Re: Just received an odd call from CVS Pharmacy.

Tinkrbl44 · ‎08-23-2010

@newjersey wrote:
The pharmacist just told me that when she tried to fill a prescription for me, that it came up on her computer that it was denied because my insurance company wanted me to start taking only one pill a day of a med I'm on instead of two! I've never heard of such a thing. Has anyone else? I will obviously have to call the insurance company on Monday and try to find out about this. Any help is appreciated. Thank you.

@newjersey

Was the actual problem the number of pills ... or the dosage?

Example .... If your MD wants you taking two 10mg pills per day (60 pills per month), would it be acceptable to take one 20mg pill per day (30 pills)?

My sister encountered this recently, and adjusting the dosage to keep the number of pills at one per day, 30 per month, did the trick.

cherry · ‎03-09-2010

I stopped dealing with the mail order pharmacy we have though my husbands retirement. I got a call from a pharmacy telling me I needed to get my statin refilled

I told him I quit taking them , and I was having bad side effects. He kept me on the phone lecturing me ,about the importance of taking this drug. I should have hung up on him. He wasn't my Dr.

If he would have had the muscle pain I did he ,wouldn't have taken them either. They just want every penny they can get

I now fill my scrips at a brick and mortar pharmacy

hyacinth003 · ‎03-12-2010

@Marp wrote:
@newjersey, I haven't yet read the responses to your post but yes this is happening.

My nephew has MS and the insurance company only wanted to allow one dose of a medication he has taken three times a day for a long time.

It was a battle but with his doctor's help he was able to get his entire prescription refilled. That is the good news. The bad news is when it comes to next month's refill they don't know if he will have to go through this again or be able to get the full prescription. No one could answer that question for him.

Yes. He can get 3/day, but they can decide to only pay for 1 per day. He would have to pay the additional cost for 2 more unless he can negotiate differently with them.

Sorry for someone with MS to get any hassle. Since my mother had it, I wouldn't want anyone denied payment for something helping them.

It's all a very big business.

Hyacinth

GSPgirl · ‎01-03-2012

@newjersey wrote:
The pharmacist just told me that when she tried to fill a prescription for me, that it came up on her computer that it was denied because my insurance company wanted me to start taking only one pill a day of a med I'm on instead of two! I've never heard of such a thing. Has anyone else? I will obviously have to call the insurance company on Monday and try to find out about this. Any help is appreciated. Thank you.

Leave CVS as quickly as you can. They pulled this with me, too. I left and went to another pharmacist. For some reason the techs there love to overrule what doctors prescribe. My doctors told me to stay away from CVS.

x Hedge · ‎08-18-2016

@Reba055 wrote:
Yes, it's happened to me before. They base what they cover on the recommended dosage. For instance, PPI's are dosed once a day. If your doctor wants you to take it twice a day, they have to get authorization through the insurance company. That would require 60'pills instead of 30. Same thing with hormone patches. The recommended dose is to change twice a week. That's all they will cover. If you burn through it faster, your doc has to get authorization for more than twice a week, I.e., more patches than 8/month. It's been going on for a long time. You've probably never had a RX outside the normal dosage before. What has gotten worse is now some will not allow for override. If a pill can be cut, your doc can write a RX for twice the dose and you can cut it in half. Been there, done that.

Yes, @newjersey, its most likely due to what @Reba055 wrote above.

I'd phone the prescribing doctor on Monday.

This may be something that's usually prescribed as a single daily dose, and for some reason your doc feels you'll benefit more by taking 2 smaller doses.

It's likely your med is available at double the dose you're taking, and the insurance will cover 30 per month, but not 60.

Havarti · ‎03-08-2014

If they will only pay for one pill per day, see if you have (or can get) a dose where you can cut the one pill in half and take half a pill AM & PM. I do that with a BP pill – not because the insurance company denied it, because the doctor prescribe a 3 month supply and rather than waste it we decided I would just cut the pill. Not all pills should be cut…some contain timed release meds and it changes the effectiveness.

Just a possible idea to consider. Now-a-days we have to try to figure out how to work with/around the crazy system we are face with in the wonderful world of medicine & insurance.

Snarky responders need not reply. Move along and share your views elsewhere.

Tinkrbl44 · ‎08-23-2010

@GSPgirl wrote:
@newjersey wrote:
The pharmacist just told me that when she tried to fill a prescription for me, that it came up on her computer that it was denied because my insurance company wanted me to start taking only one pill a day of a med I'm on instead of two! I've never heard of such a thing. Has anyone else? I will obviously have to call the insurance company on Monday and try to find out about this. Any help is appreciated. Thank you.
Leave CVS as quickly as you can. They pulled this with me, too. I left and went to another pharmacist. For some reason the techs there love to overrule what doctors prescribe. My doctors told me to stay away from CVS.

@GSPgirl @newjersey

Of all the retail pharmacies, Walmart is usually the cheapest. Good customer service.

chrystaltree · ‎05-10-2010

That doesn't sound right at all. Insurers cannot and do not change the doctor's prescription. The only thing I can think of is that if you if your doc prescribed a med at 5mg, twice a day but the same medication comes in a 10mg dose that and you would get the same benefits for a single 10mg dose.....the insurer might say that they will only allow the single 10mg dose. You should call the pharmacy back, speak to the pharmacist and ask for clear explanation.

PurpleBunny · ‎03-09-2010

@Tinkrbl44 wrote:
@GSPgirl wrote:
@newjersey wrote:
The pharmacist just told me that when she tried to fill a prescription for me, that it came up on her computer that it was denied because my insurance company wanted me to start taking only one pill a day of a med I'm on instead of two! I've never heard of such a thing. Has anyone else? I will obviously have to call the insurance company on Monday and try to find out about this. Any help is appreciated. Thank you.
Leave CVS as quickly as you can. They pulled this with me, too. I left and went to another pharmacist. For some reason the techs there love to overrule what doctors prescribe. My doctors told me to stay away from CVS.

@GSPgirl @newjersey

Of all the retail pharmacies, Walmart is usually the cheapest. Good customer service.

Costco is good too. My dog's meds (he's on a people medication) were waaaaaaay cheaper there.

( \_/ )
(='x'=)
( " )_( " )

millieshops · ‎03-09-2010

Not at all sure what's going on, but as for waiting until Monday to call the insurance company. why wait? Or is my company unusual with its 24/7 phone availability?

If there's another CVS nearby, I might call or go there - everything is in all their computers and any CVS can help.