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PostPosted: Fri Aug 08, 2014 6:08 pm 
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I've never had this much trouble before. My doctor had me switch to a different pharmacy, one he likes better, (I was going to Walgreen's but he wants me to use Rite Aide), and I take in my prescription of 45 2mg Suboxone, (a month's supply at 3mgs a day), and the pharmacy tells me it will take a few days for the priori authorization to go through. Fast forward five days. It still hasn't been authorized and they had to give me seven to last those previous five days and then they gave me ten to get through another half a week and I need to check back on Monday. The other day I called to see if the authorization had gone through yet and they said they didn't see anything about an authorization but that it's too early to get the rest since they gave me seven so I should still have some left and today when I went in is when I found out that more than half a week later the insurance still hasn't authorized my meds. I've been using this insurance for the past six months or so and never had a problem until now. Insurance companies really piss me off.

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PostPosted: Fri Aug 08, 2014 7:45 pm 
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Insurance can be a bitch! Pardon my language. I had prior auth that was supposed to last 12 months. I changed doctors, but got SAME dose, SAME everything. Had to do it all again. And my insurance tells me "if your doctor changes anything (dose, goes from weekly to bi monthly, etc) i'll have to get it authorized again... grrrrr!

To anyone dealing with Prior Authorization: My brothers wife is a pharmacist. She said it's "SOoo annoying dealing with people all day who want us to fill their scripts NOW NOW NOW. It's not OUR responsibility to contact your insurance and doctor for prior authorization!" Uhg... she's a bitch. But in a way she's right. It's UP TO YOU to call the insurance and doctor to make sure they KNOW you need P.A. , bug the piss out of them. Keep calling and checking with insurance "hey, what's the status of the prior auth bud?" and then once they say go call the doctor "Heyyyyy, insurance say's we're good to go... TELL MY DAMN PHARMACY!!!!". It worked for me.
A friend of mine went to the same doctor the same day as me to start the sub program. We have same insurance. She didn't get hers til the DAY BEFORE HER NEXT APPOINTMENT! I got mine in like 4 or 5 days.


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PostPosted: Sat Aug 09, 2014 1:24 am 
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Yeah, I've been calling both the doc and pharmacy every day. I asked the pharmacy when they'll know and they said they don't, they just keep trying the insurance til they get somewhere. Oh, I also forgot to mention that the second or third time I called the pharmacy they said that they didn't see anything about a prior authorization but that it was too early to give me the rest of my partial script because "I had some left and the insurance was telling them it was marked as too early to refill". They gave me ten to get thru the weekend and when I called to ask if it was just because they were low on stock or something, (because the lady on the phone when I called the night before said there was no mention of the prior auth just the too early to get the rest of the script), he said "No, actually it's because your authorization hadn't gone thru yet so we gave you enough for the weekend so you won't be without". I made it clear how annoyed I was after bugging everyone for five days straight and getting various answers and still getting nowhere, but, I also made sure to thank them for at least letting me have the ten they gave me. I didn't know that getting the rest of a partial script was the same as a new refill; can't fill the rest until you're done with the ones given according to how it's written. It's annoying having to get seven here, ten there and having to wait until my orders say I need more before giving me the next part of my script. It's annoying mainly because I rely on my family or the bus to get me there and back and all those trips add up. :(

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PostPosted: Sat Aug 09, 2014 4:14 am 
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I'm not sure about the legality of them making you wait until you're out of medication, and considering it a refill every single time you get a partial fill of your prescription. If it was written asa single prescription, you'd have received them all at once anyway,and in some places there are limits on the number of refills allowed per month. Other members have had this issue. Hopefully one of them can chime in and tell you how to proceed, or provide a link to the other threads I've read about this very topic. I'm glad that you're getting your meds either way, and hope this gets resolved quickly.


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PostPosted: Sat Aug 09, 2014 6:24 am 
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I have United Healthcare and I had to get a prior authorization in January for suboxone. Then as of July they wouldn't pay for suboxone films any longer and I had to change to Zubsolv. It's been OK, but let me tell you my prior authorization story.

I had a sub appointment on January 4th. I had been informed by letter of the need to obtain a prior authorization for 2014, so I researched the number my doctor's office would have to call to request it, and I brought it in to my appointment. By the time I left the office the prior authorization was in process. Several days later I called my insurance company to find out what the hold up was. Of course, they gave me a spiel about how they have 15 business days to make the decision to approve the request. But after pressing them a bit I found out that they had denied the prior auth. After a lot more questions and prodding I was told that the request was worded incorrectly and would have to be resent by my doctor's office with the right wording. (It was almost like I had to say some magic words to be given the whole truth!)

Apparently, my doctor had put on the form that I needed the suboxone for addiction and chronic pain, and that the insurance company would only approve the prior auth. if the form said "for addiction only"! So I had the doctor's office send the form again. Again I talked with the insurance company several times to find out what the hold up was. Again they told me that they had up to 15 business days to make the decision. I asked if there was any way the process could be expedited at least 3 times. Finally they let me know that if I wanted the process to be faster then the doctor's office had to fill the form out again, this time with a request that the form be expedited! I called my doctor's office again and asked them to resend the form and this time write the word "expedite" all over the form. They chuckled and resent the form. Finally, I got word from my pharmacy on the 14th that my prior auth. was approved.

This is what I learned from the experience:

1. Bug whomever you need to in order to find the right answers. Be persistent!

2. Have your doctor fill out the form with a request for expedition.

3. Make sure your doctor requests the prior auth. only for addiction reasons. Do not add other reasons for the medication request.

4. At one point they were able to OK a five day emergency supply for me. Ask for one if it's taking too long.

5. And be persistent!!!

Amy

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PostPosted: Sat Aug 09, 2014 8:05 am 
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lizzieshug2013 wrote:
I'm not sure about the legality of them making you wait until you're out of medication, and considering it a refill every single time you get a partial fill of your prescription. If it was written asa single prescription, you'd have received them all at once anyway,and in some places there are limits on the number of refills allowed per month. Other members have had this issue. Hopefully one of them can chime in and tell you how to proceed, or provide a link to the other threads I've read about this very topic. I'm glad that you're getting your meds either way, and hope this gets resolved quickly.


Thank you. It's a major pain. I also forgot to mention that when I first went in with the prescription and they told me the PA hadn't gone thru I asked how much they were and that I'd just pay cash but the pharmacy told me that since I have insurance I'm not allowed to pay cash for them. His exact words were "I'm sorry, but, we can't allow you to pay cash for these since you have insurance", which is funny because at the other pharmacy I had no problems paying cash when my insurance was acting up?

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PostPosted: Sat Aug 09, 2014 8:12 am 
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Amy-Work In Progress wrote:
I have United Healthcare and I had to get a prior authorization in January for suboxone. Then as of July they wouldn't pay for suboxone films any longer and I had to change to Zubsolv. It's been OK, but let me tell you my prior authorization story.

I had a sub appointment on January 4th. I had been informed by letter of the need to obtain a prior authorization for 2014, so I researched the number my doctor's office would have to call to request it, and I brought it in to my appointment. By the time I left the office the prior authorization was in process. Several days later I called my insurance company to find out what the hold up was. Of course, they gave me a spiel about how they have 15 business days to make the decision to approve the request. But after pressing them a bit I found out that they had denied the prior auth. After a lot more questions and prodding I was told that the request was worded incorrectly and would have to be resent by my doctor's office with the right wording. (It was almost like I had to say some magic words to be given the whole truth!)

Apparently, my doctor had put on the form that I needed the suboxone for addiction and chronic pain, and that the insurance company would only approve the prior auth. if the form said "for addiction only"! So I had the doctor's office send the form again. Again I talked with the insurance company several times to find out what the hold up was. Again they told me that they had up to 15 business days to make the decision. I asked if there was any way the process could be expedited at least 3 times. Finally they let me know that if I wanted the process to be faster then the doctor's office had to fill the form out again, this time with a request that the form be expedited! I called my doctor's office again and asked them to resend the form and this time write the word "expedite" all over the form. They chuckled and resent the form. Finally, I got word from my pharmacy on the 14th that my prior auth. was approved.

This is what I learned from the experience:

1. Bug whomever you need to in order to find the right answers. Be persistent!

2. Have your doctor fill out the form with a request for expedition.

3. Make sure your doctor requests the prior auth. only for addiction reasons. Do not add other reasons for the medication request.

4. At one point they were able to OK a five day emergency supply for me. Ask for one if it's taking too long.

5. And be persistent!!!

Amy


What a pain in the ass! Thank you for sharing this with me! I hate that people have to jump thru as many hoops to get off drugs and stay clean as they did while in active addiction! I'll definitely take your words to heart and learn from your experience and call my doctor again on Monday to see about getting him to fill out another PA form with "expedite" on it.

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PostPosted: Sat Aug 09, 2014 8:17 am 
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lizzieshug2013 wrote:
I'm not sure about the legality of them making you wait until you're out of medication, and considering it a refill every single time you get a partial fill of your prescription. If it was written asa single prescription, you'd have received them all at once anyway,and in some places there are limits on the number of refills allowed per month. Other members have had this issue. Hopefully one of them can chime in and tell you how to proceed, or provide a link to the other threads I've read about this very topic. I'm glad that you're getting your meds either way, and hope this gets resolved quickly.


Yes, it was written as a single prescription and when they gave me the ten for the weekend I made sure to say "You know this is for the rest of a partial prescription, right?" and they were like "Yes, we know," because I was afraid someone was typing in that I'd just been there five days ago and was now back wanting next month's refill when this month's isn't even filled all the way yet. :/ At least I got some for the weekend so at least that's good.

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PostPosted: Wed Aug 13, 2014 7:04 am 
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My pharmacy said I could pick up the rest of my script tomorrow because then it won't be dinged by insurance as an early refill. I asked them if filling the rest of a partial script was the same as filling a new/refill script in terms of having to wait until a specific day and they said "Yes, it's the same: Both a partial and a new prescription count how many you were given and you aren't allowed any more until the date arrives when you'd be out of your meds regardless of whether it is the same or a completely new prescription." which sucks if you have to go out of town or something, you know?

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