Venlafaxine Xr Coverage Changes

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Jenny R Says:


I was just informed by my pharmacy today today that my insurance will no longer allowe me to take Venlafaxine XR 150mg twice a day. They are only allowing it once a day. I have been taking this dosage since 1996. I called my psych and she said that my insurance company would not approve a prescription approval to keep me at my original dosage. She said the FDA made this happen and that is why my insurance company (Illinicare/Medicaide) is not covering it. She said that all insurance companies are doing this. I don't know what to do. I went on the internet to find out any info for this change in coverage and found nothing. I was given no explanation by the pharmacist, my psych or insurance company. Does anyone know what is going on here?



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Verwon Says:

Hello, Jenny! How are you? I am sorry about the problem you're having.

Most insurance companies will only cover the FDA maximum recommended daily dose. However, if your doctor approves and it isn't a controlled substance, most pharmacies will let you pay for the remainder. The maximum dose of this medication is considered to be 225mgs once daily. Thus, your doctor may be able to prescribe that amount to be taken once daily and your insurance should cover it, but it will still be a dosage cut.

I recently had to deal with something similar with a medication I take for perimenopause symptoms, my doctor has prescribed it in separate doses, so I can take more on the days I need to, but I don't have to take that much, if I don't and our insurance will only cover 2 doses a day, so I have to pay for the other 30 capsules. Fortunately, it is an inexpensive medication. So, I know that may not be a viable option for everyone. It also doesn't help with controlled substances.

Another idea would be to replace the dose you're losing with a different medication. That might be something you can ask your doctor about.

Does anyone else have any ideas that may help?

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Diane Says:
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I have been on the Venlafaxine ER version for several years. Now my new insurance only covers the XR version. Are they the same?

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