Paying for Allergy Medications

Expert Pediatrics Q&A

Q. My 25 month old toddler has allergies and was recently prescribed Zyrtec syrup. The samples the doctor gave us worked great, but our insurance doesn't cover this medication or any other prescription antihistamines and the prescription is going to cost us $60 a month. What else can we do, as we can't afford to pay full price for the Zyrtec and OTC Claritin didn't work? Max, Dallas, Texas

A. Unfortunately, since Claritin became over-the-counter, many insurance companies stopped paying for prescription antihistamines, including Zyrtec, Allegra, and Clarinex. Since these are no longer 'preferred' medications, even if you have a prescription plan with your insurance, you often have to pay full price or the highest co-pay on your plan for these allergy medicines.

Allergy Triggers

One way around this is to make sure your child really needs allergy medications. Although it can be difficult if your child has multiple allergies or if she is allergic to things outside, like trees and pollen, avoidance of triggers often works. These triggers can include things in the house, such as dust mites, pet dander, and mold, or pollens and other things outside.

If you don't know what triggers your child's allergies, an allergy test might be a good way to help you find out.

Preferred Allergy Medications

Although most antihistamines are no longer covered by many insurance companies, other allergy medications are, including Singulair and steroid nose sprays, such as Flonase, Nasonex, and Rhinocort Aqua. Since both Singulair and Nasonex are approved for use in 2 year olds, they might be good choices if they are on your insurance plan.

Medication Precertification

Even if a medication is not on your preferred drug list, your Pediatrician can sometimes get it approved by filling out a precertification form. In the case of allergy medications, you usually have to show that OTC allergy medications and other preferred medications haven't worked and that this other medications is a medical necessity. In this case, since the Zyrtec worked, you might try to get it precertified so that your child can continue taking it.

Patient Assistance Programs

If you still can't afford your child's medications, you might contact the manufacturer to see if you qualify for their patient assistance program. Many drug companies, including Pfizer, which makes Zyrtec, has these types of patient assistance programs.