First of the year insurance issues

Posted by jriemer @jriemer, Jan 3 2:21pm

Has this happened to you? I went the pharmacy this morning to pick up my prescription for oxycodone. The pharmacist said that my drug insurance (Humana) has denied the payment. She said they wanted prior authorization from the doctor. Insurance companies don’t like pain medication requests and sometimes create obstacles for already overworked doctors to deal with. I know opiates are a problem and abuse occurs but why penalize legitimate pain patients and doctors? Jeff

Interested in more discussions like this? Go to the Chronic Pain Support Group.

@jriemer I'm sorry to hear this. Usually at first of the year, they will at least give you 3-5 days of meds while waiting for the "prior authorization" to go through. Maybe your doc can request it.
We go through this every 12-15 months with several of our (non-opioid) prescriptions, some we have used for years for chronic conditions.

This is becoming a huge burden for patients and medical professionals - we all need to be alering our representatives and senators, because it is NOT reducing the cost of care, and is endangering people who don't know how to work with the system.

Were you able to reach your doctor about getting the authorization?

REPLY
@sueinmn

@jriemer I'm sorry to hear this. Usually at first of the year, they will at least give you 3-5 days of meds while waiting for the "prior authorization" to go through. Maybe your doc can request it.
We go through this every 12-15 months with several of our (non-opioid) prescriptions, some we have used for years for chronic conditions.

This is becoming a huge burden for patients and medical professionals - we all need to be alering our representatives and senators, because it is NOT reducing the cost of care, and is endangering people who don't know how to work with the system.

Were you able to reach your doctor about getting the authorization?

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Yes, it all ended well. Thank you for the comment. Jeff

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@sueinmn

@jriemer I'm sorry to hear this. Usually at first of the year, they will at least give you 3-5 days of meds while waiting for the "prior authorization" to go through. Maybe your doc can request it.
We go through this every 12-15 months with several of our (non-opioid) prescriptions, some we have used for years for chronic conditions.

This is becoming a huge burden for patients and medical professionals - we all need to be alering our representatives and senators, because it is NOT reducing the cost of care, and is endangering people who don't know how to work with the system.

Were you able to reach your doctor about getting the authorization?

Jump to this post

I had issues with a Walgreen's pharmacy, not the insurance company, to fill my pain medication of a small amount of low
dose oxycodone (15 pills, 5mg), delay and excuses. I switched the pharmacy, no more Walgreen's.

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@charlotte12

I had issues with a Walgreen's pharmacy, not the insurance company, to fill my pain medication of a small amount of low
dose oxycodone (15 pills, 5mg), delay and excuses. I switched the pharmacy, no more Walgreen's.

Jump to this post

That seems to be a common issue where we live. First we switched from XXX, then same at YYY. Finally it hit the mail order service, ZZZ. We are fortunate to have a great pharmacy in our small regional grocery chain, and are very happy with their services. And no shortages or days with no pharmacist. And it is employee-owned, so they are super helpful as the better the company does, the better they do.

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I began origional medicare on 1/1/25. I had hunana medicare advantage. One problem after another. Including my prescription meds. None are controlled substances. There are only 4. I have been paying for my own prescriptions for the past year. I have a part D plan but has issues with customer service in December giving me inconsistent info. So I continue to pay for my own. Not sure if this helps.

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@kb2014

I began origional medicare on 1/1/25. I had hunana medicare advantage. One problem after another. Including my prescription meds. None are controlled substances. There are only 4. I have been paying for my own prescriptions for the past year. I have a part D plan but has issues with customer service in December giving me inconsistent info. So I continue to pay for my own. Not sure if this helps.

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If you pay for your own prescriptions, try GoodRx or Singlecare. You can often save a bundle by using them.

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I have WellCare, $0.00 Part D premiums for 2025. Also there is no cost for Dyazide, Lasix and Atorvastatin.

My phrmacy is CVS. In 2021, I was prescribed oxycodone for post-op pain. No grief when picking it up. The second time 10 weeks later my daughter picked it up and I don't think that they gave her any grief either.

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@kb2014

I began origional medicare on 1/1/25. I had hunana medicare advantage. One problem after another. Including my prescription meds. None are controlled substances. There are only 4. I have been paying for my own prescriptions for the past year. I have a part D plan but has issues with customer service in December giving me inconsistent info. So I continue to pay for my own. Not sure if this helps.

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@kb 2014- yes it helps to share your experience with the private medicare advantage plan Humana, it is always good to do research before you drop the original Medicare, Medicare Advantage plans can come with risks -

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@heisenberg34

If you pay for your own prescriptions, try GoodRx or Singlecare. You can often save a bundle by using them.

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@heisenberg34, @kb2014- should you live in Minnesota, starting 1/1/2025:
"A new law will cap the cost of certain prescription drugs for chronic diseases like diabetes and asthma at $25 for a one-month supply. Allergies that require EpiPens also fall under this provision. That cap is $50 per month for all related medical supplies, like insulin pens, insulin pumps, inhalers, glucometers and test strips."

If your state does not offer these benefits, you may contact your state representatives for change.

REPLY
@sueinmn

@jriemer I'm sorry to hear this. Usually at first of the year, they will at least give you 3-5 days of meds while waiting for the "prior authorization" to go through. Maybe your doc can request it.
We go through this every 12-15 months with several of our (non-opioid) prescriptions, some we have used for years for chronic conditions.

This is becoming a huge burden for patients and medical professionals - we all need to be alering our representatives and senators, because it is NOT reducing the cost of care, and is endangering people who don't know how to work with the system.

Were you able to reach your doctor about getting the authorization?

Jump to this post

Very wise advice--"we all need to be alerting our representatives and senators, because it is NOT reducing the cost of care,"
Voters elect the same old officials who do nothing to help us with health care expenses.

I got quite an surprise for this new year, a prescription that was $12 in 2024, is now $120! "Placed in a higher tier" says my insurance! I have not had time to call dr. about switching scripts yet, but you bet your bippy I will. Also will call political rep about this sleazy move that moved this drug to a higher tier to earn more profits legally after bragging about lowering the price of drugs.

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