milk protein allergy-Neocate formula

DD has been diagnosed with a severe milk protein allergy. We have been through a regular formula, a soy formula, a hypoallergenic formula, and now my pedaitrician and the pediatric gastroenterologist have given us a prescription for a formula called Neocate. My insurance company will not pay for this b/c they say it is available over the counter, but the Dr and the pharmacy say it is only available by prescription.

Has anyone used this formula and had it covered by insurance? Do you know what to do to get it covered?

Re: milk protein allergy-Neocate formula

Ours is covered. You can't get it in stores, you can order it online without a prescription. It is very expensive.

My dr wrote a letter of medical necessity and my insurance (United Healthcare) sent my dr some form to fill out and it was covered.

I'll try to find the info for Apria, they seem to be able to help people like you. They got my mom's friend covered for Nutramagien with one phone call.

Re: milk protein allergy-Neocate formula

Ok, here's what Charly posted on a thread about Nutramigen

Re: milk protein allergy-Neocate formula

Yes, one of my boys is on Nutramigen and it is covered by insurance.
See if you can have your PED write a letter

Re: milk protein allergy-Neocate formula

I hope it works out for you. That is great information about the phone number.

My baby has a milk/soy protein allergy. I am so scared that something will happen to my milk supply before he grows out of this.

Re: milk protein allergy-Neocate formula

Thank you so much for the info!!

I am going to try that phone number tomorrow. It is so sad to see my little girl so obviously uncomfortable, and it gets me so angry tha the insurance companies are so difficult!!

Re: milk protein allergy-Neocate formula

i just sent you fm.

Re: milk protein allergy-Neocate formula

With a letter of medical necessity it is a NYS law they cover the formula if it's the only thing your child can have to thrive. The insurance company kept denying our request in the hope we would give up but we didn't and DH's human resources dept got involved and they reimbursed us for everything we laid out and then covered from then on. Don't back down. If you need any info feel free to FM me. I also have a few cans left over if you are interested. I would only want what I had to pay for them, which was a copay per can. I'm not sure what the amount is, I would have to work it out, it's definitely alot cheaper than normal. FM me if you are interested.

Re: milk protein allergy-Neocate formula

Just be aware that if your insurance is private, and you'll only know from calling and finding out, that law means nothing in NYS. My dd is on Neocate and it is not covered under our insurance for this reason. Keep fighting it. We fought it for months, but we were out of luck.