Dificid Prior-authorization / constipation after D.

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brandine
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Dificid Prior-authorization / constipation after D.

Postby brandine » Tue Jul 23, 2019 9:20 am

Hello,

Background: I am a 44 year old female who contracted C.diff in May after a burst appendix in April and subsequent antibiotics (levofloxacin and metronidazole).

Eight weeks after completing a 10 day treatment of Vanco., I had been feeling pretty good until this last week when I had 2 days in a row of persistent D. I'm consulting with dr. and infectious disease specialist to see if it's nec. to treat after a positive test, since my symptoms have subsided. (I don't want to over-treat)
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Question: How did those of you who treated with Dificid obtain prior-authorization from dr.--I mean, how was the case made that you needed the Dificid, as my dr. seems to think it will be difficult to do so (should I need it for relapse). My insurance does cover it.

Also: have any of you, in your recovery, gone from days of D./M. to a couple of days of C.? I seem to be on the opposite side of the spectrum as I was a few days ago, and I don't know how to interpret this as I move forward to make decisions about when/if to treat. It's so hard to know what's normal during recovery.

Thank-you so much for your support and for all of your answers to my first post in the general discussion forum. I look forward to helping others in the future, as I gain more experience/knowledge with this disease.

Brandy

beth22
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Re: Dificid Prior-authorization / constipation after D.

Postby beth22 » Wed Jul 24, 2019 1:19 am

I did not need pre-authorization from my insurance for Dificid. If they cover it, I would call your insurance company and ask what is needed. Maybe you just need a prescription and nothing else.

CindyP
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Re: Dificid Prior-authorization / constipation after D.

Postby CindyP » Thu Jul 25, 2019 4:01 pm

I recently relapsed 10 days after a 14 day vancomycin treatment. My GI prescribed Dificid - they called it in to a specialty pharmacy in another city, and it had to be overnighted to me.

The pharmacist used a manufacturer's coupon and got it down to $50. Apparently you can do that up to 4 times, from the dificid website. I think the coupon only works if you have regular medical insurance (which seems really backwards).

And, yes - after 5 days of treatment with Dificid, I'm now constipated. I had IBS-C before, though, so this is nothing new.

Bobbie
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Re: Dificid Prior-authorization / constipation after D.

Postby Bobbie » Fri Jul 26, 2019 12:33 pm

CindyP,

Another welcome to the site. Do read the first forum.

Thank u for the info on Dificid. It has helped many on this site and is the first Med. Developed specifically for c diff.

Check with your doc about battling constipation - drinking lots of water, stool softeners such as Colace, etc. - you don't want to tip the scales to the other end.

Hope this works for you. Many good wishes. Keep posting.

CindyP
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Re: Dificid Prior-authorization / constipation after D.

Postby CindyP » Fri Jul 26, 2019 3:01 pm

Thank you, Bobbie.

I checked with my GI and she suggests 4 oz of warm prune juice in the morning. Works really well, and is actually a tasty drink when it's warm.

brandine
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Re: Dificid Prior-authorization / constipation after D.

Postby brandine » Fri Jul 26, 2019 10:53 pm

Thank-you, Cindy and Beth.

The Infectious Disease doctor that I met with this Thursday called my health insurance for prior authorization and was able to get it for Dificid. But we're postponing treatment, since my fear of a recurrence seems unfounded for now. I thought I was having a first recurrence last weekend, but after 30 hours the D. and yello M. stopped, and now I've had 6 fairly normal days since then. ID doctor said, "don't treat" if symptoms have stopped. I appreciated this approach, since my primary doctor wanted to treat, and I feared over-treatment.

Since no one carries dificid in my area, and it would have to be overnighted, the ID doctor assured me that vanco could be used for a couple of days before the dificid was available, which gave me peace of mind.

But for now, no treatment unless symptoms persist. And he said to wait for 48+ hours if D. returns (as long as I'm overall stable otherwise and staying hydrated) to see if symptoms subside on their own--because he sees c.diff as being over-treated, and he has seen patients' symptoms resolve on their own, as mine did last weekend.

I learn something new every day about this c.dff disease!

beth22
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Re: Dificid Prior-authorization / constipation after D.

Postby beth22 » Sat Jul 27, 2019 2:03 am

Your doctor told you basically the same thing as my doctors told me when I was at that point. I got myself into a real mess by overtreating in the beginning and I won't make that mistake again. The problem is that many doctors don't know enough about c difficile and just go by the book, but even guidelines say to treat on symptoms and not just test results. Did you ask him what kind of test you had?

Ril
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Re: Dificid Prior-authorization / constipation after D.

Postby Ril » Sat Jul 27, 2019 8:35 am

Brandy, thankfully you have a smart dr. No symptoms no treatment! Hopefully it will stay that way.
Good luck.

brandine
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Re: Dificid Prior-authorization / constipation after D.

Postby brandine » Sat Jul 27, 2019 10:41 am

Thank-you, Beth and Rita.

Beth, I forgot to ask exactly what test I was given, but it sounds like it was just the PCR. If I have to test again down the line, I will definitely ask a lot more questions about the test. I'm guessing that I should be asking if there's both a PCR and EIA? My ID doctor said that because he mostly looks at symptoms, a positive test result is helpful but not the reason to treat.

roy
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Re: Dificid Prior-authorization / constipation after D.

Postby roy » Sat Jul 27, 2019 11:12 am

Brandy
You seem to understand c.diff better than most!
One thing to consider though is that the reason Dificid is superior is that it kills less gut flora than vanco.
If you use it as a stop gap untill dificid is delivered it will negate the dificids advantage and target the 20% of your gut flora species that Dificid does not kill.
Flagyl, broad spectrum kills everything.
Vanco, narrow spectrum, kills mostly gram positive bacteria and that's around 20% of your gut flora.
Dificid, specific killer to c.diff. (possibly a few others)
If you do need treating but symptoms are not life threatening it might be better to wait for Dificid. (if your Dr agrees).

brandine
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Joined: Fri Jun 21, 2019 11:59 am

Re: Dificid Prior-authorization / constipation after D.

Postby brandine » Sat Jul 27, 2019 12:45 pm

I'm so glad you brought this up, Roy. Excellent. I will definitely heed this advice and follow up with the ID doctor. Thank-you!


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