Non-formulary Drug - Update at the end

M

Mommafirst

Guest
Non-formulary Drug

UGGGGHHHH!!! I'd definitely fight this, ESPECIALLY if it is not stated in the program benefits. If you haven't already done so, get the social worker involved at the CF center and consider getting the HR person at your work involved as well.

I'm sooo sorry, this sucks!!!
 
M

Mommafirst

Guest
Non-formulary Drug

UGGGGHHHH!!! I'd definitely fight this, ESPECIALLY if it is not stated in the program benefits. If you haven't already done so, get the social worker involved at the CF center and consider getting the HR person at your work involved as well.

I'm sooo sorry, this sucks!!!
 
M

Mommafirst

Guest
Non-formulary Drug

UGGGGHHHH!!! I'd definitely fight this, ESPECIALLY if it is not stated in the program benefits. If you haven't already done so, get the social worker involved at the CF center and consider getting the HR person at your work involved as well.

I'm sooo sorry, this sucks!!!
 
M

Mommafirst

Guest
Non-formulary Drug

UGGGGHHHH!!! I'd definitely fight this, ESPECIALLY if it is not stated in the program benefits. If you haven't already done so, get the social worker involved at the CF center and consider getting the HR person at your work involved as well.

I'm sooo sorry, this sucks!!!
 
M

Mommafirst

Guest
Non-formulary Drug

UGGGGHHHH!!! I'd definitely fight this, ESPECIALLY if it is not stated in the program benefits. If you haven't already done so, get the social worker involved at the CF center and consider getting the HR person at your work involved as well.
<br />
<br />I'm sooo sorry, this sucks!!!
 
H

hmw

New member
I agree with getting the attorney involved, because as you say- if there is NO OTHER OPTION, it should be covered. This is what the dr wants for him, this is what is medically necessary for him, and he will be overdosed on the pills.

If they cover Actigall/Urisidol for everyone else, then they need to cover it for him too; hiding behind the 'no coverage for compounding' is ridiculous. That should not apply when it's a covered medication and all the pharmacist has to do is stand there, dump those very same capsules that they cover for everyone else into a bottle and mix them up with some cherry bile that costs pennies... <img src="i/expressions/face-icon-small-mad.gif" border="0">

It's not like you are requesting the compounding of something 'unique' (i.e. a med specially formulated with no coloring or certain allergens in it, for example.) I hope dropping the idea of mentioning it to your attorney is enough to get it covered.
 
H

hmw

New member
I agree with getting the attorney involved, because as you say- if there is NO OTHER OPTION, it should be covered. This is what the dr wants for him, this is what is medically necessary for him, and he will be overdosed on the pills.

If they cover Actigall/Urisidol for everyone else, then they need to cover it for him too; hiding behind the 'no coverage for compounding' is ridiculous. That should not apply when it's a covered medication and all the pharmacist has to do is stand there, dump those very same capsules that they cover for everyone else into a bottle and mix them up with some cherry bile that costs pennies... <img src="i/expressions/face-icon-small-mad.gif" border="0">

It's not like you are requesting the compounding of something 'unique' (i.e. a med specially formulated with no coloring or certain allergens in it, for example.) I hope dropping the idea of mentioning it to your attorney is enough to get it covered.
 
H

hmw

New member
I agree with getting the attorney involved, because as you say- if there is NO OTHER OPTION, it should be covered. This is what the dr wants for him, this is what is medically necessary for him, and he will be overdosed on the pills.

If they cover Actigall/Urisidol for everyone else, then they need to cover it for him too; hiding behind the 'no coverage for compounding' is ridiculous. That should not apply when it's a covered medication and all the pharmacist has to do is stand there, dump those very same capsules that they cover for everyone else into a bottle and mix them up with some cherry bile that costs pennies... <img src="i/expressions/face-icon-small-mad.gif" border="0">

It's not like you are requesting the compounding of something 'unique' (i.e. a med specially formulated with no coloring or certain allergens in it, for example.) I hope dropping the idea of mentioning it to your attorney is enough to get it covered.
 
H

hmw

New member
I agree with getting the attorney involved, because as you say- if there is NO OTHER OPTION, it should be covered. This is what the dr wants for him, this is what is medically necessary for him, and he will be overdosed on the pills.

If they cover Actigall/Urisidol for everyone else, then they need to cover it for him too; hiding behind the 'no coverage for compounding' is ridiculous. That should not apply when it's a covered medication and all the pharmacist has to do is stand there, dump those very same capsules that they cover for everyone else into a bottle and mix them up with some cherry bile that costs pennies... <img src="i/expressions/face-icon-small-mad.gif" border="0">

It's not like you are requesting the compounding of something 'unique' (i.e. a med specially formulated with no coloring or certain allergens in it, for example.) I hope dropping the idea of mentioning it to your attorney is enough to get it covered.
 
H

hmw

New member
I agree with getting the attorney involved, because as you say- if there is NO OTHER OPTION, it should be covered. This is what the dr wants for him, this is what is medically necessary for him, and he will be overdosed on the pills.
<br />
<br />If they cover Actigall/Urisidol for everyone else, then they need to cover it for him too; hiding behind the 'no coverage for compounding' is ridiculous. That should not apply when it's a covered medication and all the pharmacist has to do is stand there, dump those very same capsules that they cover for everyone else into a bottle and mix them up with some cherry bile that costs pennies... <img src="i/expressions/face-icon-small-mad.gif" border="0">
<br />
<br />It's not like you are requesting the compounding of something 'unique' (i.e. a med specially formulated with no coloring or certain allergens in it, for example.) I hope dropping the idea of mentioning it to your attorney is enough to get it covered.
 
R

Ratatosk

Administrator
Staff member
Was a little concerned when I picked up the script at noon that I'd be responsible for 100% being they told me compounding wasn't allowed. But they view it as a non-formulary. I DID have to pay 70 cents more -- $80.80 instead of the $80.10 I paid last month.

Oh and it says right on the letter that appealing is NOT an option. Yeahhhh, righhhhht! We'll see about that. Drives me bonkers!
 
R

Ratatosk

Administrator
Staff member
Was a little concerned when I picked up the script at noon that I'd be responsible for 100% being they told me compounding wasn't allowed. But they view it as a non-formulary. I DID have to pay 70 cents more -- $80.80 instead of the $80.10 I paid last month.

Oh and it says right on the letter that appealing is NOT an option. Yeahhhh, righhhhht! We'll see about that. Drives me bonkers!
 
R

Ratatosk

Administrator
Staff member
Was a little concerned when I picked up the script at noon that I'd be responsible for 100% being they told me compounding wasn't allowed. But they view it as a non-formulary. I DID have to pay 70 cents more -- $80.80 instead of the $80.10 I paid last month.

Oh and it says right on the letter that appealing is NOT an option. Yeahhhh, righhhhht! We'll see about that. Drives me bonkers!
 
R

Ratatosk

Administrator
Staff member
Was a little concerned when I picked up the script at noon that I'd be responsible for 100% being they told me compounding wasn't allowed. But they view it as a non-formulary. I DID have to pay 70 cents more -- $80.80 instead of the $80.10 I paid last month.

Oh and it says right on the letter that appealing is NOT an option. Yeahhhh, righhhhht! We'll see about that. Drives me bonkers!
 
R

Ratatosk

Administrator
Staff member
Was a little concerned when I picked up the script at noon that I'd be responsible for 100% being they told me compounding wasn't allowed. But they view it as a non-formulary. I DID have to pay 70 cents more -- $80.80 instead of the $80.10 I paid last month.
<br />
<br />Oh and it says right on the letter that appealing is NOT an option. Yeahhhh, righhhhht! We'll see about that. Drives me bonkers!
 
B

Buckeye

New member
WTH, they can't tell you that appeal is not an option. That's ridiculous. I hate insurance companies, they just try to make our lives hell for the heck of it (and to save them a few dollars)!
 
B

Buckeye

New member
WTH, they can't tell you that appeal is not an option. That's ridiculous. I hate insurance companies, they just try to make our lives hell for the heck of it (and to save them a few dollars)!
 
B

Buckeye

New member
WTH, they can't tell you that appeal is not an option. That's ridiculous. I hate insurance companies, they just try to make our lives hell for the heck of it (and to save them a few dollars)!
 
B

Buckeye

New member
WTH, they can't tell you that appeal is not an option. That's ridiculous. I hate insurance companies, they just try to make our lives hell for the heck of it (and to save them a few dollars)!
 
B

Buckeye

New member
WTH, they can't tell you that appeal is not an option. That's ridiculous. I hate insurance companies, they just try to make our lives hell for the heck of it (and to save them a few dollars)!
 
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