prescription plan no longer covering medication-what to do?

[Anonymous]

Yes, this is CVS Caremark. Thanks for the info about the generic Pentasa just being releaseed--I had no idea. Unfortunately, it is not on the list of medications being offered as an alternative. I will try asking for help from the benefits director again and will Cc his supervisors. I'll have to find out if prescriptions count towards out of pocket maximums. Thank you for all the advice...I really appreciate it!

[Anonymous]

Here is the info on the generic: https://www.drugs.com/availability/generic-pentasa.html.

It is called mesalamine. I would monitor coverage in advance of July 1.

[Anonymous]

Does Kaiser cover the medication? I'd switch to Kaiser. We had Kaiser years ago when I was pregnant (2 deliveries) and had little kids. We only had good experiences.

It's annoying to me how insurance companies can override a doctor prescribing medications. Our insurance won't cover my name brand thyroid medication anymore, only generic. This is extremely frustrating to me as the generics are proven to not be as effective as their quality control is horrible. I suck it up and pay the cost for the name brand.

[Anonymous]

look up mesalamine on goodrx, I think you’ll be pleased!

[Anonymous]

My spouse in on Pentasa and we have Caremark

You will need a special exemption. This will be denied. Then, your doctor will need to file an appeal. This will likely yield coverage.

I was all over the doctor to get the paperwork filed to expedite the process. My spouse was running low on pills and temporarily reduced the dose to make the medication last longer. This is NOT medically recommended, but prescription coverage is not designed to help patients! You need to make sure your doctor is filing the paperwork electronically. This will significantly speed up the process. Is your doctor part of a large hospital system? If that is the case there is usually someone assigned to drug appeals and such for that department.

BTW, I did not realize a generic was available and would look into it before switching.

Also, look at the manufacturer site for coupons.

I am sorry you have to deal with this.
Good luck.

[Anonymous]

Anonymous wrote:Does Kaiser cover the medication? I'd switch to Kaiser. We had Kaiser years ago when I was pregnant (2 deliveries) and had little kids. We only had good experiences.

It's annoying to me how insurance companies can override a doctor prescribing medications. Our insurance won't cover my name brand thyroid medication anymore, only generic. This is extremely frustrating to me as the generics are proven to not be as effective as their quality control is horrible. I suck it up and pay the cost for the name brand.

I am assuming you are on Synthroid. There is a coupon on the manufacturer website. I use this with my insurance and it lowers the cost to $75 for 3 months.

[Anonymous]

ALSO-- Op, you should be talking to a pharmacist

[Anonymous]

Anonymous wrote:Yes, this is CVS Caremark. Thanks for the info about the generic Pentasa just being releaseed--I had no idea. Unfortunately, it is not on the list of medications being offered as an alternative. I will try asking for help from the benefits director again and will Cc his supervisors. I'll have to find out if prescriptions count towards out of pocket maximums. Thank you for all the advice...I really appreciate it!

I’m the PP who asked about CVS Caremark. For what it’s worth, the insurance specialist and my doctors office said that the prescription is always covered after the appeal as PP said; the whole thing just causes everyone headaches and a lot of paperwork. So I imagine you will ultimately get your meds.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Does Kaiser cover the medication? I'd switch to Kaiser. We had Kaiser years ago when I was pregnant (2 deliveries) and had little kids. We only had good experiences.

It's annoying to me how insurance companies can override a doctor prescribing medications. Our insurance won't cover my name brand thyroid medication anymore, only generic. This is extremely frustrating to me as the generics are proven to not be as effective as their quality control is horrible. I suck it up and pay the cost for the name brand.

I am assuming you are on Synthroid. There is a coupon on the manufacturer website. I use this with my insurance and it lowers the cost to $75 for 3 months.

Thank you! I will check this out

[Anonymous]

I tried again with the benefits director/his supervisors but they are unable to help. I may reduce my medicine from 8 pills a day to 7 pills a day to buy a little more time while the doctor's appeal is being processed. He is part of a large practice and there is an individual in his office who handles the appeal

[Anonymous]

Op again...I found it much cheaper through amazon's new online pharmacy...$186 a month...keeping my fingers crossed this is legit

[Anonymous]

Anonymous wrote:Op again...I found it much cheaper through amazon's new online pharmacy...$186 a month...keeping my fingers crossed this is legit

I have used their pharmacy and it was perfectly legit. Hope the same for you!

[Anonymous]

Did you check with your pharmacy. Some will lower the price if it is not covered by insurance. It will not be cheap, but might help you afford to while you work out other options.

[Anonymous]

Anonymous wrote:Op again...I found it much cheaper through amazon's new online pharmacy...$186 a month...keeping my fingers crossed this is legit

Great! The Amazon pharmacy is indeed legitimate. My Synthroid is not cheaper there than at Kaiser, but they really helped me out last year, when I needed to leave the country for a year to go to another that did not offer Synthroid, and Kaiser could not fill such an order. The Amazon pharmacy came to the rescue - all they asked is that my doctor at Kaiser send them the script, which she did, given my circumstances.

[Anonymous]

If you have the option for paid medical leave, I would let my principal I will likely be on leave in the fall due to the meds issue. Maybe the principal can get the benefits coordinator to pay attention. Probably easier to pay for your meds than pay for disability and find subs frequently.