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Rx confusion

ausrebel53's picture
ausrebel53
Posts: 74
Joined: Dec 2012

Hello again kind friends, I am checking to see if anyone has had similar problems with their prescriptions. I have been prescribed MS coton for pain, this is slow release and the dose prescribed is 60 mg per 12 hrs. which I have been taking. I tried to refill the script the first time but the chemist said the insurance wouldn't  pay for another day, so I waited and filled it then. Yesterday I tried again to fill the next script but was told this time I had to pay $110(approx) as insurance wouldn't pay for another 2 days. I presume I would be reimbursed after insurance paid....the chemist wasn't clear. This seemed a little odd as I haven't had to do this with any other meds. Any comments please? 

Billie67's picture
Billie67
Posts: 834
Joined: Jul 2012

With the meds you mentioned but I do know that some narcotics or opiates are regulated by insurance companies to keep us from from having too many a once. That's not to say you couldn't pay out of your pocket. I know my pharmacist gave me a couple of pills in advance of my ins co's waiting period. Then my hubby went a couple days later and was able to fill the RX.
That could be what's happening in your case.
Good luck'
Billie

Billie67's picture
Billie67
Posts: 834
Joined: Jul 2012

With the meds you mentioned but I do know that some narcotics or opiates are regulated by insurance companies to keep us from from having too many a once. That's not to say you couldn't pay out of your pocket. I know my pharmacist gave me a couple of pills in advance of my ins co's waiting period. Then my hubby went a couple days later and was able to fill the RX.
That could be what's happening in your case.
Good luck'
Billie

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

Drug plans look at your doctor's directions on how to take them.  I take hydrocodone every day.  One time my med onc wrote the directions wrong as far as how many to take and when.  When I went to fill it, my drug plan would only pay for x amount of pills.  They said if I took it how the doctor prescribed it that time, I wouldn't need as many as the prescription called for.  I contacted my doc and asked him to write another script with the directions like he had been doing.  The drug plan had no problem with paying for the whole prescription that way.

Laralyn's picture
Laralyn
Posts: 436
Joined: Apr 2012

I think it happened when I got a 30-day prescription and filled it that day, then tried to get a refill a couple days before I ran out. The insurance wouldn't pay for the next 30 days' worth until a certain period of time before the next period began. The pharmacist said they could sell me 1-2 days' worth out of pocket, then I could come back for the rest when insurance would cover it. Maybe that would work for you?

NJShore's picture
NJShore
Posts: 411
Joined: Nov 2012

We had quite a few insurance woes.. For the exact same issue. make sure you tell you doctor that you have an insurance company  that works like this, and ask them  to make sure each prescription will last for the time that the doctor expects you'll be taking it. I wish I had known early, I would have told the doctor to give me the anticipated scripts for nausea, etc in advance and the when the doctor changed meds in the middle, the insurance company would have covered more, because there would have been more time in between. It got to the point where I paid for $1000 worth a nausea meds, because they said we already treated that symptom with other meds. I'll gladly fight them over it, what they do is wrong.

You might consider calling your prescription company and advising them of your condition. I am not sure if it helped our situation, but boy did I feel better after!

ausrebel53's picture
ausrebel53
Posts: 74
Joined: Dec 2012

Yes NJ, I marvel how insurance companies think they know what meds we should have and what treatments we should have. They aren't even going by the doctors script because the pills run out when doc sais so but somehow there are always a couple days not accounted for according to insurance.

longtermsurvivor's picture
longtermsurvivor
Posts: 1768
Joined: Mar 2010

MS coton is fairly expensive, about $4 per tab.  So if you are being charged something like $110 dollars, that is about 25 of them, or half the cost of a thirty day prescription.  DOesn't make sense, but that would be between you and your insurance company, not the pharmacy and the insurance company.  YOu need to call your representative and sort it out.  Morphine ER is a lot cheaper, btw.  If this cant be resolved suggest this as an alternative to your provider.

 

Pat

ausrebel53's picture
ausrebel53
Posts: 74
Joined: Dec 2012

I thank you all for your input. I wish I could talk otherwise I would be embarrassing the insurance company as I am taking the pills in accordance with the script. What you all say makes sense, I just wanted to make sure the chemist wasn't messing me around, he is a little wierd at times and not just with this script. I will get my daughter to call ahead and ask "is the prescription ready to pick up?", he would say "yes" and when I get there he would say "it hasn't been called through yet". Done that a few times.

Michael

donfoo's picture
donfoo
Posts: 1165
Joined: Dec 2012

Hi Michael,

In the past, I have issues with medication coverage and for me what worked was working closely with my doctor to use generics rather than patent only meds. Now I was lucky as there were options so that saved a bunch. The other tactic was "fiddling" with the dosage and quantities. My recollection was I had no restrictions on let's say 30 x 40mg but they did with 60x20. So my doctor just scripted 30 x40 and I split pills. I was lucky to find workarounds. good luck don

 

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