Why is Neudexta not covered?

Does anyone have any idea why Neudexta is not covered in their Hospice? This is certainly a med that can provide comfort for pseudobulbar affect dysregulation especially in advanced dementia, stroke,etc..

My best guess is because it's not on any hospice's formulary. This is VERY expensive medication and it's really not a cost effective medication when other medications may provide a similar enough outcome. Remember, hospice isn't about making some better - just more comfortable, and that result can likely be provided a whole lot cheaper.

yep, it's not covered by most hospices because it's ridiculously expensive. I had one patient who we just did dextromthorphan 10mg/5ml (give 20mg/10ml) with the quinidine 10mg/1ml liquid (give 10mg/1ml) once daily for the first week and then twice daily ongoing - WAAAAAAY cheaper than the neudexta and it's the identical meds/dosing.

We have covered it but rarely.

As others already pointed out - it is very expensive. A hospice is paid a "flat rate" per day, which has to cover everything from nursing care to equipment and medications, the other team members and so on and forth.

"The cost for Nuedexta oral capsule (20 mg-10 mg) is around $797 for a supply of 60 capsules, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans."

Obviously it is possible to split the medication and to give the two substances separately, which is much cheaper.

Where do you get oral quinidine? Or are you using injectable?