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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

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bajjerfan | @bajjerfan | 6 days ago
In reply to @sueinmn "I got a new bit of insight today. My daughter is a highly experienced RN currently..." + (show)
@sueinmn

I got a new bit of insight today. My daughter is a highly experienced RN currently working in a pharmacy doing med advice, injections as and general pharmacy work. She said over 50% of their workload since January 1st has been helping patients (not only on Medicare) through insurance transitions. It take an entire extra staff person to help manage the transition.

Her coworkers are frustrated, but as a former ER nurse, she says these changes are nothing compared the approval issues they had to deal with - often in life-or-death scenarios. So she gets assigned all the anxious or upset callers/customers (including her Mom.)

I didn't think to ask if her coworkers thought 2025 was more difficult than prior years - it is for me so far. One of my meds was approved for 15 months in September 2024, but due to a change in the Pharmacy Benefit Plan, I have to do it all over again now! In the same call, the rep informed me that this change will require new PA's for all 4 of the medications we just did a few months ago. Que horrible!

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I'm thankful that so far I don't need those meds that you have to jump through 350 hoops in order to get them.

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charlotte12 | @charlotte12 | 5 days ago
In reply to @bajjerfan "I think it's foolish and dangerous to be so dependent on foreign suppliers for intermediates and..." + (show)
@bajjerfan

I think it's foolish and dangerous to be so dependent on foreign suppliers for intermediates and active pharmaceuticals. I expect the manufacturer is the one who produces the active drug. Someone buying components and putting out a finished product is a compounder.

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It's also foolish to rely on foreign suppliers for medical equipment.

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