Mary's Magic Mouthwash

Mgbfoster
Mgbfoster Member Posts: 18
in Head and Neck Cancer #1

My radiation doctor wrote a prescription for me for Mary's Magic Mouthwash. When I went to the pharmacy to pick it up, I was informed that it was not covered under my health insurance plan. I have Blue Cross Blue Shield health insurance. We have a great plan. Has anyone else ran into this problem? One would think that as much as this drug is used that it would be covered. I am fortunate to have the ability to pay for it out of pocket. I know there are people that can't.

Bob F.

Comments

  • RottiesMom
    RottiesMom Member Posts: 167
    edited October 2016 #2

    I had magic mouthwash too.  The reason it wasn't covered under my plan is it is a compounded prescription

    Joanne.

  • CivilMatt
    CivilMatt Member Posts: 4,722 Member
    #3
    MMW

    Same here Joanne, but I still went through 6 bottles.  Yum, yum, yum.

    Matt

  • georgiasurfer
    georgiasurfer Member Posts: 63 Member
    #4
    Call BCBS

    we had the same problem. Call Blue Cross Pharmacy number on back of card. You may also have to get the pharmacy to call them directl. Blue Cross WILL cover it but it has to be entered differently.  Good luck. Gotta have the magic mouthwash!!

  • swopoe
    swopoe Member Posts: 492
    #5
    We had a similar problem. We

    We had a similar problem. We don't have BCBS insurance, but when we went to CVS (our regular pharmacy) to fill the script, they said our insurance would not cover it and they would not make it for us anyway. So we went to Walgreens, and not only did they make it, but they gave us the first bottle for free! Our insurance covered the rest under our plan. So maybe just try a different pharmacy too.

  • Mgbfoster
    Mgbfoster Member Posts: 18
    edited October 2016 #6
    Update on Mary's Magic Mouthwash

    I contacted Blue Cross Blue Shield of Illinois. Here is their response "The mouthwash was not covered as it is not a covered prescription drug under your plan coverage. This item is not listed on the drug list and is considered as non-formulary. Therefore the cost of the mouthwash would be the wholesale cost." My pharmacy charges me the wholesale price.

  • RottiesMom
    RottiesMom Member Posts: 167
    #7
    CivilMatt said:

    MMW

    Same here Joanne, but I still went through 6 bottles.  Yum, yum, yum.

    Matt

    Me too!!

    I went through 6 bottles too...I have half of a 7th in my fridge!!

  • georgiasurfer
    georgiasurfer Member Posts: 63 Member
    edited October 2016 #8
    Mgbfoster said:

    Update on Mary's Magic Mouthwash

    I contacted Blue Cross Blue Shield of Illinois. Here is their response "The mouthwash was not covered as it is not a covered prescription drug under your plan coverage. This item is not listed on the drug list and is considered as non-formulary. Therefore the cost of the mouthwash would be the wholesale cost." My pharmacy charges me the wholesale price.

    Unbelievable

    I think I'd have to ask for a supervisor. We have BCBS of Georgia and were told that, as a cancer patient, if one ingredient was covered the entire mixture was covered.  The pharmacist just needed to enter it coded differently.  My husband could not have survived without it. Formulary or not they have to make some concession.  Our pharmacy CVS would have charged $65 if it wasn't covered. 

  • Hondo
    Hondo Member Posts: 6,636 Member
    #9
    Mary's Magic Mouthwash

     

    That is pretty much the reason why as I was told and I was paying right $100.00 bucks a bottle. But what could you do but to buy it

     

    Tim

     

  • MemphisTn
    MemphisTn Member Posts: 41
    edited October 2016 #10
    Cigna also

    Cigna would not cover the 'magic mouthwash' series at all. Was 33.00 from CVS where I live for the West Cancer Center version and 50.00 I think for my ENT's version at the same CVS. Ive learned that there is a very large gap in what w think health insurance is for and what health insurance will actually do.

  • robswife87
    robswife87 Member Posts: 209
    edited October 2016 #11
    Insurance did not cover

    for us either, but what the doctors and pharmacy were able to do was order each ingredient seperately. They were covered as seperates and they gave me the measurements of each to make it myself

  • slk2015
    slk2015 Member Posts: 54
    #12
    Insurance coverage

    You can never tell what will be covered.  I have/had (it kind of went away after my teeth were extracted) oral lichen planus.  My ENT prescribed an oral steroid.  When I filled it, I found it was not covered by insurance--because they did not cover medications that were used in my mouth.  My dental insurance did not cover it because it was not about my teeth.  I had never heard of that.  Fortunately, it's only about $50 to $75 a tube and lasts a long time.  Every insurance company I have had since told me the same thing. 

  • Jillyemble
    Jillyemble Member Posts: 1
    edited October 2016 #13
    I'm in the UK . My sister had throat cancer.

    Is Marys Zmagic Moughwash the registered ndme? My sister had throat cancer and s mouth full of ulcers. I'm wondering if it's available here? Thank you

  • CivilMatt
    CivilMatt Member Posts: 4,722 Member
    #14
    Jillyemble said:

    I'm in the UK . My sister had throat cancer.

    Is Marys Zmagic Moughwash the registered ndme? My sister had throat cancer and s mouth full of ulcers. I'm wondering if it's available here? Thank you

    welcome

    Jillyemble,

    Welcome to the H&N forum, I am sorry to hear about your sister.

    Mine was called Magic Mouth Wash, but I imagine it goes by a number of names.  If you suggest it to an informed doctor or nurse they should be able to help you out.

    Good luck,

    Matt

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