Insurance and prescriptions

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uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 3/4/2009 9:55 AM (GMT -7)   
 
 
I have a question to ask...My insurance won't cover my methadone...this I already knew, but I have another script for Roxicet 15mg. for 120.  My insurance will only cover 80 of them?  That is such an odd number I was wondering if anybody might know the reason for that number?
 
Me. confused

 
We are all in the same boat...unfortunatley it seems like it's sinking...
 
Rhonda
Post Lamenectomy Syndrome
Hemi Lamenectomy
Spinal Fusion
 
120 mg. Methadone daily
60 mg. Oxycodone daily
Lyrica as needed 

 


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13473
   Posted 3/4/2009 10:48 AM (GMT -7)   
I would ask the pharmacy whats up with that..Susie


Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2283
   Posted 3/4/2009 12:52 PM (GMT -7)   
Who knows? Insurance companies are weird like that. Call your insurer & ask them why only 80 and whether they will cover more if it is determined to be medically necessary. Sometimes they will allow a higher amount if they just get a short letter from your PM stating what's wrong with you & why you need more meds than 80/month.

best wishes,
frances

uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 3/10/2009 7:20 AM (GMT -7)   
Yes, I think I will talk to my PM and see if they know why? Thanks

Me.
 
We are all in the same boat...unfortunatley it seems like it's sinking...
 
Rhonda
Post Lamenectomy Syndrome
Hemi Lamenectomy
Spinal Fusion
 
120 mg. Methadone daily
60 mg. Oxycodone daily
Lyrica as needed 

 


Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 3/10/2009 7:51 AM (GMT -7)   
I have Blue Cross<>Blue Sheild and usually get qty-120 x #15Oxies a month & 90 x #10 Methadones a month and they never said a word. Can you find Oxicodone #15 where you live? My Doc gave me Perc #10/325 again yesterday because they said no one had the Oxie's yet????
Good luck w/ your Insurance Co. I like the idea of a letter from Doc too!
Huggs,
Pete
56 years old, Surgury, Radical Prostatectomy 8/20/03, PSA 6.6, Gleason 3 + 3 = 6, Adenocarcinoma extent (moderate) Stage & Margin:T2NOMX, No Metastases, Organ Confined, bone scan: Neg. 3 1/2 years of depression after surgery prior to Hypogonadizm DX, Testosterone Theropy> new 2/6/09> 400mg injections every 2weeks . 56 and so glad to still be here to see my two sons grow up to be fine young men. They are both serving in the US Navy, one on the aircraft carrier USS John Stennis in port in Japan and the other on a Gator Freighter USS Bataan stationed in Norfolk, Va. I am one proud PaPa! 


shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 3/10/2009 10:18 AM (GMT -7)   
Cant answer for you but can tell u taht today i tried to fill my zolfran and i was told by my pharmicyst that BCBS will only cover 21 pills per month.....WHAT????
Jan. 2009, complete hysterectomy, diagnosed stage 4 endometriosis & adenomyosis (age 36)
2003, dx moderate UC
2000, dx selective IGA deficiency w/ anti IGA antibodies
2000, dx Antipholipid Antibody Syndrome
1999-2009, chronic hemmoragic ovarian cysts, w/ partial ovary removal
1977, complete reconstruction of foot after lawnmower accident (chronic pain)
 
Meds
6mp 75mg, prednisone 40mg (just starting meds again)
percocet 5mg 3x day
potassium 3x day
 


Pamela Neckpain
Veteran Member


Date Joined May 2008
Total Posts : 1821
   Posted 3/10/2009 11:47 AM (GMT -7)   
Your insurer won't cover Methadone!! They are making a big mistake there. Methadone
is one of the least expensive (and most effective and least harmful) of all the
Opiods. They are dum dums. tongue
Pamela
Good luck, Me

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 3/10/2009 11:57 AM (GMT -7)   
Shannon,
Sometimes the number of pills can be affected by the diagnosis that's given. I don't know that much about this medication, but I wonder if it's given for shorter term problems, and unless the doctor's office gives specific instructions you can only get it for a short period of time? I'd call your pharmacist and ask if they know anything - is the medicaiton prescribed for different things. And maybe your doctor's office needs to intervene.

Just a thought. Maybe someone else here knows more.

PaLady

uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 3/10/2009 2:29 PM (GMT -7)   
 
Hey Pete,
I had to get the Perc 10's last month due to the recall on oxycodone. This month I didn't have any problems getting the oxycodone 15mg.  But my insurance would only cover 80 of the 120.  And it won't pay for my methadone.  It used to a few years ago, but not any more....
 
Crazy, huh?
 
Me.

 
We are all in the same boat...unfortunatley it seems like it's sinking...
 
Rhonda
Post Lamenectomy Syndrome
Hemi Lamenectomy
Spinal Fusion
 
120 mg. Methadone daily
60 mg. Oxycodone daily
Lyrica as needed 

 


uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 3/10/2009 2:35 PM (GMT -7)   
 
 
Pamela,
Yes they are dum dums...Methadone at a clinic for maintainence treatment is very costly.  To go to a Methadone clinic it costs $360 each month to get up to 120 mg. each day.  It costs the same no matter what your dose is... Methadone from a Dr. and getting it at the pharmacy costs me $60 a month for 360 pills.  Talk about a giant rip off!!! nono
 
Those clinics are making a fortune off of people's misery.  And I don't understand why TennCare won't cover methadone but it will cover morphine, oxycontin, and many other more expensive narcotics...Go figure.
 
And...not all pharmacies even have methadone...Krogers won't carry it at all.  And some of the pharmacies run out so I have to go from pharmacy to pharmacy just to find it.
 
I'm going to talk to my doc about getting something stronger then the oxycodone 15mg. for BT pain.  They will only cover 80 of them so I might as well get something better anyway...
 
Me.

 
We are all in the same boat...unfortunatley it seems like it's sinking...
 
Rhonda
Post Lamenectomy Syndrome
Hemi Lamenectomy
Spinal Fusion
 
120 mg. Methadone daily
60 mg. Oxycodone daily
Lyrica as needed 

 

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