Why Is Motegrity So Expensive and Not Covered by Insurance?

Motegrity is a prescription drug used to treat chronic constipation. It is not covered by most insurance plans, which can make it difficult for people to afford. There are a number of reasons why Motegrity is not covered by insurance.

High Cost of Motegrity

Motegrity is a very expensive drug. The average wholesale price for a 30-day supply of Motegrity is over $1,000. This is a significant financial burden for many people, especially those who do not have insurance.

Lack of Generic Competition

Motegrity is a relatively new drug, and there are no generic versions available. This means that there is no competition to drive down the price of the drug.

Insurance Companies’ Coverage Policies

Insurance companies typically do not cover drugs that are considered to be experimental or investigational. Motegrity is still considered to be a relatively new drug, and some insurance companies may not cover it for this reason.

High Rate of Side Effects

Motegrity can cause a number of side effects, including nausea, vomiting, diarrhea, and abdominal pain. These side effects can be severe enough to make it difficult for people to take the drug. Insurance companies may be reluctant to cover a drug that has a high rate of side effects.

Limited Evidence of Effectiveness

There is some evidence that Motegrity can be effective in treating chronic constipation. However, the evidence is not as strong as it is for other drugs that are used to treat the same condition. Insurance companies may be reluctant to cover a drug that has limited evidence of effectiveness.

In Summary

There are a number of reasons why Motegrity is not covered by insurance. The high cost of the drug, the lack of generic competition, the insurance companies’ coverage policies, the high rate of side effects, and the limited evidence of effectiveness all contribute to the fact that Motegrity is not covered by most insurance plans.

Why is Motegrity not Covered by Insurance?

Motegrity is a prescription medication used to treat adults with chronic idiopathic constipation (CIC). It is a selective serotonin receptor agonist (SSRA), which works by increasing the activity of serotonin in the gastrointestinal tract. This helps to improve bowel movements and relieve symptoms of constipation.

Insurance Coverage for Motegrity

Insurance coverage for Motegrity varies depending on the insurance plan and policy. Some insurance plans may cover the cost of Motegrity, while others may not.

Factors that Affect Insurance Coverage

There are a number of factors that can affect insurance coverage for Motegrity, including:

1. The type of insurance plan: Some insurance plans are more likely to cover the cost of prescription drugs than others. For example, employer-sponsored health insurance plans are more likely to cover prescription drugs than Medicare or Medicaid plans.
2. The policyholder’s deductible and copay: The deductible is the amount of money that the policyholder must pay out-of-pocket before the insurance plan begins to cover the cost of prescription drugs. The copay is the amount of money that the policyholder must pay for each prescription drug.
3. The drug’s formulary status: The formulary is a list of prescription drugs that are covered by the insurance plan. If Motegrity is not on the formulary, the insurance plan may not cover the cost of the drug.

Alternatives to Motegrity

There are a number of alternative treatments for CIC that may be covered by insurance. These include:

1. Lifestyle changes: Lifestyle changes, such as eating a healthy diet, getting regular exercise, and drinking plenty of fluids, can help to improve bowel movements and relieve symptoms of constipation.
2. Over-the-counter laxatives: Over-the-counter laxatives, such as stool softeners and stimulant laxatives, can help to relieve constipation.
3. Prescription medications: Other prescription medications, such as linaclotide and lubiprostone, may be used to treat CIC.

Cost of Motegrity

The cost of Motegrity varies depending on the dosage and the pharmacy. The average cost of a 30-day supply of Motegrity is about $350.

Financial Assistance Programs

There are a number of financial assistance programs available to help people afford the cost of Motegrity. These programs typically provide discounts on the cost of the drug or help people to pay for their copay.

Conclusion

Insurance coverage for Motegrity varies depending on the insurance plan and policy. There are a number of factors that can affect insurance coverage for Motegrity, including the type of insurance plan, the policyholder’s deductible and copay, and the drug’s formulary status. Alternatives to Motegrity include lifestyle changes, over-the-counter laxatives, and other prescription medications. The cost of Motegrity varies depending on the dosage and the pharmacy. Financial assistance programs are available to help people afford the cost of Motegrity.

FAQs

1. Why is Motegrity not covered by my insurance plan?

There are a number of factors that can affect insurance coverage for Motegrity, including the type of insurance plan, the policyholder’s deductible and copay, and the drug’s formulary status.

2. What alternatives to Motegrity are covered by insurance?

There are a number of alternative treatments for CIC that may be covered by insurance, including lifestyle changes, over-the-counter laxatives, and other prescription medications.

3. How much does Motegrity cost?

The cost of Motegrity varies depending on the dosage and the pharmacy. The average cost of a 30-day supply of Motegrity is about $350.

4. Are there financial assistance programs available to help me afford the cost of Motegrity?

Yes, there are a number of financial assistance programs available to help people afford the cost of Motegrity. These programs typically provide discounts on the cost of the drug or help people to pay for their copay.

5. What can I do if my insurance plan does not cover Motegrity?

If your insurance plan does not cover Motegrity, you can talk to your doctor about other treatment options or financial assistance programs that may be available.