Insurance update/ Xopenex not covered

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saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>bmombtoo</b></i>

u sure? The letter states it will no longer be covered under your pharmacy benefit!</end quote></div>


Right. Which simply means you need to ask your doc to do a prior authorization for the medication.

I've been working in this industry for 7 years so I promise you I know what I'm talking about.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>bmombtoo</b></i>

u sure? The letter states it will no longer be covered under your pharmacy benefit!</end quote></div>


Right. Which simply means you need to ask your doc to do a prior authorization for the medication.

I've been working in this industry for 7 years so I promise you I know what I'm talking about.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>bmombtoo</b></i>

u sure? The letter states it will no longer be covered under your pharmacy benefit!</end quote></div>


Right. Which simply means you need to ask your doc to do a prior authorization for the medication.

I've been working in this industry for 7 years so I promise you I know what I'm talking about.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>bmombtoo</b></i>

u sure? The letter states it will no longer be covered under your pharmacy benefit!</end quote>


Right. Which simply means you need to ask your doc to do a prior authorization for the medication.

I've been working in this industry for 7 years so I promise you I know what I'm talking about.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>bmombtoo</b></i>
<br />
<br />u sure? The letter states it will no longer be covered under your pharmacy benefit!</end quote>
<br />
<br />
<br />Right. Which simply means you need to ask your doc to do a prior authorization for the medication.
<br />
<br />I've been working in this industry for 7 years so I promise you I know what I'm talking about.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>crickit715</b></i>

i dont know what has been going on lately with "needing prior authorizations"....it seems that several of my daughters cf meds that were never any problem to get at the pharmacy suddenly have become a huge hassle! i wonder if it isnt a "precursor" to what we will experience with our new health care system. hhhmmmmmm???</end quote></div>

Although I am not a fan of proposed "healthcare reform," I think you hyposthesis about your formularly list for your insurance isn't related to current COngressional legislation.

Rather, it's related to the contract prices pharmaceutical companies negotiate with these insurance companies. Contracts are often up for renewal and if the terms aren't satisfactory, then boom! Your drug is "off formularly."

That doesn't mean you can't get it. It just means you have to do some more work to get it.

If it's a brand name drug, call the manufacturer of the drug and ask for a phone number of a local sales rep. They're armed and dangerous with tools to help you get the medication approved through a prior auth by working with your doc.

Xopenex is made by Seprecor - so call Seprecor. Aks for the name of the rep in your area or ask your doc for the name of the rep if she/he has it.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>crickit715</b></i>

i dont know what has been going on lately with "needing prior authorizations"....it seems that several of my daughters cf meds that were never any problem to get at the pharmacy suddenly have become a huge hassle! i wonder if it isnt a "precursor" to what we will experience with our new health care system. hhhmmmmmm???</end quote></div>

Although I am not a fan of proposed "healthcare reform," I think you hyposthesis about your formularly list for your insurance isn't related to current COngressional legislation.

Rather, it's related to the contract prices pharmaceutical companies negotiate with these insurance companies. Contracts are often up for renewal and if the terms aren't satisfactory, then boom! Your drug is "off formularly."

That doesn't mean you can't get it. It just means you have to do some more work to get it.

If it's a brand name drug, call the manufacturer of the drug and ask for a phone number of a local sales rep. They're armed and dangerous with tools to help you get the medication approved through a prior auth by working with your doc.

Xopenex is made by Seprecor - so call Seprecor. Aks for the name of the rep in your area or ask your doc for the name of the rep if she/he has it.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>crickit715</b></i>

i dont know what has been going on lately with "needing prior authorizations"....it seems that several of my daughters cf meds that were never any problem to get at the pharmacy suddenly have become a huge hassle! i wonder if it isnt a "precursor" to what we will experience with our new health care system. hhhmmmmmm???</end quote></div>

Although I am not a fan of proposed "healthcare reform," I think you hyposthesis about your formularly list for your insurance isn't related to current COngressional legislation.

Rather, it's related to the contract prices pharmaceutical companies negotiate with these insurance companies. Contracts are often up for renewal and if the terms aren't satisfactory, then boom! Your drug is "off formularly."

That doesn't mean you can't get it. It just means you have to do some more work to get it.

If it's a brand name drug, call the manufacturer of the drug and ask for a phone number of a local sales rep. They're armed and dangerous with tools to help you get the medication approved through a prior auth by working with your doc.

Xopenex is made by Seprecor - so call Seprecor. Aks for the name of the rep in your area or ask your doc for the name of the rep if she/he has it.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>crickit715</b></i>

i dont know what has been going on lately with "needing prior authorizations"....it seems that several of my daughters cf meds that were never any problem to get at the pharmacy suddenly have become a huge hassle! i wonder if it isnt a "precursor" to what we will experience with our new health care system. hhhmmmmmm???</end quote>

Although I am not a fan of proposed "healthcare reform," I think you hyposthesis about your formularly list for your insurance isn't related to current COngressional legislation.

Rather, it's related to the contract prices pharmaceutical companies negotiate with these insurance companies. Contracts are often up for renewal and if the terms aren't satisfactory, then boom! Your drug is "off formularly."

That doesn't mean you can't get it. It just means you have to do some more work to get it.

If it's a brand name drug, call the manufacturer of the drug and ask for a phone number of a local sales rep. They're armed and dangerous with tools to help you get the medication approved through a prior auth by working with your doc.

Xopenex is made by Seprecor - so call Seprecor. Aks for the name of the rep in your area or ask your doc for the name of the rep if she/he has it.
 
S

saveferris2009

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>crickit715</b></i>
<br />
<br />i dont know what has been going on lately with "needing prior authorizations"....it seems that several of my daughters cf meds that were never any problem to get at the pharmacy suddenly have become a huge hassle! i wonder if it isnt a "precursor" to what we will experience with our new health care system. hhhmmmmmm???</end quote>
<br />
<br />Although I am not a fan of proposed "healthcare reform," I think you hyposthesis about your formularly list for your insurance isn't related to current COngressional legislation.
<br />
<br />Rather, it's related to the contract prices pharmaceutical companies negotiate with these insurance companies. Contracts are often up for renewal and if the terms aren't satisfactory, then boom! Your drug is "off formularly."
<br />
<br />That doesn't mean you can't get it. It just means you have to do some more work to get it.
<br />
<br />If it's a brand name drug, call the manufacturer of the drug and ask for a phone number of a local sales rep. They're armed and dangerous with tools to help you get the medication approved through a prior auth by working with your doc.
<br />
<br />Xopenex is made by Seprecor - so call Seprecor. Aks for the name of the rep in your area or ask your doc for the name of the rep if she/he has it.
 
C

Cherylwithone

Guest
My daughter can not due albuterol. She does Xopenex. Just get the prior and the reason. Alot of the insurance companies hope that we don't follow through. I started to look at it this way. They are in a business to make money but at the same time if you or your doctor will do the paper work they will work with you. I have had it where they will turn down a $300 drug but will be willing to pay $400 for the exact same drug just did'nt name. IT's a pain but it works for some reason.
 
C

Cherylwithone

Guest
My daughter can not due albuterol. She does Xopenex. Just get the prior and the reason. Alot of the insurance companies hope that we don't follow through. I started to look at it this way. They are in a business to make money but at the same time if you or your doctor will do the paper work they will work with you. I have had it where they will turn down a $300 drug but will be willing to pay $400 for the exact same drug just did'nt name. IT's a pain but it works for some reason.
 
C

Cherylwithone

Guest
My daughter can not due albuterol. She does Xopenex. Just get the prior and the reason. Alot of the insurance companies hope that we don't follow through. I started to look at it this way. They are in a business to make money but at the same time if you or your doctor will do the paper work they will work with you. I have had it where they will turn down a $300 drug but will be willing to pay $400 for the exact same drug just did'nt name. IT's a pain but it works for some reason.
 
C

Cherylwithone

Guest
My daughter can not due albuterol. She does Xopenex. Just get the prior and the reason. Alot of the insurance companies hope that we don't follow through. I started to look at it this way. They are in a business to make money but at the same time if you or your doctor will do the paper work they will work with you. I have had it where they will turn down a $300 drug but will be willing to pay $400 for the exact same drug just did'nt name. IT's a pain but it works for some reason.
 
C

Cherylwithone

Guest
My daughter can not due albuterol. She does Xopenex. Just get the prior and the reason. Alot of the insurance companies hope that we don't follow through. I started to look at it this way. They are in a business to make money but at the same time if you or your doctor will do the paper work they will work with you. I have had it where they will turn down a $300 drug but will be willing to pay $400 for the exact same drug just did'nt name. IT's a pain but it works for some reason.
 
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