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mad_about_mickey

Prior authorization for medicines....a tad long

18 years ago

just thought of this after reading the post about medicare costs. We have a drug plan thu hubbys work that we can use for mail away or at the local pharmacy. Everytime I go to the Dr. she asks me where I am going to take the script, so she knows how to write it. since I take Ambien CR and it is $80.00 for 90 tabs to mail it in, opposed to the $40.00, to go to Wal-mart so that is what we did. Imagine my surprise when I received the Ambien and was told that I could only get 60 tablets instead of the 90 as I did not have a prior authorization in place. But, they charge the $80.00 for the 60 just like if i had gotten the 90. When I called to complain, they told me they could do nothing this time , but if I had a prior authorization the next time I filled it, they would send they 90 for the $80.00. I called Dr. and they got the pA thing done and girl in office told me that our plan is notorious for doing this and that if they give me a hard time to ask to file an appeal, they don't like to do appeals because it costs them $, but if that is the only way to get companys attention then that is what you have to do. The plan says that in a rolling 90 day period you are allowed 60 pills. I told that to the girl in Dr. office and she said that we are aware that patients need the medication to sleep but the only thing we can do is offer you the 7 day trial coupons and she wasn't sure how many times a pharmacy would accept those. She was really nice and the plan said I would be getting the 90 this time so let's see what happens. Geez, has anyone else had this happen to them?

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