Mugard - help...

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j4mie
j4mie Member Posts: 218
in Head and Neck Cancer #1

Hi everyone. Pat finished day three of his radiation treatment today. He was well enough to drive himself to the treatment center, so I stayed at home to work on getting to the bottom of why we haven't been able to get the Mugard prescription. I know this is something that should have been started by now, but I have had a real 'run around' with our insurance company!

Has anyone ever been turned down for Mugard because the insurance company classifies it a surgical device, and not a prescription? I tried until I was practically blue in the face to tell them that Mugard is in fact a prescription, prescribed by a radiation oncologist, and it is prescribed and used all over the US, as we are intending to use it...I felt I had finally made some headway with that, and they proceeded to inform me that this would then be considered a 'specialty drug' and our plan does not cover 'specialty drugs'. If we were to pay for this out of pocket, the total for a 6 week course would be roughly $1500, unfortunately this is not feasible for us. I feel like they are making any excuse in the book to not cover this. 

I am not going to give up on trying to get the Mugard! Have any of you been in this situation and been able to get your insurance/prescription drug carrier to change their mind? AND, If I absolutely can't get it approved, are there any other substitutes out there that any of you know about? 

Jamie

Comments

  • phrannie51
    phrannie51 Member Posts: 4,716
    #2
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    Just sent you a PM....

    I don't know why the insurance company isn't being more cooperative unless they just don't know what it is....or why the Mugard company isn't helping you out like they did so many of the rest of us...

    p

  • Hummingbird3
    Hummingbird3 Member Posts: 67
    #3
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    Jamie,  I found about the

    Jamie,  I found about the Mugard from this support team too. I told my doctor about it and when i had such a good experience with it they started carrying it in there supporitng hospital pharmacy also for future patients. Not sure if this is an option where your at or not but wanted to suggest it.  Sure hope you can get someone to listen aNd cooperate. 

    christie

  • j4mie
    j4mie Member Posts: 218
    #4
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    phrannie51 said:

    Just sent you a PM....

    I don't know why the insurance company isn't being more cooperative unless they just don't know what it is....or why the Mugard company isn't helping you out like they did so many of the rest of us...

    p

    My hunch

    after going round and round with them all day is that the insurance companies don't know what it is or how it is used. Secondly, if I'm not mistaken, I believe that this was just recently put 'on the market' after the clinical trial. Maybe, because it is now 'legitimatley' on the market and not a 'trial' anymore the Mugard company isn't as forthcoming in helping defray the cost??? 

    I don't know for sure anything, except that when you need a certain prescription to make quality of life better when going through something like this and you can't get your hands on it, it is maddening!

  • j4mie
    j4mie Member Posts: 218
    #5
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    Hummingbird3 said:

    Jamie,  I found about the

    Jamie,  I found about the Mugard from this support team too. I told my doctor about it and when i had such a good experience with it they started carrying it in there supporitng hospital pharmacy also for future patients. Not sure if this is an option where your at or not but wanted to suggest it.  Sure hope you can get someone to listen aNd cooperate. 

    christie

    Thank you Christie

    I am going to bring this up with Pat's team tomorrow when we go in for his radiation. I am not one to give up a fight easily Wink and if it will make it easier/better for not only us, but someone joining 'the club' after us all the better...

  • nick770
    nick770 Member Posts: 195
    #6
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    j4mie said:

    Thank you Christie

    I am going to bring this up with Pat's team tomorrow when we go in for his radiation. I am not one to give up a fight easily Wink and if it will make it easier/better for not only us, but someone joining 'the club' after us all the better...

    Have you called muguard

    Have you called muguard directly? It might be worht a shot, They gave me a pretty good discount.

    sending you a PM

  • j4mie
    j4mie Member Posts: 218
    #7
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    nick770 said:

    Have you called muguard

    Have you called muguard directly? It might be worht a shot, They gave me a pretty good discount.

    sending you a PM

    Thank you Nick

    Yes, I did talk to them today. They were not willing to come down in price at all for me. I did try though...maybe worth another try tomorrow? Sometimes maybe it depends on who you are talking to???

  • robswife87
    robswife87 Member Posts: 209
    #8
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    j4mie said:

    Thank you Nick

    Yes, I did talk to them today. They were not willing to come down in price at all for me. I did try though...maybe worth another try tomorrow? Sometimes maybe it depends on who you are talking to???

    I have 2 bottles

    unopened.

    I can send them to you. Send me an email with your address and I can get it out to you.

    Sandy

  • donfoo
    donfoo Member Posts: 1,771 Member
    #9
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    new

    Hi Jamie,

    I do believe muGard is quite new, even still in some clinical trials, yet has garnered some positive news as highlighted by the recent stock run-up. I know as my RO wanted me to be a guinea pig in his trial, I declined. Even if it is past trials and full FDA approved, I do think there can be a lag before the drug is listed on the approved list of medications of the insurance companies. 

    Not using MuGard is not the end of the world. Sure it helps but there are far more who get along without it. The standard baking soda/salt rinse, magic mouthwash, etc. do a pretty good job. MuGard is NOT some miracle drug that fixes all the problems. I would not get overly stressed out if you don't get your hands on it. There are plenty of other daily symptoms to keep you busy.

    Don

  • j4mie
    j4mie Member Posts: 218
    #10
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    donfoo said:

    new

    Hi Jamie,

    I do believe muGard is quite new, even still in some clinical trials, yet has garnered some positive news as highlighted by the recent stock run-up. I know as my RO wanted me to be a guinea pig in his trial, I declined. Even if it is past trials and full FDA approved, I do think there can be a lag before the drug is listed on the approved list of medications of the insurance companies. 

    Not using MuGard is not the end of the world. Sure it helps but there are far more who get along without it. The standard baking soda/salt rinse, magic mouthwash, etc. do a pretty good job. MuGard is NOT some miracle drug that fixes all the problems. I would not get overly stressed out if you don't get your hands on it. There are plenty of other daily symptoms to keep you busy.

    Don

    Thanks Don!

    As always, I appreciate all of the different viewpoints I am exposed to here on this forum, and I certainly appreciate your input and encouragement on Mugard had we not been able to get some.

    However, I did manage to get some Mugard after all, and I feel better just knowing that it is one more thing in our line of defense against mouth sores and mucositis. Unfortunately, you are right, there is no 'miracle drug', if only...right?!?!? 

    Jamie

  • DaveRJ
    DaveRJ Member Posts: 9
    #11
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    j4mie said:

    Thanks Don!

    As always, I appreciate all of the different viewpoints I am exposed to here on this forum, and I certainly appreciate your input and encouragement on Mugard had we not been able to get some.

    However, I did manage to get some Mugard after all, and I feel better just knowing that it is one more thing in our line of defense against mouth sores and mucositis. Unfortunately, you are right, there is no 'miracle drug', if only...right?!?!? 

    Jamie

    Hi J4mie

    Mugard is better than nothing, but the much more effective stuff AND much cheaper at $50 for two week supply is the Healios I used during my 6 weeks of radiation.  You can find it online at www.healiosproducts.com   It IS a miracle and without the harsh chemicals found in Mugard such as:

    benzyl alcohol, sodium saccharin, polysorbate 60 and phosphoric acid

    My sincerest best wishes...Dave. 

  • j4mie
    j4mie Member Posts: 218
    #12
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    DaveRJ said:

    Hi J4mie

    Mugard is better than nothing, but the much more effective stuff AND much cheaper at $50 for two week supply is the Healios I used during my 6 weeks of radiation.  You can find it online at www.healiosproducts.com   It IS a miracle and without the harsh chemicals found in Mugard such as:

    benzyl alcohol, sodium saccharin, polysorbate 60 and phosphoric acid

    My sincerest best wishes...Dave. 

    I'll definitely look into it...

    Sounds worth looking into!! Thank you for the info. Would it be overload to use this with the Mugard??? 

  • robswife87
    robswife87 Member Posts: 209
    #13
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    j4mie said:

    I'll definitely look into it...

    Sounds worth looking into!! Thank you for the info. Would it be overload to use this with the Mugard??? 

    On its way

    You should have it on Thursday.

    Sandy

  • robswife87
    robswife87 Member Posts: 209
    #14
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    j4mie said:

    I'll definitely look into it...

    Sounds worth looking into!! Thank you for the info. Would it be overload to use this with the Mugard??? 

    On its way

    You should have it on Thursday.

    Sandy

  • j4mie
    j4mie Member Posts: 218
    #15
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    robswife87 said:

    On its way

    You should have it on Thursday.

    Sandy

    Can't thank you enough...

    Your generosity is greatly appreciated! Thank you again!!

  • sassysrice
    sassysrice Member Posts: 117
    #16
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    YES

    Hi Jamie

    Our insurance would not pay either. The rep from the drug company called and I told them what I could pay and still got the run around. I called them everyday. Our treatment center just gave us the bottles as we needed them. I think we went through 4. It does really make a difference. Keep pushing them. And maybe your center has some extras they can give you.

    Good luck and hang in there. There is a light at the end of this .

    Sue & Jeff

  • DaveRJ
    DaveRJ Member Posts: 9
    #17
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    j4mie said:

    I'll definitely look into it...

    Sounds worth looking into!! Thank you for the info. Would it be overload to use this with the Mugard??? 

    I would not say overload, but

    I would not say overload, but one clearly works better than the other so use all the Mugard you have until you get the Healios.  Good luck!!!

  • donfoo
    donfoo Member Posts: 1,771 Member
    #18
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    likely reason

    Here is some very interesting news. Just this June MuGard sold its marketing rights to another small pharma company. It would not surprise me the recent discontinuing of heavy discounting is related to this new company.

    http://www.amagpharma.com/products/MuGardRelease.pdf

     

    Here is a link to information that may help get the drug covered and paid for by insurance. Look for the form links Good luck.

    http://www.amagpharma.com/products/mugard.html

  • j4mie
    j4mie Member Posts: 218
    #19
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    donfoo said:

    likely reason

    Here is some very interesting news. Just this June MuGard sold its marketing rights to another small pharma company. It would not surprise me the recent discontinuing of heavy discounting is related to this new company.

    http://www.amagpharma.com/products/MuGardRelease.pdf

     

    Here is a link to information that may help get the drug covered and paid for by insurance. Look for the form links Good luck.

    http://www.amagpharma.com/products/mugard.html

    Hmmm...

    Yes, very interesting for sure! I only had time to skim through the article, but it looks like they paid a pretty hefty price for the rights to Mugard! Thank you for the info, at least now I can understand why they weren't very forthcoming in giving us a financial break as they seem to have done for many others. Timing is everything I guess Tongue Out

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