I could tell you STORIES!!! OMG. Medicare is denying everything for me at the end of the year. They do it in drips and drabs which is a death knoll. But they haven't met their match - an informed, EXPERIENCED and NOT patient - ME.
First let me add some info to some misconceptions: There WAS a drug shortage of Percocet in spring/summer of 2023. The DEA decided there was enough on the market and they STOPPED distribution. Isn't that crazy? but there was a substitute and that was getting the OXY codone (those teeny pink pills) and using tylenol alongside. That is what I did. It was horrible for me because I had TWO major spine surgeries in a month. I was freaked out but the substitute was made.
TIP: if you have Medicare WELLCARE part D those untrained, ill epuipped, ignorant, not - english as a first language speakers are just horrid. It makes me sad because they are SO NICE - but ask them to transfer you stateside so you don't spend all day on the freaking phone like I do. (I usually am doing work while I am waiting). Nothing gets accomplished. I've had medicine denied and they give you ONLY one reason at a time. So its death by a thousand cuts, literally! Its crazy. It bogs the doctors down as they have to repeat the same request over and over and over for a different reason. Then they don't respond in 24 hours and they shut the case!
TIP: start your med request month in advance of need.
TIP: they have NARROWED the formulary! So they don't allow you what you took before.
TIP: the meds IN THE FORMULARY are not targeted for what you may need!!! I had that 3 times happen! I have to tell those idiots - I can't take, I've already taken, or the medication (for example) is for RA and I have OA!
This is political now. It is the only reason that I can't get my meds. They don't have to do away with Medicare and Medicaid they can just sabetoge it all the way! I am telling you - who you vote for matters and you'd better contact your elected officials and file complaints.
TIP: file greivances. They can do it over the phone.
TIP: Be leary of Medicare Advantage problems. The intermediary billing companies suck. Everything gets denied. We've had another convo about that here in this group - you can google it.
TIP: If you really want to hassle it you can get your meds (they will call the pharmacy for you) but you pay, work on your appeal and they will reimburse if you win.
TIP:If you aren't too ill, and take my suggestion to not back down. Its hard when you are too sick and I understand. Find a good assembly/congress persons office and they can assist sometimes.
TIP: If you have other insurance USE THEM. With all 4 or my "ROUTINE" Requests denied between Nov./Dec (oh my gosh, my poor doctor and the paperwork!) I switched from using Medicare part D to my champVA Meds by Mail where everything was immediately approved - as my doctor ordered it - with ZERO money needed from me.
TIP: this is important: They are switching medicines on us that are NOT appropriate, or have inferior ingredients, or are not targeted for what ails you. Be sure to do your research or have someone do it for you. All 4 times they tried to get me to take something wholly inappropriate for my medical needs.
Get ready folks. Honestly, the political desire to balance the national budget is coming to a pharmacy near you.
TIP: LEARN about your insurance formulary in advance of your needs. They change! No notice given! Its not the Walgreens or the CVS or the Costco its the insurance company and the governmental regulations.
TIP: If we don't fight (I mean stand up for ourselves and our needs) it will continue to deteriorate. If our doctors are tied up writing requests, prior auths, justifications and appeals they can't doctor us.