Migraine

Yesterday I called in a refill of my Fiorinal, which is my rescue med. It's my rescue med. I use very few of them. However, the prescription has not yet expired. The bottle shows five more refills available.

When I got home, I had an automated message that said my prescription was delayed while they checked with my insurance. This morning, I called to find out what the problem was. The pharmacist asked if I took 80 mg. propranolol daily. I said I did, but what did that have to do with Fiorinal? She said the insurance was saying that since I was now on a maintenance dose of propranolol, I shouldn't need the Fiorinal anymore. She said she would call them. I told her to call me if I or the doctor needed to call them about it.

I want to nip this in the bud. After all, are they next going to say I don't need my Axert? The nerve of them, to try to tell me I don't need a med my doctor has ordered.

Yeah, the head banging is exactly what I would do!

What gives the isurance the right to decide what you need over your doctor???!!!! I get the same look every time I fill my 25mg topamax, and then 2 weeks later need to fill my 50mgs - I tell the pharmacy every time - I take 75mgs a day people! It's easier to have two different pills because of what the insruance allows then gobble up 3 25's a day! They don't care, but at least my pharmacy knows me and does it.

As far as the insurance, like you said, what's next? Thank god they still let you fill your preventive!!!

I just went through a lot of nonsense getting my propranolol switched from the local "retail" pharmacy to the mail order pharmacy. The mail order pharmacy kept losing my doctor's fax, they just couldn't seem to get it from the fax machine to wherever it needed to go to actually get filled. That situation is resolved now, and a 90 day supply of propranolol arrived in the mail yesterday. And that is a separate issue from my Fiorinal, and the (lack) of right the insurance has to say I don't need it. Maybe if they had to experience one of my migraines when my Axert has failed?

Yet I don't really think I could wish that on anyone.

Baby steps I guess, right? We can be thankful for the propranolol arriving!

Now onto the Fiorinal battle huh!

Always something with insurance - I swear!

Hooray! I guess the pharmacist was successful when she talked to the insurance people. I got another automated message that my Fiorinal is now ready to be picked up. I was getting ready to do battle; I was going to give a heads up to my neurologist's office, then call the insurance myself. But I didn't have to.

Fiorinal is one of my rescue meds too. In order to avoid the insurance denial nightmare my neuro wrote it for "one per night". When I first read how he wrote it I had to ask was that really what he expected me to do because that wasn't how I used it. He explained that he had patients get denied before....

I'm so glad you got everything taken care of Nut.

Thank goodness, nut. I didn't want to have to flip out on anyone!!!

Nut, I am *very* happy to hear it worked out.

Nancy, I can tell you I felt like "flipping out" on someone. I was trying to get calmed down to talk to the insurance in a civil manner when the call came that the prescription was ready. I was going to give the doctor's office a "heads up" before I called the insurance, so they would be ready to back me up.

I used to have trouble with the pharmacy having my Axert available. They never had all 12 I was supposed to get. They would give me however many they had, and then I would have to go back several days later to get the rest. I wanted to continue using this pharmacy if I could, though, because it is only a block away.

When I told my neurologist about the problem, she had her office people call both the pharmacy, and the company that made Axert--they definitely want their medication available for sale. Since then, I haven't had any trouble. I guess for the pharmacy, the possiblity that a doctor might tell patients, "Don't bother going there--they don't keep the medicine in stock," was a risk they wouldn't take.

My pharmacy does the same thing with Maxalt, it is partially filled but then, when I go back I still have to pay the co-pay again! I never used to have to do that before. It may be that I am exceeding the limits for the month?

That doesn't sound right. You can't exceed the limits set by the insurance because you'd need pre-authorization for that, and I would hope the pharmacy wouldn't have limits.

quote:

My pharmacy does the same thing with Maxalt, it is partially filled but then, when I go back I still have to pay the co-pay again! I never used to have to do that before. It may be that I am exceeding the limits for the month?

That's ridiculous!

Are they charging you for each time you pick up a partial fill at the time you pick them up? If they're doing that, then the computer might be treating the prescription as different transactions, which might assign a co-pay to each.

Whenever my pharmacy does a partial fill, they never charge for the first part when I pick it up. They mark the bottle "partial fill", and when I pick up the remainder, then I pay for the whole prescription at once.

Then again, I don't have a co-pay thingie on prescriptions. The way our plan goes is that you pay the entire total, minus any negotiated adjustments, when you pick up the med. Then, if your deductible is met, you're reimbursed the amount the plan covers. If you haven't met the deductible, then it's applied. Nothing is tiered or anything like that. Every med is covered 80/20 once I've met my deductible.

quote:

Originally posted by LauraHOST:
My pharmacy does the same thing with Maxalt, it is partially filled but then, when I go back I still have to pay the co-pay again! I never used to have to do that before. It may be that I am exceeding the limits for the month?

In the days when the pharmacy didn't have all 12 Axert in stock at once, I paid the copay when I picked up the first however-many. When I picked up the rest, it didn't cost anything. One time, I think, they tried to charge me another copay. I protested, and they didn't charge me. Laura, maybe you should ask for the pharmacy manager and ask about this?

You guys have a great point! Before I moved I didn't have this issue but then again, I figured it had to do with the region I'm in. For some reason DH's insurance is by the region he is stationed in. Same company but different contacts. Crazy huh?

My insurance limits me to a certain amount of Maxalts per months or per quarter. Like in November, I think, I was able to get 14 but last time 6, then 9 so it is a touch and go...however, I am now armed with a letter about unfair treatment. (I think that is phrase).

As for paying each time, you might have a point, that it is being treated as a new prescription each time when it should be a partial.

New project for Laura....

I just came back from RiteAid and was able to get both my rescue meds and they ordered my Zomig NS which is already pre-approved and will be there tomorrow.

No problem this time....odd huh?