I took my son to the doctor the other day for flu like symptoms. She prescribed cipro for him and told us to keep him home over the weekend. Well, when I went to the pharmacy to have this filled I was told that our insurance company requires that they "approve" cipro and since it was late Friday it would be impossible to get it approved. We ended up calling the Doc and getting the prescription changed. This really pee'd me off!!!! Who the heck do these insurance companies think they are?????? If a DOCTOR prescribes cipro....who are they to say that they have to APPROVE this prescription since they have not seen the patient, nor do they know what it is being given for??? HOW DARE THEY???? The insurance company is Coventry and they ARE going to get a call from me!!!
Anyone else run into this??
Oct 30, '01
They've got us up against a brick wall is where they're at.
What else could you do but call for a replacement. I guess you could have paid the big bucks and then tried to collect.
MY Blue sent me a letter saying they were investigating my ZANTAC!!! (Generic is $11 for 60) They wanted to make sure it wasn't for casual use. And then they said they would only pay for 90 every 90 days unless-get this- my GI doc CALLED their pharmacy consultant. Written notification would not be accepted.
Sheesh I guess I could get an Rx for one of the proton pump thingies....think they'd rather pay for that?
Oct 31, '01
what a bunch of crap. they are always doing things like that because they can.
i once had bronchitis and the generic form of the hydrocodone syrup they gave me was ineffective. i had been to the doc. she could see the difference. she ordered "no substitution"
i had to pay for it myself. a few years later i recieved notice of a class action suit against my hmo, asking if i would like to be included. this patient was suing the hmo for basically the same thing that happened to me. somehow he got a list of everyone across the country that this had happened to and contacted them. of course we won the suit. i got my money back for the whole cost of the script.
we need more ppl like this.
its my understanding something like this is going on with lorazepam...anybody know anything about that?
Nov 1, '01
Our hospital uses a formulary. If we have the hospital's insurance we can get our scripts filled there. Cipro is not on our formulary, Tequin is used instead. If our doctor writes a RX for a drug not on the formulary, the pharmacy automaitcally switches it to the approved formualary drug. If we want the drug that the doc wrote for, or the doc wrote no subsitute, we have to pay the difference. That can add up to some big bucks. Zantac is the H2 antagonist on the formulary, and Protonix is the proton pump inhibitor. Oh, yeah. They also subsitute ibuprofen for all the NSAIDS like Relafen, Cataflam, etc. They were even subsituting ibuprofen for Vioxx and Celebrex. I hit the roof on that one! My husband has GERD and a bad back. Our doc prescribed Prevacid for him (which got changed to Protonix) and Vioxx for his back. The doc did not want him to take ibuprofen because of his GERD. The pharmacy said I would have to pay the diffference. Since I work at a small county hospital, I started talking to some of the docs on staff (including mine) about the pharmacy subbing the Vioxx with ibuprofen. The docs weren't too impressed either and Vioxx soon ended up on the hospital formulary. I don't care how much a phamacist tells me that if drugs are in the same class, they all should work the same. Phooey!! People are all different and of course meds are going to be effective for some people and not for others. Maybe some day in this country the people who are actually working day to day with the patients will get to make some of the decisions the affect us!! LOL!!!
I am afraid with the national emergency that exsists now healthcare is going to be put by the wayside, again!!
Nov 1, '01
Dee, that really ticks me off!!! How dare they substitute anything with something you can buy over the counter and have the nerve to price it as an Rx!!!!
I share your concern about the way healthcare will "fall along the wayside" but remember the majority of living Americans are baby boomers. You know, the ex-hippies (sell-outs) that are CEO's and bean-counters who now run these damned HMOs and pharmacies. When their peers get into the senior citizen range, and crappy substitute Rx's affect them, I have a feeling we'll start to see changes.
Nov 1, '01
Our pharmacy will not order acne meds, infertility meds, erectile dysfunction meds, meds for weight loss, smoking cessation meds, or BCP. I can kind of understand the meds dealing with sexual reproduction and performance, but the smoking cessation drugs? I think it would be cheaper to get the Zyban now, then pay for that employee's meds and healthcare when the develop a smoking related illness. Insurance companies make me so mad! I could never do UR because I would lose my temper really quick with the insurance people. My philosophy is that insurance companies are out to put the screws to you, period. I could go on for days and days about this topic.
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