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PostPosted: Tue Sep 21, 2010 5:10 pm 
Ok, so here's the deal. Im in my 17th month and im taking generic 8mg subutex. The generic isnt really working well for me. My insurance takes affect the first of next month. Its my moms insurance and its pretty good however, they make you start with generic medication. They want you too try generic 1 time and if it doesnt work then they will approve you to get name brand. I already know the generic isnt working for me. Should i call them and ask them too go ahead and approve me or would that be a waist of time? I guess my main question is, does anyone know how insurance companies work? I mean, im in a crappy situation. The generic is totally not working. Im literally putting myself at risk by continuing to take it. I took suboxone in the beginning but came to find out im allergic to the artificial sweetner(Acesulfame K sweetner). I've also heard the name brand subutex works very well. I just need some advice. I've heard insurance companies can be a real pain sometimes. Anyone ever got they're insurance company to switch them from generic to name brand? I would really appreciate anyones advice or opinion. Thanks!! :D ~PEACE~


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PostPosted: Tue Sep 21, 2010 7:51 pm 
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Well I have taken both genaric and name brand from the Subs to subetex there is no diffrence in the way thay work you might just need to go up on the dose have you told the doc about this and the insurance company don't give to shits about you and what you want there fucking prics sorry for the languuage I hate my insurance company I was sheduled for a lumabr fusion last year about this time and just now getting approveds and I have bone on bone in my back so thay suck but you can try and call them and tell them that you don't think that the genaric is working there are very few medication out there that have genarics that dont work like there supposed to. I'm coming down from my high horse now and best of luck to you ask the doc about it.

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PostPosted: Tue Sep 21, 2010 11:04 pm 
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Because you are just starting out with a new insurance company they may not care that you can't take a generic. They will probably have you fill it as a generic at least once and then your doc will have to write a prescription with "DAW" written on it and justify the medical necessity of the name brand medicine. It may also cost you more.

Let us know how it works out for you.

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PostPosted: Sat Sep 25, 2010 9:55 am 
Thanks for the replies!! DAW, is that "DISPENSE AS WRITTEN"? I have a few things in my corner or at least i think i do. My mom has had this insurance for 15 plus years and never once has she ask for name brand medication. She never misses a payment and its always on time. When i got switched to subutex, my doctor actually wanted me too take the name brand. He was kinda against me taking generic. He wasnt looking out for my better interest as it appeared. He was trying too make sure i didnt get the generic since its made by another company. However, this will work out very good if i have to get him to write DAW on the prescription. If my doctor writes DAW on the script, does that mean the insurance company has to approve me or is it just a lot better chance that they will approve me? Anyways, im only able to get an internet connection every now and then so it may take a couple days for me to respond. I'll be online for about another hour or so. Thanks!! ~PEACE~


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PostPosted: Sat Sep 25, 2010 12:52 pm 
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You said you would only be online an hour or so, but I just saw your post. Maybe you will come back.

I worked for an insurance company for 21 yrs. I was in the death benefits dept. But you hear things. Just like "Dispense as Written" We have WOM..."Word of Mouth"

If you get a notarized letter from your doctor stating you had generic, it doesn't work and you absolutly need the name brand for your treatment, they may make an exception, if they want to maintain a good reputation. I'm not guaranteeing it will work, but it's worth a try.

You need to get on track as soon as possible for your treatment to be effective. (put that in the letter)

Good luck no matter how it turns out. Don't give up & don't give in. Love & hope, queenie

p.s. (to make it more impressive, FedEx the letter to the Insurance Company. That way it seems urgent & important)


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PostPosted: Sun Sep 26, 2010 8:17 am 
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I am pretty sure all your doctor has to do is put dispense as written on the script and he might have to call the insurance company. You do have protest rights to any denial and you may request reconsideration. If they deny coverage of the brand name or if they cover a lesser amount, you can write in why you need the brand name and have your doctor write a letter on your behalf and they will probably have to give it to you if it is medical necessity. However, if they only cover a certain amount for brand name medications, that is the insurance plan and you will likely be stuck with that. It all depends.

I know recently my insurance coverage went up for suboxone because the insurance company used to indicate I "could" take methadone which is much less expensive and has a generic so I had to pay a high rate for the sub. It was recently removed from that list since methadone is NOT a substitute for suboxone and they are NOT the same thing.

Cherie

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PostPosted: Sat Oct 02, 2010 9:13 am 
Thanks everyone for your replies!! I will find out on monday when i go to the doctor whats gonna happen. I will let everyone know how it goes. ~PEACE~


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PostPosted: Sat Oct 09, 2010 9:40 am 
Well, everything worked out and im finally back on track and doing quite well. When i called the insurance company they first told me that because it was a restricted drug they wouldnt be able to cover name brand at all. I kept explaining over and over how important this medication is and that its a life or death situation for me. He finally put me on hold and said he was gonna look into something real quick. Im still thinking the worst when after a few minutes he comes back and tells me, the only way they will approve it is if the prescription is marked DAW(Dispense As Written). Thanks to the people on this forum i knew about that and i had already gotten my doctor to sign the DAW part of the prescription when i went to the doctor on monday. Woo what a relief!! Then he tells me that its a process called prior authorization and said it may take a few days. I said, i dont have a few days. Im completely out of medicine. So, thankfully i was speaking with a compassionate and understanding person, he tells me i would just have to call my pharmacy and get them to call the insurance company to verify that the prescription did in fact say DAW. So, end result was a complete success!! Thank the lord. I know everyone is different but for me, the name brand compared to the generic is like the difference in night and day. I dont know if its because i've been taking it for 17 months and am able to tell the difference or what but its a huge diffference. Its so big of a difference i actually in some ways feel like the generic never really trully worked for me. I know that may sound crazy but its just my experience. When i was taking the generic i was angry all the time. I had feelings that kind of resemble withdrawal. It was crazy. I actually just thought i was going through a weird stage in recovery but ever since i started taking the name brand, i feel back to myself again. Clear headed and motivated. I always felt tired and lazy while taking generic. Again all this may sound crazy but its just my experience. The name brand actually last all day unlike the generic. Their much smaller also which makes for a lot easier process of putting it under my tongue and keeping it in one place. I'll leave the generic alone cuz im sure it works very well for many people and i dont want anyone to get the wrong idea. Lets just say, generic is not for me. Soooo, i guess i lucked out with my insurance company. I pay $40.00 for 60 name brand subutex. Anyway, hope everyone has a great day and if anyone has any questions or anything feel free to ask. Thanks for listening!! :D


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