A run-around.......vent

[eyeamdry]

I wrote that I was starting Lyrica a few weeks ago.  Well, my rheum had given me some samples and were enough to see if I could take it without any problems.  I never took a 3 x a day dose, but took one at night for awhile and seemed just fine.  I called the rheum's office and left message that I was ok and please call in a regular prescription so I can start the meds.  I made sure I included the pharmacy phone #.  I finally got a call from the pharmacy my RX was in.

My husband was there for something else and they said my RX was $88 and not covered by ins.  He didn't pay for it.  I went in later to see what the problem was.  Seems it wasn't "approved" as this requires prior approval.  OK, I thought I can pay the $88 and at least try it for a month and see how it works.  I'd try and get my money back minus my co-pay.  I got home and there were 30, THIRTY.....pills in the bottle.  They had prescribed one per night.  Well, a therapeutic dose for Lyrica is 3 x a day of different mgs.  So, I paid $88 for about 10 days worth.

I can't go into all the details as this would be 13 pages long.  Rheumy must not know Lyrica needs prior approval?  Unlikely.  They called in a dose that isn't enough to last more than 10 days?  Once a day.......duh.  I call the rheum office and they know "nothing" of course, and it's all muddled up.  The doc said call ins, ins said call the doc, pharmacy said call ins and doc etc.  I should note rheum is 75 miles away or I would have gone to the office.  I gave my GP a jingle and said I was having problems.  THEY knew it needed prior approval.  THEY knew once a day isn't a real dose.  THEY knew about you needing to try several meds prior to being able to order Lyrica.  It so happens that I have tried neurontin, tegretol and am currently taking Effexor, which covers the requirements.  My RHEUM apparently didn't know that, and certainly didn't ask me.

I'm out the $88 but think this will be approved by my GP's involvement.  I have wasted about 3 days on the phone getting recordings, leaving messages and waiting for "a representative."  I am ticked that my RHEUM'S office could be so dumb.
If anyone is going to try LYRICA--be prepared, you might have to go through the gates of Heck depending on your insurance.  Lucy

[Scottietottie]

Hi Lucy

Considering what's been going on I think that was a very controlled vent! You must be seeing red and feeling like turning the air blue! Thanks for warning others. Sorry that you're out of pocket like hat too.

Take care - Scottie 

[Pooh]

Lucy dear, have you checked the placement of your horseshoe lately?   Are the ends pointed up or down?  If in the down position, please turn over, you can't anymore of your luck to run out.

Take care dear and I sure hope things start running smoother for you. 

Hugs, Pooh

[eyeamdry]

I usually have to be careful and not tick my doctors off.  I really need them, especially the GP.  So, I always temper my responses.  Sometimes it's more than I can do.  I have even let the rheum's office off easy on this,but I am going to ask they reimburse my RX $$$ because they were so DUMB.  Fat chance, but i can always ask.      Lucy

[irish]

Lucy, Been there-done that. I get so sick of having to be on the phone trying to get things straightened out. There are times I have taken a few days off just to get my head on straight again. It takes so much energy!!!

I have 3 bottles of long acting Mestinon amounting to about 150$ that was ordered by doc and one was filled inadvertently by my pharmacist and I didn't notice until I got home. I always check my bottles now so I can refuse them while at the drug store. Hope you can get settled down after that.

Also, for any of you on Social Security I am sure you have already figured out to take your book with covered medications with you to the doctors appt. It is something we can't remember and can't keep up with. I am sure the docs have problems at times also with all the different insurance companies. Irish

[Skylar]

Been there, done that, bought the T shirt LOL I've learned not to pay for the medication, instead I go back to the Dr. to get the ball rolling to get my insurance to pay for it. It is confusing for the Drs office too because everyone's insurance has a different list of what medications they will pay for and what hoops you have to jump through to get them to pay for some. Even within the same insurance, different groups will have different lists and rules. It's so complicated and it really only hurts us the patients. I wouldn't blame the Dr. for not knowing it's not covered under your health plan, but I would blame them for not prescribing the right number of pills. Anyhow, you have enough to maybe get you through until your insurance will pay for them.

I hope you get it straightened out soon.

Skylar

[eyeamdry]

I've learned not to pay for the medication, instead I go back to the Dr. to get the ball rolling to get my insurance to pay for it. It is confusing for the Drs office too because everyone's insurance has a different list of what medications they will pay for and what hoops you have to jump through to get them to pay for some.

Skylar, this doc is 75 miles away so I was unable to just go over to her office and straighten things out.  I worked for an HMO about 10 years ago and doctors are supplied with formularies and they are updated almost monthly.  My insurance is the most common one and I know the doc had to know the ins and outs of Lyrica because she was the one who suggested it to me.  She carefully gave me two different strength samples and written instructions.  It's through the communication with her office via messages on phone mail that things got screwed up.  My mistake was not knowing it was only for 30 pills. 

My GP's office is still working on this for me.  Apparently it's complicated enough to cause some hoops to jump through.  I do have a clerk's private number for the rheumy's office now.  I ALWAYS get voice mail.  The calls are long distance for me too which is another pain.  I'm sure my GP will get things going.  Now, I hope it helps after all this hoopla.  Lucy

[eyeamdry]

Well, now, more than a week later.............I had to go to the hospital for a check of my carotid arteries and thought I'd stop off at my GP's office on the way home.  I had called the office again and am getting no where.  I'm being told "they are working on it" but no one seems to know what "it" is.  My fave nurse was given this job by me thinking there wouldn't be any of this happening.

I went to the office unannounced.  Tried explaining what the "problem" was. I kept getting asked "how do you know that Lyrica isn't prescribed once per day?"  Well, duh, I know that's why.  I read their website.  Did find out that the GP's office had called an RX in to the pharmacy...but FOR 30 TABLETS.  iIT ALSO NEEDED PRIOR AUTHORIZATION AND HAD BEEN THERE SINCE 7-15. 

It was suggested I see the P.A. today and I agreed.  In fact, I suggested this over to the phone when I first started working the GP's office on this.  Totally offered to go in if needed.   I see the P.A. today and he gives me a hard time.."how do you know.."   Also I told him that i HAD TAKEN ENOUGH OF THE ALTERNATE MEDS TO KNOW THEY WON'T WORK.  He wanted to know where in my file.  Well, gee, I've gone there 40 years and have never had my hands on my file.  That's the real problem, no one wants to look up documentation in my huge file.     I asked the PA if he wanted the rejection letter I got from my ins company and he said, "sure."  I gave it to him and he told me that was for me to take care of.  I explained that I could not profess to have taken all these pills and have them believe me, they need a drs verification. 

PA then wanted to know WHO had worked with me and I didn't want to say, but did.  I said "don't yell at her, she's usually very good."  He said, "it would have been good of her to let us know she was working on this."    Guess who was standing outside the door when I walked out of the exam room?  Yep, the nurse.  I spoke to her and left.  By this time, I was really in torment and felt like tormenting someone.  My worst eye was throbbing and burning so I'm driving home with one eye closed.  I came home and took two Vicodin and lay down for a couple of hours.  It p-**ed me off the PA was so snotty to me.  I know what the problem was and it was that I knew more than he did about prescribing Lyrica.  I didn't try to tell him how much to prescribe, just that one pill a day is not it.   He assured me that HE would take care of this.  We'll see.  I don't care now if I do get a RX for Lyrica.   Some things are just not worth it.  I was already rooked of $88 for 30 pills thinking it was for 90.  I didn't fall for that one a second time.

I'll let ya' all know later what happens.  Lucy