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Prescription Insurance question.

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kimberlyann

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Hi all, I was wondering if any of you have run into this. Upon release from the hospital last Thursday, I was given a prescription for Norco 10/325, #60, take 1-2 tabs every 4-6 hours as needed for pain.
I have taken 2 tabs every 4 hours around the clock, which is 12 per day. I had less than 10 left, so I called for a refill today. The doctor authorized the refill, but the Insurance company denied it saying that 60 tablets had to last me at least 8 days.
I insisted that the technician call the insurance company for an override because I was following my doctor's orders, which she did, and they filled it for my copayment. My husband went to pick it up and said that there was a note attached saying that the insurance company insisted that I be counselled by the pharmacist to receive the override, but he did not say why I should be counselled. My husband always says, "she's a pharmacist", and they just give him the bag and go on about their business. Is it because of the acetaminophen amount or the hydrocodone? Or what?
I am a pharmacist, but have not worked in retail for a very long time, and I don't recall having this problem before.
Have any of you had a limit placed on your daily use of narcotics by the Insurance company?? I sure don't want this hassle each time!
 
I have been on percocet since last June. Yes I have faced that. Once my pharmacist said the insurance company would not pay as i had it filled too soon. I don't know what there specifics are though. I thought I was going to face that again last week. I was ready to crack anyway, but it went through.
My spine doc had me try a new pain med that just came out. I used if for a week and did not like it. So I then got a prescription for percocet again. They did fill it, maybe because it was for a different drug the week before.
Glad you got your prescription, it is a bummer to have to worry about pain management
judy
 
I'm just curious....what type of insurance do you have? I've not heard of them trying to override a doctor's prescription like that...especially so soon after major surgery. It seems a bit odd.
 
Mine actually sis that right after surg ......i ended up paying full price a few times not wanting to fight......not sure why..............i was the same after surg 2 - 4 hrs...........sometimes i think they dont count theyt date you got them filled for taking them ........thats the only thing i could figure i guess anyway they can to not pay right !!!!!!!!!!!.....hope you doing well.............(...
 
Thanks for your replies ladies, Jamie I have Express Scripts. It has been so wonderful, it even covered Procrit injections for me pre-op, but I am at a loss about this.
 
I'm not at all familiar with Express Scripts and the only thing I could suggest would be to contact them immediately if you have problems with them paying for medications prescribed by your doctors. You certainly can challenge their decision and require them to tell you why something is not covered.
 
Oh my! Yet another down side to private insurance medicine.
 
I don't really think this is a common problem though, Jo. Maybe it depends on what state you're in, but I've never heard of anyone being denied meds prescribed by a doctor for an approved procedure here in the Kansas City area.
 
I still don't know their reasons, I have been on their website to try to figure it out, but no luck there. I am almost afraid to call for fear of messing it up worse since I eventually got my way. I know it doesn't work like that, but I am a little paranoid about that.

Hopefully there are no future glitches, they have always been so great!
 
I agree Kimberly. If things are resolved now, I'd let it go. You may have to deal with the problem again and you want to be prepared for that. But you could open up a can of worms by bringing it up now. You know that old saying..."If it ain't broke...don't "fix" it!"
 
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