisinb on October 5, 2008, at 10:32:07
Yes, this is probably legal...the only way around it is to have her doctor contact the insurance company and explain to them why Lexapro is the best choice in this case. They still may not authorize coverage, but they might if the doctor makes a case for it.
Posted by azalea on October 5, 2008, at 17:56:56
In reply to Re: is this legal? » Phillipa, posted by Phil on October 5, 2008, at 16:23:54
Citalopram (generic for brand Celexa) is available for $4 per month even without insurance. Celexa is racemic, a 50/50 mixture of R-citalopram and S-citalopram. Escitalopram (generic for brand Lexapro) is pure S-citalopram. Lexapro is not yet available in generic form in the US. A month supply costs ~$100.
This approach saves insurance companies money. The goal of the insurance company is to minimize cost. One way they achieve this is by only covering expensive brand medicines after cheaper generic options have proven ineffective.
> Celexa and Lexapro are two different drugs from the same manufacturer. Celexa came out first, Lexapro second. Both are brand, not generic.
Posted by Phil on October 5, 2008, at 18:52:54
In reply to Re: is this legal?, posted by azalea on October 5, 2008, at 17:56:56
My insurance company won't cover brand at all if there's a generic available. Even if the script is written dispense as prescribed.
Posted by Phillipa on October 5, 2008, at 19:52:25
In reply to Re: is this legal? » azalea, posted by Phil on October 5, 2008, at 18:52:54
Mine won't either but Your friend could pay cash for it? Celexa did come out first and is being used as generic for lexapro although they the patients state lexapro works better. Phillipa
Posted by Hygieia's Bowl on October 6, 2008, at 5:05:32
In reply to Re: is this legal? » Phil, posted by Phillipa on October 5, 2008, at 19:52:25
> Celexa did come out first and is being used as generic for lexapro
~~~ Hate to tell ya, but that's not a true statement ya made there.....
Posted by Hygieia's Bowl on October 6, 2008, at 5:58:50
In reply to Re: is this legal? » Phil, posted by Phillipa on October 5, 2008, at 19:52:25
To Add:
Celexa®'s active compound is: citalopram hydrobromide
Lexapro®'s active compound is: escitalopram oxalate
Citalopram has been available for quite some time. Escitalopram was to be available - thus generic - in 2009 however, glitches occurred and it will most likely not be available until 2012.
It is true that RX drug plans would prefer a pt. use citalopram as opposed to Lexapro® for cost reasons - in particular, if one hasn't trialed citalopram. The plans almost seem to look at the use of Lexapro® as a step program drug like with some other drugs with step programs.
My Rx plan required a form for nonformulary meds for the last two years. For 2009, Lexapro® has returned to their formulary list. Go figure?
Some folks do not find differences in the two meds and some find big differences. That's not anything new, IMO. There are the arguments that drug companies tweek their compounds when the patent is up on a med they owned. I'm of the belief that will probably continue to be a finding.
While the meds may be related, they are not the same compounds.
Posted by Hygieia's Bowl on October 6, 2008, at 11:03:00
In reply to Re: is this legal? » Phillipa, posted by Hygieia's Bowl on October 6, 2008, at 5:05:32
> > Celexa did come out first and is being used as generic for lexapro
>
> ~~~ Hate to tell ya, but that's not a true statement ya made there.....
~~~ In light of the civility guidelines I should rephase to:"I disagree with your above statement."
Sorry for any lapse to the civility guidelines.
Posted by Phillipa on October 6, 2008, at 12:57:27
In reply to Re: is this legal?, posted by Hygieia's Bowl on October 6, 2008, at 11:03:00
Really? Seriously thought they were the same. I am sure I've read threads on here that said they were the same. But that would explain why when I took celexa it was tiring and lexapro stimulating. Thanks Phillipa hope you are well.
Posted by Phillipa on October 6, 2008, at 13:08:46
In reply to Re: is this legal? » Phillipa, posted by Hygieia's Bowl on October 6, 2008, at 5:58:50
Yup found this hope it is helpful. Phillipa
Lexapro vs. Celexa -- The Practical Differences
Both Lexapro and Celexa are approved for the treatment of depression. However, only Lexapro is approved to treat anxiety. This does not mean that Celexa will not work for anxiety or that your healthcare provider cannot prescribe Celexa for anxiety; it just means that Celexa has not been adequately studied for anxiety treatment.
Another difference between Celexa and Lexapro is that Celexa is available as a generic, while Lexapro is not.
Regarding the effectiveness of the two medicines, some studies have suggested that Lexapro may be more effective than Celexa for depression treatment, while others have not found significant differences between these two medications.
Finally, many people find that Lexapro works for them when Celexa does not (or the other way around). If Lexapro works for you, this does not necessarily mean that Celexa will also work for you (and the opposite is true).
Lexapro vs. Celexa: A Summary
While Lexapro and Celexa are very similar chemically, there are a few important differences. Lexapro and Celexa are not interchangeable, and they are not approved for all of the same uses. Be sure to ask your healthcare provider about any other questions you may have about the differences between Lexapro and Celexa.
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Posted by 10derHeart on October 6, 2008, at 17:41:38
In reply to Re: is this legal?, posted by Hygieia's Bowl on October 6, 2008, at 11:03:00
Posted by yxibow on October 6, 2008, at 23:55:42
In reply to thanks :-) (nm) » Hygieia's Bowl, posted by 10derHeart on October 6, 2008, at 17:41:38
In the US if you get a nasty insurance company (I'm not asking you to reveal it), unfortunately they can do anything.
I'm fortunate that my [nameless] insurance company allows at least certain medications with prior authorization (although I don't like that invasion of privacy).
Yes, they dispense generic, I don't know if you asked for "the real thing" whether they would do it, but then I really haven't noticed any differences and have never asked otherwise.
Some people do, and sometimes its a placebo effect, sometimes there are realities to certain ones.
Getting into a tussle with your insurance company is risky, but one should at least be able to ask whether there is prior authorization (that is, your doctor says, my patient will do better on medication x for y condition).
There is supposedly a difference in how the body reacts to lexapro than celexa, as far as side effects, at least for some, one could also say its a patent extender -- in the sense that there hasn't been enough research of new SSRIs and beyond them.
But then its been tougher to push new medications through the FDA, what with them practically putting a suicide warning on every antidepressant since the 1970s.
Same can be said of the downing of all COX-2 inhibitors except for one.
True, there are really bad cases that have happened but it puts an extra damper on approval, I think. Which is why you don't often see attempts of European medications in the US.
This is the end of the thread.
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