Dificid & Kaiser Permanente HMO in CA

Treatments, possible treatments, unsubstantiated/unproven treatments. Consult your doctor first.
3charmer
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Joined: Mon Jul 25, 2022 8:30 pm

Dificid & Kaiser Permanente HMO in CA

Postby 3charmer » Wed Aug 03, 2022 12:10 am

Hello, I was wondering if anyone has been successful in getting prescribed dificid from Kaiser Permanente HMO? It's not on the formulary.
I am on Obamacare, so because this is a government insurance program, it looks like I wouldn't qualify for the dificid discount or assistance program which specifies it is for commercial plans only.

NanciT
Long Time Contributor
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Joined: Thu Sep 18, 2014 12:01 pm

Re: Dificid & Kaiser Permanente HMO in CA

Postby NanciT » Thu Aug 04, 2022 12:07 pm

I personally have found due to cost most insurances will battle giving Dificid and push Vanco. If you have any history of CDIFF like I do, it may be easier to get Dificid. I have Blue cross/Blue Shield and they limit the amount per year of Dificid. My last bout of CDIFF I had allergic reaction to Vanco so I hope in the future I won't have this problem

I have an Infectious disease specialist and in 2020 when I had it again, he was able to get me two rounds of DIficid. I needed 3 and ended up paying for it myself. The only thing that has worked for me is a Dificid taper. It is VERY expensive. Dificid has a site and you can apply for help there depending on income level. You might try and apply if your insurance will not cover it.

I called all over and found a CVS in Livermore( I am also in Northern CA) that had an amazing Pharmacist who checked every discount site and got the cost from $5000 down to $620. I paid for the 3rd round myself although some may not be able to do that.

There are new studies that prove Dificid is superior to Vanco for those who have had reoocurance. If you have had it before, that may be a good argument.
Kaiser is limited but if you have had issues in the past with Vanco or had to have a taper or several rounds, your GI should be able to get it for you.

Wishing you the best

NanciT

notheidi
Regular Contributor
Posts: 265
Joined: Sun May 17, 2015 11:24 am

Re: Dificid & Kaiser Permanente HMO in CA

Postby notheidi » Tue Aug 09, 2022 12:05 am

I wanted to update this. My doctor consulted Infectious Diseases and they did mention that if I have a recurrence I can be considered for dificid, monoclonal antibodies plus vanco, FMT, etc. I have the distinct sense that the route to these treatments at my HMO is through Infectious Diseases specialty. Which is fine! I just want to know that there *is* a way.
2010 mod/sev w/leukocytosis, cefdenir-sinus inf, metro rx'd wrong, resurged during tx. recovered w/dose change, lost 40 lbs. 2015 mod recur fr SNF, no abx, resolved w/vanco. 7/2022 mod recur, community acq, no abx, intermittent prodrome but didn't realize


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