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 Post subject: Jumping Through Hoops
PostPosted: Thu Dec 07, 2017 12:08 am 
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Not sure how much trouble other people with BCBS are having with getting Prior Authorization for Suboxone.

I recently changed not insurance companies but just the company that supplies the medical insurance. My Federal BCBS would approve a six month period for the Prior Authorization and that was no big deal for the staff at my doctors office. More work, yes, but still not too bad. It normally got approved the same day I was in the office.

Now I have BCBS through another company that actually has lower copay's and such but this Prior Authorization thing is killing me. The first time it took 6 weeks to get it approved to fill the script. Luckily, I had some stock but it got down to almost nothing before approval. So I go again two months later and it's denied again for the same reason. So I called them and they said my doctor only approved a months supply. So I call my doctors Prior Authorization person and she said there is no place on the form to ask for a longer period of time. It's been 3 weeks since I turned the RX into CVS. It is getting close to panic time.

Today I get a letter stating it was denied until two things are supplied. 1) Prescription from my treating physician. 2) Treatment plan from a Behavioral Specialist. This last one I don't know what it means. They sent the same letter last time and it still got approved.

Has anyone had to deal with Blue Cross Blue Shield about this other person I'm supposed to see? To me, they are just trying their hardest to get me off the Suboxone. Funny how it's the same insurance company but this division has totally different rules. And doesn't seeing another professional cost the insurance company more money?

So yes, I'm pissed and will now have to be on the phone tomorrow trying to get this straightened out for the 2nd time.

Thanks for letting me vent. No wonder I have high blood pressure!

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PostPosted: Thu Dec 07, 2017 12:38 pm 
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I have BCBS and they also made me jump through hoops every 6 months. It stinks that they outsource their prescription coverage because it seems to make more of a disconnect. My clinic had counselors on site, who did the treatment plan so that made it slightly easier.

i then changed coverage to percentage based copay and now pay 60% of my prescription which is a lot! So i went to the suboxone website and printed out their coupon for $25 and that covers the balance. Now my pharmacy just automatically applies the coupon every month. With the new coverage BCBS stopped asking for authorizations probably because they are only paying 40% of $340 :roll:

have you tried using the coupon on your prescription when your authorization hasn't gone thru in a timely manner?


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PostPosted: Thu Dec 07, 2017 2:44 pm 
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Hi Sylvia, yes, I have always used the coupon for the discount. They are offered every year and I get a new card from my doctor every year.

This new version of BCBS is nothing like my previous experience with them. My doctor is a D.O. and got his special DEA number to prescribe Suboxone way back when it first came out. The clinic is actually a walk in Urgent Care so there are no Behavioral Specialists on staff.

I'm trying to decide whether to wait for my doctors office call or be proactive and call BCBS and then my doctor. This crap just drives me nuts. If it wasn't so darn expensive I'd pay cash for it.

Bottom line, BCBS does not want to keep paying for a medication they think all people should only use temporarily. It's always about money, not health, with insurance companies. I have enough to last maybe two more weeks then that's it. If they haven't resolved it by Monday then I'll start calling.

Thanks for your input.

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PostPosted: Thu Dec 07, 2017 8:44 pm 
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Hi Sylvia and my good buddy, Rule,

I have been very fortunate. I have been seeing the same doctor for 7 years. He started me on 32 mgs and in those years brought me down to 8mgs. The first 4 years I saw him monthly. The last 3 years, every 6 months. I have Anthem BC/BS as a retiree. Medicare pays 80% BC/BS pays 20%. I never had any problems and I hope I don't. The only time anything changed is when he told me a new law said he could only prescribe 30 tablets monthly but, by that time he had gotten me down to 8mgs.

On my visit, I see him, he asks how things are going. Any cravings? Have I been tempted to take more than one a day and if I had anything I want to talk about. I see him every Oct. and every April. If I have any problems I can get in touch with him in 12 hours or less. My chart is online and he is the best at replying right away. When I had my surgery to remove the tumors, I was worried that my pharmacy might give me trouble filling my RX for oxycodone since they fill my Subs. I e-mailed him and in 4 hours he replied, "I know you are in the hospital and had surgery, I know you are being discharged today, I already called your pharmacy and spoke to them, your rx for Oxycodone will be waiting for pick up". You can't ask for more. He knew I was in the hospital and had surgery because he is affiliated with my other doctors through Montefiore Hospital here in New York City. He pulls up my chart online and he knows what's going on with me. It's all there. I wish you could all solve these problems and just worry about doing what you have to do, which is hard enough. Right?

Wishing you all happy holidays. I love you all.


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Queenie


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PostPosted: Fri Dec 08, 2017 6:52 pm 
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I’m so sorry you’re going through this. It’s awful :( When I started up again last month they gave me generic tablets. Would that be an option for you?

I can’t believe you were able to get through 6 weeks! I’m guessing it’s from when you tapered down from 6mg. I’ve always gotten only the exact amount I needed and had to wait until the very last day to get my next month’s supply.

I think most people in your position (and I’m sure you’re not the only one) would have gone through a full, miserable detox in 6 weeks. I can’t believe the insurance companies have the power to do that to someone. It’s criminal!


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PostPosted: Sat Dec 09, 2017 12:40 am 
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Yes, Lilly, I receive the 4 mg films but only take 2mg's per day. I can make a film last 3 days w/o any ill effects so that is probably my next task.

Talking to the insurance company today they keep saying it's no problem getting it approved. They keep putting it on my doctors office. Now I'm starting to believe that is the case. My doctor has someone who is just overwhelmed with her work and puts stuff off. The last time we spoke was two weeks ago and I gave her the number to call. She said give her 4 days to resolve it. Today is her day off so I'll call again on Monday. My last script was filled 10/04/17 so that is now over two months and I'm getting down to just a couple of films left.

I may need to go in and be a bit more forceful to make sure it gets done right. Wish I could see what the form looks like that she can't seem to figure out.

Good luck on keeping your MAT group job. That really is messed up. Why are so many people against this life saving medication? So many of us have to fight hard just to get it. And that's if you can find a doctor in your city. All doctors should be able to prescribe it if they feel you're a good candidate.

Enough from me. Hopefully I'll get my script filled early next week. Never have I been down to so few films. I may need to go in monthly again to build up my stock.

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PostPosted: Thu Dec 14, 2017 1:32 am 
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W/o a call back from my doctors office I decided to drive the 20 miles and visit them. In my head I wasn't going to leave until it got approved. Wrong. They once again sent the paperwork in and got no response. So back on the phone I went calling BCBS's prescription division.

Reopened the case and told them I only had one days medication left. Yes, I lied to get it moved up faster. I have 3 films left so that's six days worth. There is a chance I may have to pay cash for the script and ask for reimbursement. How much is one box of 30-4 mg films? In all the years I've been on it I never knew how much it cost. Members here say a couple of hundred bucks. We'll see.

So how do I go about finding a Behavior Specialist? Not getting the letter until last week leaves me at a big disadvantage. I'll need to find one and get some kind of treatment plan. What a friggin' joke! My doctors office said they've never heard of an insurance company ask for that. Seems like the largest health insurance company doesn't know much about Suboxone. I may sit and write a letter to the head person and include Dr. Junig's articles on discontinuation of treatment. A simple Google search states a relapse rate of over 90% of those who stop it when they aren't ready.

Hopefully you won't hear much more from me once I get this settled. I just want my medication and get on with life. I will post when I get it resolved.

Thanks for letting me vent. And I do hope no one else has to go through all this bull just to get their Suboxone.

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PostPosted: Thu Dec 14, 2017 9:47 pm 
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My insurance falls under BCBS. Last month they charged me $77 for 15 2mg generic tablets. This month they charged me $110 for 30 generic Wellbutrin, then they gave me 30 2mg Suboxone films for $0. I don’t know if it’s because I finally reached my deductible. If so, I think I could be looking at $300 for 30 2mg films next month. It’s anybody’s guess.
One time they made me get “pre-approval” for generic clonazepam, which I’ve been on for over 2 years. There’s no rhyme or reason, and the pricing is anybody’s guess.
I have to admit I sometimes feel resentful of my patients who are on state insurance and get their medication (methadone or Suboxone) paid for 100%, and then complain that they have to attend free (for them) counseling and groups.
Rule - your situation is a wake up call that any one of us could be cut off of our medication at any time, through no fault of our own.


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PostPosted: Fri Dec 15, 2017 8:26 am 
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Lilly I admit I do sometimes feel that same way. I see ppl all the time complaining about counseling and I'm thinking how lucky they are to have the opportunities they do.

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PostPosted: Fri Dec 15, 2017 1:50 pm 
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I hate when these companies do this. I had some of these issues early on in my sub use and once I had to wait 3 days without any sub at all and I got really really sick. From then on I told my doctor I needed 16mg per day even though I was only taking 4-6. Even after I weaned down a lot I still got 16 mg per day. In the end I had such a large stash that it lasted me over a year without seeing my doctor before I finally jumped, and I still had a lot that I threw away. Maybe this is not wise for everyone but my doctor was not very knowledgeable about suboxone at all so I knew I was going to have to taper myself. And that's what I did, I just wanted to make sure I was covered in case anything happened. Good luck rule.


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PostPosted: Sat Dec 16, 2017 12:36 am 
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Update and ending to the saga. This is the first time I've not had a decent back stock hidden away for a rainy day. Years ago I did have about a 3 months supply and then something happened where I needed almost every one.

It has to do with not having any problems for several years and getting complacent. Taking 2 mg's and being prescribed 4 per day I didn't stash them away. Instead, I only went to see my doctor every other month, thereby saving a copay, etc. That just bit me in the ass. Down to my last 2 films which will last me until next Tuesday, that is cutting it short.

The good news is I made the decision to call up a Behavior Specialist and try to expedite the appt. and treatment plan so as to get my insurance to approve it. Just before I started to call my BCBS office called and said they approved my Suboxone for 2 years. So that is great news and I should get it by Monday. Whew! Cutting it very close. The pharmacy has to order it like they always do and this is a Friday too so it won't arrive till then. Close calls are okay but this won't happen again. I'll make sure I have at least 2 months of backup just in case.

So that's it. Good news all around. Thanks to all of you who were so kind as to post back to me. It means a lot. Normally, it's the other way around so it's nice to know we mods get support like everyone else.

My fingers are still crossed because it officially hasn't gone through yet. At least so says CVS.

Now I know why the black market thrives selling Suboxone. So far I've yet to break any laws ever since getting off pain meds.

rule

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