# Prescription Not Covered by Insurance



## debodun (Dec 4, 2015)

My doctor gave me a new prescription, but when I went to fill it, the pharmacist said my insurance didn't cover it and it would be over $200. There is no generic equivalent available. I tired to contact the doctor's office, but as luck would have it, they leave early on Friday. Now I'll have to wait until Monday to try to reach the doctor and I have to start taking it very soon. Any advice?


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## applecruncher (Dec 4, 2015)

Sometimes the pharmacy will give you a few days supply either free or for a small amount of money.  Other than that nothing you can do except wait until Monday. Also sometimes the doctor will give patients samples from pharmaceutical rep to help them out.


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## Pappy (Dec 4, 2015)

I agree with applecruncher. When my first trip to get my Xarelto pills, the tab was $900. These are suspose to help the heart attack, not give me one. Anyway, the pharmacy was kind enough to give me a 30 day supply instead of 90 days. Since then, my insurance has helped pay some of the cost.


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## applecruncher (Dec 4, 2015)

Wow, Pappy, I had no idea Xarelto was so expensive.


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## jujube (Dec 4, 2015)

You can always file an appeal to your insurance company for an "override" on the medication.  It doesn't happen overnight though, unfortunately.  Your doctor will have to be very convincing in his explanations about why he wants you to take Xarelto and not another medication that is covered by insurance.  

When a new medicine comes out and is heavily advertised, everyone wants THAT one but the new ones are seldom covered at first by insurance.


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## Pappy (Dec 4, 2015)

applecruncher said:


> Wow, Pappy, I had no idea Xarelto was so expensive.



Yes, it is. $10 a lousy pill. Thank God I have insurance but the trouble is, it puts me in the donut so fast that I have to pay 40% after a few months.


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## Butterfly (Dec 4, 2015)

Debudon, what was the med, if you don't mind sharing?

Most insurances, even medicare supplements and advantage plans, have formularies and will not cover anything not in the formulary (that's why people shop around for a part D plan that will cover the medications they are on), OR, they can require you to have tried other similar medications and have "failed" (they didn't work for you) before they will cover certain ones.  

In my case, I was prescribed Xarelto right before hip surgery and for 30 days thereafter.  My coverage wouldn't cover hardly any of the cost at first, but then my doc  explained to the plan that there was a medical reason for the Xarelto over the cheaper coumadin right after surgery, so the plan did cover it for that specific period of time, but no more -- i.e., not for long-term use, but for me that was dandy because I didn't need an anti-coagulant for long term use.  I still had a fairly high co-pay for it, though, because it was not on the plan's "preferred" list. 

It's a maze.


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## hollydolly (Dec 4, 2015)

American medical costs sound like a nightmare...and extremely confusing. 

Now this may be a tall order, but can anyone explain Obama care for me, and for  those of us who don't know the workings? Yes I could google it, but I'd rather hear the the reality of it, rather than the theory.


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## Pappy (Dec 4, 2015)

Holly, it is a freaking nightmare. I have a very good friend who had to declare bankruptcy to to terrible medical charges.


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## debodun (Dec 5, 2015)

Butterfly said:


> Debudon, what was the med, if you don't mind sharing?



Misoprostol


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## oldman (Dec 5, 2015)

I just checked http://www.goodrx.com/misoprostol and they have a coupon that will allow you to buy it for as low as $33.23. Could this be right?


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## debodun (Dec 5, 2015)

oldman said:


> I just checked http://www.goodrx.com/misoprostol and they have a coupon that will allow you to buy it for as low as $33.23. Could this be right?



The doctor gave me a coupon, but the pharmacy wouldn't honor it. They said the only so many coupons could be redeemed, and that particular medicine had already exceeded the redemption number.

Makes me wonder why some doctors insist on patients getting brand name drugs instead of generic? Are they getting "incentives" from drug companies?


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## jujube (Dec 6, 2015)

debodun said:


> The doctor gave me a coupon, but the pharmacy wouldn't honor it. They said the only so many coupons could be redeemed, and that particular medicine had already exceeded the redemption number.
> 
> Makes me wonder why some doctors insist on patients getting brand name drugs instead of generic? *Are they getting "incentives" from drug companies*?



Oh, you betcha!  Not as bad as it used to be, but it still happens.


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## Butterfly (Dec 7, 2015)

jujube said:


> Oh, you betcha!  Not as bad as it used to be, but it still happens.



AND, a lot of doctors have no idea of what is on your insurance plan's formulary, or what a drug actually costs you.   My doc always prescribes the generic alternative, if one exists -- there often is no generic alternative if the original med is still under patent.  Perhaps your doc can prescribe an alternate medication.


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## oldman (Dec 7, 2015)

I was always told that doctors want some patients to receive brand name because of its purity. I am pretty sure that doctors who take kickbacks from pharmaceutical companies must now disclose this information, however, many doctors are disingenuous when doing so by falsely reporting the reason why they receive the kickback.


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## fureverywhere (Dec 7, 2015)

I am American and I don't understand Obamacare. But trying to get medications can make you feel worse than your condition. Especially with Medicaid, my son got a simple prescription for an acne medication...benzoyl peroxide, not terribly expensive and not a controlled substance. The doctor had prescribed the gel instead of the liquid. I had to call doctor and pharmacy back and forth for two weeks to get it switched to the liquid that would be covered.

My heart goes out to people who have for fight for important meds. Sometimes the drug companies have assistance for low income patients, it's worth finding out.


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## Don M. (Dec 7, 2015)

Pappy said:


> I agree with applecruncher. When my first trip to get my Xarelto pills, the tab was $900. These are suspose to help the heart attack, not give me one. Anyway, the pharmacy was kind enough to give me a 30 day supply instead of 90 days. Since then, my insurance has helped pay some of the cost.



I've noticed some TV commercials about Xarelto being among the drugs the lawyers are suing over...due to the side effects.  

http://www.drugwatch.com/xarelto/lawsuit/

These "blood thinners" can turn your internal organs to Mush.  My old Dad had a minor stroke a few years ago, and the doctors put him on Plavix.  About two years later, he woke up one morning in severe pain and was rushed to the hospital, where they found he had severe internal bleeding, and there was little they could do for him.  About two days later, he was gone.  Take these drugs with a Great Deal of Caution.


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## Lon (Dec 7, 2015)

Pappy said:


> I agree with applecruncher. When my first trip to get my Xarelto pills, the tab was $900. These are suspose to help the heart attack, not give me one. Anyway, the pharmacy was kind enough to give me a 30 day supply instead of 90 days. Since then, my insurance has helped pay some of the cost.



I just checked and I paid a $12.80 Co Pay last week for 90 supply of Xarelto


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## Pappy (Dec 7, 2015)

Geez, Lon. I like your insurance a hell of a lot better than mine.


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## jujube (Dec 7, 2015)

That's me this morning.  Doctor gave me a prescription and my Part D Rx drug plan won't pay for it.  $130 a month.  Not gonna happen.  Back to the drawing board.

Edited:  I THOUGHT it was $130....it ain't....it's $165.


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## Lon (Dec 7, 2015)

Pappy said:


> Geez, Lon. I like your insurance a hell of a lot better than mine.



I have to switch my Drug Plan for 2016 and it will be with Aetna for $24.80 a month premium. It will pay the same as my prior Drug Plan. I get all my meds from CVS pharmacies.


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## Ina (Dec 7, 2015)

I'm sort of stuck in the middle.  I've been on disabilty since I turned 61. Last year, when I turned 63, I recieved Medicare A and B. So I thought I could get the suppliment this open enrollment season. (It closed today) But they said I have to wait until my regular sign up time for SS, which is when I turn 66, in two years, although I do get a widow's pension from SS as well as my disabilty.  My monthly office visit is $180. and I then spend $350. on my monthly meds.  I'm scared to get a cold now days.


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## Butterfly (Dec 7, 2015)

Don M. said:


> I've noticed some TV commercials about Xarelto being among the drugs the lawyers are suing over...due to the side effects.
> 
> http://www.drugwatch.com/xarelto/lawsuit/
> 
> These "blood thinners" can turn your internal organs to Mush.  My old Dad had a minor stroke a few years ago, and the doctors put him on Plavix.  About two years later, he woke up one morning in severe pain and was rushed to the hospital, where they found he had severe internal bleeding, and there was little they could do for him.  About two days later, he was gone.  Take these drugs with a Great Deal of Caution.



I only took Xarelto for 30 days after hip surgery.  The doc explained that though blood thinners are not without risk, the risk of throwing a clot after hip replacement is great during the first few weeks.


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## Butterfly (Dec 18, 2015)

Debudon, how did your prescription problem work out?


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## AZ Jim (Dec 18, 2015)

Medical Insurance in this country is a financial mountain.  Between the wife and I we pay $900 per month health insurance.  That covers our Medicare and our supplemental policies.  It really cuts into Social Security and small pension receipts.  On the other hand it has covered 100% except for prescriptions.   It is a ripoff but where would we be without it.


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## jujube (Dec 18, 2015)

I've started taking my formulary with me to all doctor's appointments.  When the doc says "I'd like to start you on _______", I whip out the formulary and look it up.   It seems to annoy the heck out of the doctors, but I don't give a........   When you get to the pharmacy and find out it's a $175 drug, then it's a hassle to have to call the doctor's office back and try to get him to prescribe something else.  I'd rather head it off at the pass.


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## debodun (Dec 19, 2015)

Butterfly said:


> Debudon, how did your prescription problem work out?



I got some free samples from the doctor's office, enough to see how it will work for me.

BTW - my moniker is debodun, not debudon.


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## Butterfly (Dec 19, 2015)

OOPS, sorry about the scrambling of the vowels!


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