Family and Caregiver Schizophrenia Discussion Forum

Getting insurance to pay for monthly injection

Hi all. My son received an Invega Sustena shot in the hospital last month. He was due for another two days ago, but I ended up taking him to the psychiatrist before that because I felt he was “slipping”. She used a sample injection that she had in office, so he isn’t due for another for another 3 weeks or so. He just received a notice from his insurance (which is paid for through Medicaid) that he did not qualify for payment for the shot, which runs about $2000. The reason stated was “You have not been shown to be unable to take oral solid alternatives”. I very much want him to stay on the shot. It is so much easier to get him to do one thing once a month, then one thing everyday. He has already stopped taking one of his oral meds that were prescribed on his discharge. Has anyone here ever had to battle with insurance to get them to pay for the injection? Do I need to lean on the prescribing doctor to do something?

Our insurance doesn’t cover my son’s injection either (not sure why because it does cover the pills). Luckily, he is on the haloperidol deconate injection which is older and less expensive. I was paying $68 a month when he was on the 100mg shot but they recently raised his dosage to 125mg so I’m now paying $113. Still not cheap but much more affordable than the atypical meds.

Go for pherfenazine depo. Cheap efficiency. It doesn’t cause sexual side effects and doesn’t cause much weight gain. I know it is used in the states but I don’t know if the long acting form is approved in the states. The Catie trial show it worked just as well as the newer ones

Thank you @Cat_Nip and @Sonofsz. Since we just got him on the Invega (first time he’s been on an anti psychotic for more then a few days after ten years of suffering), I would really like to continue with it for at least a while so we have a good idea of the effects. I contacted his prescriber and she is putting together an appeal to the insurance company. I am hopeful there is a good chance they will change their decision as he has a history of not taking meds once he is discharged from the hospital. He’s due for his third injection in 19 days. We’ll see.