What is Xifaxan and What Is It Used For?
Xifaxan is a relatively new drug used for Adult IBS-D (Irritable Bowel Syndrome with Diarrhea). IBS is a relatively common gastrointestinal disorder that affects 7-21 percent of the general population. Abdominal pain and discomfort, bloating, and frequent changes in the stool, along with chronic diarrhea are the symptoms of IBS-D. While there is no known cause of IBS-D, there are certain factors that can contribute to IBS-D.
Some patients experience rapid contractions of the intestine that allows little time to absorb the liquids from digested foods. Some patients who have had a prior gut infection can develop IBS-D, which can last for weeks, months, or even years. For some people, allergies or sensitivities to certain foods could play a role, while others may be gluten or lactose intolerant, leading to IBS-D.
While researchers do not believe stress causes IBS-D, they do believe it can worsen the symptoms.
Although IBS-D is not considered life-threatening, it can significantly affect a person’s quality of life. Treatments like Xifaxan can significantly reduce the symptoms of IBS-D. Many adults have found that two weeks of Xifaxan treatment provides substantial relief and up to six months relief from abdominal pain and diarrhea. Xifaxan is the number 1 doctor-prescribed medication to treat IBS-D and is recommended by the American College of Gastroenterology.
Is Xifaxan Considered Medically Necessary?
For those suffering from IBS-D, Xifaxan would absolutely be considered medically necessary as one of the few drugs that can alleviate the symptoms. Those who suffer from severe IBS-D are unable to live a “normal” life. They could be unable to work, go to school, or have any sort of social life at all. Taking a vacation, sitting through a concert or play, or even going to the grocery store could be out of the question for those with severe IBS-D. Unfortunately, insurance companies may make you try many different (less expensive) alternatives before they will approve Xifaxan or could claim the drug was not medically necessary.
Does Insurance Cover Xifaxan?
The cost for Xifaxan is high—up to $1,800 per month for 30 tablets. Because of the cost, your insurer may refuse to cover Xifaxan. The drug could be on your insurer’s list of excluded drugs, or the insurer may make you try a variety of other drugs before they will approve Xifaxan. This can be disheartening and frustrating. Those who have suffered from IBS-D hardly need additional headaches in getting their insurers to approve a drug they really need. Should you find yourself in this position, attorney Scott Glovsky can help.
Why Would Your Xifaxan Claim Be Denied?
Claims can be denied for many different reasons. Some are as simple as missing or incorrect information on the claim, outdated insurance information, or a claim that was filed too late. These issues can be easily corrected, and the claim re-submitted. Xifaxan could be denied because there is an exclusion on your insurance plan, or because you have not undergone “step” therapy as the insurer requires. One patient was denied Xifaxan, even though his doctor felt the drug was medically necessary for his IBS-D symptoms. The patient had gone through step therapy, trying four other less expensive drugs, however, the insurer denied the claim, saying the patient had only failed two preferred formulary alternatives (dicyclomine and loperamide).
Insurers may do everything in their power to deny Xifaxan due to the cost. Many patients become discouraged and simply give up because they are tired of fighting their insurance company—and don’t really think they can win. When you are feeling exhausted and overwhelmed, it’s not time to give up—it’s time to call attorney Scott Glovsky and get the help you need.
What Should You Do if Your Xifaxan Claim is Denied?
Any insurer could deny your claim for Xifaxan, including Anthem Blue Cross, Blue Shield, Health Net, Kaiser, UnitedHealthcare, Aetna, or others. A denial is never the end of the story, however. Your doctor can re-submit your claim along with a letter explaining why the drug is necessary for your IBS-D. If this does not prompt the insurance company to change its mind about the drug, you can file an internal appeal.
If the internal appeal is unsuccessful, you can file an external appeal where a third party will make the determination—not the insurance company. Having a trusted advisor is an invaluable resource during this process. The Law Office of Scott Glovsky has helped many people just like you who are facing an insurance denial for a necessary drug or treatment.
When Your Insurance Company Won’t Approve Xifaxan, Attorney Scott Glovsky Can Help
If your insurance company won’t approve Xifaxan, you may be facing an uphill battle to get approval for the drug. Xifaxan insurance denial may feel like the end of the world for you—after all, the drug allows many patients with IBS-D to live a normal life, something they may not have been able to do for a very long time. Attorney Scott Glovsky has experience working on the other side in large corporate law firms that defend big insurance companies in bad faith lawsuits.
Because of this, Scott has a unique understanding and perspective regarding how insurance companies think and operate. Scott and his legal team are well-respected and well-known for fighting aggressively for their clients. At the Law Offices of Scott Glovsky, client care is always exemplary. We take few cases, so each case has a tremendous amount of time, care, and hard work that goes into it. Contact the Law Offices of Scott Glovsky today for the assistance you need to force your insurer to reverse a denial for Xifaxan.
