Sunday, October 24, 2010

Pharmacy Frustrations

Pharmacy Rx symbolImage via WikipediaFor the most part, I have been fairly happy with my current health insurance.  We have a fairly low copay with our primary care physician.  If we need any vaccinations or tests done, they are all covered.  There is no deductible to meet, other than $50 for our prescriptions.  While a great deal of the premium is covered by my employer, our share is fairly expensive.

Last year at this time, I had the lowest cost option from the options my employer had offered.  Unfortunately, we discovered that there were a lot of things that weren't completely covered, plus we had a deductible that we had to meet.  My current plan costs me nearly twice as much as last year, but it is worth it to not have the deductible.

As I said, I have been fairly happy with the current plan.  There have been some things on the pharmacy side of the coverage that have been a bit frustrating and/or confusing.  We currently have a three tier formulary plan for prescriptions.  Our copay is $10 for generic, $25 for branded drugs that are on the formulary, and $40 for branded drugs that are not on the formulary.

At times, the formulary has been particularly frustrating because it is constantly changing.  I had one prescription that the first time I had it filled was on the formulary, and was charged $25.  When I went to have it refilled, it was no longer on the formulary and they wanted to charge me $40.  Then there was a generic medication that we thought should be $10, but they said it wasn't on the formulary, so we ended up paying close to $40.

Our most recent battles with the insurance company have involved prescriptions for my son.  There have been two occasions where the insurance would not cover the full amount of the prescription that the doctor prescribed.  One involved a medication that came in 10mg tablets and 20 mg tablets.  The doctor wanted our son to take 30 mg per day.  They would only allow one 20mg table per day.

The second one was a little more vexing.  The doctor had been prescribing a 1mg tablet to be taken twice per day.  With some of my son's recent issues, the doctor decided to increase the dosage to one tablet in the morning, and two tablets at night.  In their infinite wisdom, the insurance company will only cover two tablets per day.  I guess they know more than the doctor. 

The most frustrating thing about this one is that the medication comes in 1mg, 2mg, 3mg, and 4mg.  If the doctor wanted to prescribe two 2mg tablets per day for a total of 4mg per day, and they would cover that.  However, they will not cover three 1mg tablets per day for a total of 3mg per day.  To my simple way of thinking, that just doesn't make sense.
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  1. My wife actually works for UnitedHealthCare as a claims processor, and we are subjected to the same "stuff."

  2. I have 5 seperate pill bottles here at my side, and with 2 of them, I have to be drug tested every time I visit my doctor to be sure I am taking them, and not out selling them on the street. I fight with my Ins. provider every month about my medications and the dosage, and can tell you the questions they ask by heart.
    It makes me so mad sometimes when I talk to them, and I always end up reminding them that they never had a problem taking my payments for the past 18 or so years with no claims, why fuss now ?

  3. Fish, I guess we all are subject to it.

    Lot, for some reason I fear it will get even worse when we are subject to the full force of Obamacare



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