Prescriptions and denials thereof....

My doctor wants me to go on a medication. My Blue Cross pharmacy provider denied it. The doctor made an appeal, very eloquently. Blue Cross denied it again. I appealed it; they denied it a third time. The pharmacist said, well, let me see if we can get the manufacturer to help you with that, because they do quite often when it's too expensive (which it is). And then he said, oh, no, you have pharmacy insurance, so you can't get help from the manufacturer.

I said, well yeah but they denied it. Apparently that doesn't matter....as long as you have insurance, the manufacturer won't help you. So, if I didn't have insurance, they'd help me. But because I DO have insurance, even if they deny it and won't pay for it, the manufacturer won't help me. He did say he'd look for other programs that might help. Nothing so far.

That's the way it goes. They have what they call "affordable housing, etc" but you have to be too poor to actually afford the "affordable" rent. And you have pharmacy insurance but they won't pay for stuff.

Arrrgggghhhh!!!

Back to the drawing board.
 
You know when I read stories like this it makes me sooo mad !
I know our NHS leaves an enormous amount to be desired these days, but at least for the vast majority, if the doctor says we need a certain medication... then we get it..no-one stops it..and we get it for FREE!...

I wish you could come here Jujube, and get it prescribed for you here...
 
i know our pharmacy denies coverage on meds that are too expensive in an effort to force the hands of the makers to bring the price down to keep them from gouging us.
 
Could you find out if the drug qualifies for the $2500 limit. I know youd have to pay out of pocket but but at least you could have it. It is totally unfair?
I think that limit,
only applies to a medicare part d plan, not a private like blue cross.

And in a part d plan, that limit is only for a drug the plan accepts, and not for any med that isn't included in their formulary list of meds covered.
 
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