OMGosh, the cost of the patches , which are hung up again!

[buddy]

I just got an email from the pharmacy that the catapres patches have not yet been renewed...they list the medication by part of the number and the quantity so I know it is the patches...

8 patches for $879. So each time we lose a patches in a pool or something it is like throwing away over 200 dollars. That HAS to be a rip off. There is a generic but it is awful. really huge and burns. I have been working on this for two weeks and now we are wearing our last patches so they sure as heck better get this fixed. I am afraid our docs are gonna be out an this is going to be ugly due to the holidays. That is why I started so early.

 

[klmno]

OUCH!! Although I admit, I have no idea what type of patches those are.

 

[buddy]

OUCH!! Although I admit, I have no idea what type of patches those are.

Clonidine in patch form. He wears two Catapres patches per week. yeah, ouch is right...glad insurance pays. they are telling the pharmacy that they changed their procedures. well, fine but to take over two weeks to do a refill is not ok. These are the patches that affect blood pressure and once they come off, there is a risk of a blood pressure spike and stroke. He is on his last two and they should last till Wed unless something happens that is why I always like to have them ordered a week in advance in case things like this happen. So, we are on our back up two and if they come off??? the E R I guess. It is amazing that they think that would be a less costly alternative...

 

[klmno]

Ohhhh....any chance psychiatrist or pediatrician would have some samples they'd give you?

 

[DammitJanet]

He cant take the pills? I had those patches years and years ago when the doctors gave them to me. I wonder if you could have pills as a back up for emergencies.

 

[buddy]

OK the doctor talked to insurance...after over two years of prior authorization on this medication from the pediatrician because he needs it on board in the morning (meaning we already tried the pills only) they are saying that they can't approve it until we try the pill form first. THey can't see in their own records that we already have done that. So that means the new doctor needs the old medicaton records and to pour thru them and then to send copies to the insurance of what they already have to show that he has already been on the pill form, sigh... and then they need to show that we tried the generic form of the patch when that came out a year ago in OCT....oh my how can an insurance company not see this is a huge problem??? Thanks for the vent...

 

[DammitJanet]

Buddy...I know how idiotic insurance is. I have had to go rounds with them myself. Medicaid can be extremely difficult.

 

[buddy]

sure he can take tons of pills, but then the medications are not on board in the morning, and you want to be here when he falls apart and kicks walls and I cant get him to take any other medications lol? that is why we put him on the patches and it was a miracle

now they are saying that they dont see he has ever been on it ever ever ever...oh really? I promise you the ones on his butt right now were not stolen. And I did not pay over eight hundred bucks a month for them myself....oh gosh

 

[DammitJanet]

Get the pharmacy to pull all the records of the past two years of where the medications were filled and billed. That will help. Then have the doctor...whomever prescribed these to fax it to whomever is giving you this runaround. That will show them that they have been paying for them.

 

[buddy]

OH gosh so the day ends, the departments close and no one is open on Monday of course. We left it that both docs the old one and the new one are working on trying to get records together to just start over and write a pre auth. saying when he tried pills only and then when he tried the generic. Seems some little tiny procedure change don Dec 12th and I called on the 15th so some extra piece of info is needed.... But they still say that they never did any pre auth. ever before. Pharmacy and doctor say they did but I dont even care. Just do what you need to do to get the patches. duh.

 

[tiredmommy]

Chances are that the pharmacy is open today... Janet is right that they can probably pull your records.

 

[buddy]

Yes, that was a great idea, I had her do that and then she called the doctor and insurance to send it so they have the dates and which forms of the medications we used.  Thanks guys!

 

[DammitJanet]

medicaid did just do some federal changes so this may be caused by that. they are refusing to fill lipitor anymore so now its generic

 

[buddy]

update: still no patches, still no authorization, getting angry.... they need to be changed tomorrow

 

[buddy]

Another day, another NO patches ....tomorrow is change day and so who knows. I do have it confirmed straight from our pediatricians mouth that he himself took it over and sent a prior auth request. He said he will call in generic ones tomorrow to just have him wear till the auth comes thru if they dont come by tomorrow. He is really a good guy. So glad he is back this week.

 

[DammitJanet]

Call the supervisor at Medicaid careline that is on the back of the medicaid card. There is some 800 number on there. You may have to go through some idiotic phone tree to reach a live person. If you have to keep punching numbers to get to the representative, thats who you want. You want a live person. LOL. The computer isnt going to be able to help you, and probably the first person you get on the line isnt going to be able to help you. You will need someone's supervisor so you might as well tell them that at the start. I try to ask them that at the start. Say to them, I realize what I am going to tell you is going to be above your pay level to help me with, do you still want to hear the whole tale or do you want to just go ahead and transfer me now and save yourself a half hour phone call? Lol.

I ended up on the phone with some idiot at medicaid when I was trying to find out with her if I could get it approved to have pre-authorization to have my dental work done at a local dentist for denture work because they want to send everyone over two hours away here. My dentist had already referred me for the denture work. This imbecile kept going on about how did I need a referral. NO...I had one. Did I need transportation. No...I understood Medicaid provided that but my issue is I cannot physically ride over 2 hours with my physical disabilities comfortably. My knees and my back just kill me when I travel that far and to drive that far and have about 13 teeth out and dentures put in in the same day just didnt sound like a fun time to me. Not something I would be able to do. I could maybe manage it in my own town. This idiot kept offering me a ride on the van. Finally I told her I couldnt even ride the van because I simply cannot ride that far in a vehicle...period. She finally told me my dentist could call for pre authorization if they so chose. I dont believe her.

 

[buddy]

OH geepers Janet. Yes, I did call the help desk too. they finally figured out where the issue happened, some policy thing on the 12th and I had called for our refill on the 15th. but did anyone say anything back then? NOPE. Still it meant they had to go thru the process again. So today I found out the medication. assist. at the pediatricians office did the opposite of what I asked, the pharmacy said that the medications were authorized but no price went thru so they would not let me buy them yet, And dr said, well we never did send the prior auth...so turns out that since I had requested all the records be sent to the psychiatrist for future since she is taking over all the behavior medications, they just went ahead and did it and in two days it is done. Now I just got a call from the pharmacy and the payment went through! YIPEE! Gonna go get them tomorrow morning (the pharmacist gave me two of them to take home knowing the payment would go thru at some point once they had the prior auth confirmed.

What a bunch of silliness. Every year there is at least one drama like that with them. So crazy. All it would have taken is a note, the medication you have been on for the last several years has been removed from our formulary, you will need to do a prior auth before the next refill...or something like that. Or when the pharmacy found out the refill on an already authorized medication did not go thru??? BIG read flag.

OH well, it is over now.

Janet, I sure hope you get the closer appointment. That would be torture to ride and worse to ride home after all of that.

 

[DammitJanet]

Medicaid is famous for telling you AFTER something goes off their approval list. I just got a letter telling me they have decided to deny eye exams for anyone over the age of 21. Now they had already decided to deny eye glasses for anyone over 21 but I was going to go get an eye exam and then get the script and have it filled online at one of those cheapie places. Now I have to go to a regular doctor and do it all on a very low check.