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Unread 04-11-2013, 03:42 PM   #1
seesidegurl
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Default Pre-Authorization after years

Hello All. I'm new here and I was hoping I could get some input on an issue I'm dealing with. First off, I've been on Suboxone for about three years. I started at 8 mgs. and have worked my way down to 4...I'm starting to titrate down to 2 mgs this coming month. I'm on it due to an addiction to opiates to include Percocet, Opana & Fentynl Patches (my previous doc WAY over prescribed me - not all his fault, I never stopped him or said no - just took his advice). precipitated by recurring back problems. The Suboxone has been a life saver for me..I've not touched any other opiate in three years!

Although at first I had to pay for my medication, it quickly broke me and I ended up having to go on Medicaid, sadly. Now, for three+ years I've gotten my meds with no co-pay or problem through the insurance. I had to go to a new pharmacy this month because they discontinued the pills (to switch to a film) and this particular pharmacy was the only one that had any pills left (because my script was written for the pills and not the film). Well, this pharmacy says that now I need to get pre-authorization from my doctor EVERY time I fill an Rx. I've never heard of this...my insurance has not changed and I don't understand it. The pharmacy I went to to fill my last prescription gave me all but 4 of my pills saying they could only give me a 14 day supply (but obviously 56 pills is more than a 14 day supply - only thing I can think of is that they gave me a generic - something I've also never had - and they were able to give me more).

I went to my doc for a follow up today and told him what happened. He was even perplexed. He told me that in some cases some insurance carriers are very strict about making you go to psychiatric drug treatment programs if you are to get the meds through insurance. Even my doc said he really didn't think it was something I needed (I've been a model patient & really am trying to get off of them. To boot I was never that hard core of a user/abuser...I just took what I was given as prescribed). Now, I'm wondering what I should do...my doc has written me a new Rx for the film. I'm not due to fill it, though, until the end of the month.. That's fine because I have the pills - less the 4 the new pharmacy refused to give me. Should I go back to that new pharmacy and pick up the remaining 4 pills in my current Rx (which will require the doc's pre-auth business) or should I just struggle through lowering my dose those few days and wait and fill the film at my regular pharmacy? My doc said when he put my Rx in his computer he got the green light and nothing that said pre-auth so I'm wondering what the deal is? I really don't have the time money or wherewithal to attend some classes or something that even my doc agrees I don't need! On the same token, I'm afraid to wait until I'm due for the new film Rx and then have to wait for the pre-auth and possibly be without meds for days on end, be sick and unable to work (I don't earn much but what I do I desperately need to live). Has anyone had a similar situation and what would you recommend? Thanks for listening and for your time!
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Unread 04-11-2013, 04:20 PM   #2
NancyB
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Hi seesidegurl, welcome. Have you called your insurance company to see what they have to say? It seems rather strange - especially about not being able to give you those 4. Will you be going to that pharmacy again or back to your old pharmacy?

When you say you'll be short 4 pills, are they 8mg or 2mg pills?

Sorry for all the questions.

Nancy
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Unread 04-12-2013, 05:38 PM   #3
seesidegurl
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Hi Nancy: No, I haven't called the insurance yet, but I may try...just so much red tape with them! It is strange because the pharmacy I went to (new one) told me they could only give me a 14 day supply which at 2 - 2mg pills per day would be only 28 but they gave me 56??? The only thing I can think of is that they were able to give me a bit more than a 14 day supply because they gave me a generic (which I've also never gotten before).

I'm not quite sure what to do at this point. I'm thinking I won't bother to go back to the new pharmacy for the 4 pills (I'll just suffer with one per day for a few days). They probably won't even have any pills left anyway since all the other pharmacies were out and going to the film. I was just thinking that I'd wait and go back to my regular pharmacy when due with my next Rx for the film and hope for the best. Only thing is, if I wait until the insurance says they will fill I'll end up short and possibly having to wait for pre-authorization, which could take a while since I'm due on a weekend (doctor's office closed). Not quite sure what to do! I don't even know if my regular pharmacy will need pre-auth since my doctor said when he but the Rx in his computer nothing popped up (no red flag) like he thought he'd see if I needed the authorization????
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Unread 07-30-2014, 11:58 AM   #4
lahopeful
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Posts: 21
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The preauthorization is normally received from the insurance company it's basically just a letter that states they will cover x amount of cost of the prescription for a certain period of time ( normally a year at a time) until u need another preauthorization latter. One u get it you don't need another until the previous one expires. This is to ensure the pharmacy will get paid for their services. The reason you were told you needed to get it from your doctor is because the pharmacy tech was either too busy or just didn't know that he/she could do it themselves. Insurance changes from year to year regardless of a "change" in policy. They add new drugs, take obsolete drugs off and refuse to pay full amount for more expensive drugs. It's normally explained in a yearly. Encyclopedia sized newsletter from the ins company. Hope this helps.
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