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Medicare Or Medicaid For Accutane?

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(@paperbag)

Posted : 11/15/2013 2:39 pm

I was wondering if anyone here has had Medicare or Medicaid pay for their accutane?

I live in the USA.

Isotretinoin (10mg,20mg,40mg) and Claravis(30mg) are listed in my Medicare 2014 Formulary List of Covered Drugs. I have Medicare Part D (prescription drug insurance), and my insurance company is Blue Cross MedicareRx.

I also have Medicaid.

I just went to CVS, and they said there is no Isotretinoin, because there is no generic. CVS said that they do sell Claravis, but when the pharmacist ran it through her computer, she said Medicare was rejecting it. The pharmacist said that their computer system does not say why Medicare rejects medications. Medicaid also rejected the Claravis.

Any advice?

I was on Claravis for 8 months from July 2012-March 2013. I paid completely out of pocket, $700 a month. My acne is returning, and I was so hoping that Medicare or Medicaid would cover Accutane again if I needed it. I really can't go back to paying $700/month again.

If Medicare or Medicaid doesn't cover it, I'm going to have to delve into the murky waters of online accutane prescriptions.

Thank you so much for any advice or help.

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MemberMember
38
(@brandolynn)

Posted : 11/15/2013 2:58 pm

Some insurances do refuse to cover it. It's frustrating I know. They don't deem it to be medically necessary. I once had an insurance company stop paying for it about mid-way through my 5 month course! I couldn't believe it. Had to pay the remainder out of pocket (which I didn't have at the time so it went on a credit card). sad.png

I would not resort to buying it online though unless you have a valid prescription and find a reputable online pharmacy. Bootleg Accutane is just too risky. You honestly have no idea if what you are getting is real or not.

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31
(@like-moonlight)

Posted : 11/15/2013 11:55 pm

You may need a prior auth. I would recommend calling your insurance company and seeing what's up. It is hit or miss if insurance companies cover it. If it helps I took accutane while being on Medicare as well. My insurance covered it with out any issues.

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