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I can't figure this one out

Preacher49
Posts: 3
Joined: Jan 2017

My doctor prescribes for me to take 4 weeks of Cipro because I had a high PSA at 5.1 and then come  back for a recheck. I take 2 weeks and had to go back to pharmacy today to get the remaining 2 weeks of pills because for some reason they could only give me half at a time; should have been a red flag, and they said; Insurance won't pay for them till the 27th. I question them and they said according to insurance you only need to take 2 weeks worth. My recheck on PSA is the 24th but I can't get rest of medicine  till 27th. What a screwed up system we have! Nevertheless, doctor going to go ahead and recheck PSA 2 weeks early. Very confused!!

Swingshiftworker
Posts: 1013
Joined: Mar 2010

I've run across this "problem" as well.

The doctor may prescribe a certain medication for you but the insurance carrier can arbitarily determine how many pills you are "entitled" to get under their coverage for a certain time period in order to be entitled to for payment under your policy.

On the other hand, if you want to pay for the drug out of pocket w/o coverage, then you should be able to buy them w/the doctor's prescription regardless.  Only problem is that you will have to pay full price for them; no deductible applicable.   The price difference may or may not be significant. 

For example, in the case of ED drugs, which are not eligible for medical coverage discounts under my policy anyway, it wouldn't matter at all becaause I'd have to pay full price regardless. 

Ran into this problem recently when my doc prescribed some 20mg cialis to use in conjuction w/my daily dose of 5mg.  He placed an order for 90 pills of the 20mg cialis which was rejected by PrimeMail (the mailorder supplier for Blue Shield) because they normally only "allow" the purchase of 8-10 pills at a time.

Didn't want to pay full retail for the medication anyway.  So, I asked the doc to just send me the prescription which I emailed a copy of to a discount pharmacy online (US office w/manufacturing facilities in India) that they accepted and filled w/o problem.

 

Old Salt
Posts: 720
Joined: Aug 2014

The pharmacy should have helped you to straighten out the problem. On the other hand, cipro is inexpensive and I would have paid for it out of my pocket and not have the aggrevation of dealing with the, at times, idiotic (US)  insurance system.

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