Note from pharmacist

[Cyborg]

I probably spent over an hour on the phone last month arranging for the prior authorization for my test strip prescription. I finally got everything resolved and approved for testing 12 times a day and picked up my 350 test strips last month. The prior authorization is good for one year. I go to get my 350 test strips this morning and this is the note I was given by the pharmacist:

Insurance flagged #300 for 30 days, only will pay for #250 for 30 days - which is enough.

I can understand UHC constantly screwing up, but to get the pharmacist's opinion on how many test strips is enough does not please me...

[Injecto]

:mad:

If you got pre-authorization, then punishment is due. I have no patience for this kind of ****.


When I was first dxd, I was told that I can only get enough strips for 4 tests per day and they would only give me enough strips for a rolling 20 friggin days no word of a lie. I had to go in every 20 days to get 100 strips to last me my 4 daily tests. I finally got approval to test around 8 times per day, with a rolling 10 days, so I had to go into the pharmacy every 10 days to get 100 strips but was told that it was only a temporary permission to test 8 times per day. I complained to my doctor and said "are you kidding me, are you telling me that us diabetics have to go into the pharmacy every 20 days to get a measily (sp?) 100 strips to test a max of 4 per day?, this is NO way to live".

He told me that some pharmacists are morons and that he could give me a list of diabetic understanding pharmacists. I know go to a diabetic specialist pharmacist, whos own child has Type 1. They actually have 24 hour emergency service incase we need something when they are closed. But what the **** would I have done if there wasn't such a pharmacists? Or if this one goes away in the future?

[2high]

I probably spent over an hour on the phone last month arranging for the prior authorization for my test strip prescription. I finally got everything resolved and approved for testing 12 times a day and picked up my 350 test strips last month. The prior authorization is good for one year. I go to get my 350 test strips this morning and this is the note I was given by the pharmacist:

Insurance flagged #300 for 30 days, only will pay for #250 for 30 days - which is enough.

I can understand UHC constantly screwing up, but to get the pharmacist's opinion on how many test strips is enough does not please me...

test strip Nazi...

[xMenace]

:mad:

If you got pre-authorization, then punishment is due.


Take away her jellybeans!

[bryan42]

Maybe thats what CVS stands for..."Cant verify stuff" :(

[kgm0612]

Things like this IRK me!

Many of you know the problems I've had with United Healthcare (only been with them 2 years) paying for my strips & pump supplies. I used to have B/C Coast-Coast. They allowed me 400 test strips per month and paid the claim immediately. The State of RI decides to go with United Healthcare for their state employees and it's been **** ever since. The max they will pay for is 300 test strips a month but every month they deny my claim because they require "further medical records" and feel testing 10-12 times a day is "excessive". So far I'm waiting for them to pay claims from Jan, Feb & March. I have called, written letters, my endo has written letters, and it all falls on deaf ears!

Karen

[Doug]

Things like this IRK me!

Many of you know the problems I've had with United Healthcare (only been with them 2 years) paying for my strips & pump supplies. I used to have B/C Coast-Coast. They allowed me 400 test strips per month and paid the claim immediately. The State of RI decides to go with United Healthcare for their state employees and it's been **** ever since. The max they will pay for is 300 test strips a month but every month they deny my claim because they require "further medical records" and feel testing 10-12 times a day is "excessive". So far I'm waiting for them to pay claims from Jan, Feb & March. I have called, written letters, my endo has written letters, and it all falls on deaf ears!

Karen

Every UHC plan is different BUT you can get approved for more. I did - It is a PAIN in the BUTT. Im my case they were hitting me for extra co pays and I didnt pick up on it at first

The Dr wrote for 8 tests a day - they would only send 1200 for 90 days BUT the online refill woudl let me refill after like 72 days. So what happens is that they KNEW they couldnt change the Drs orders BUT their internal prectices only allow so many strips per co pay - so they just shorten the reorder time.
I finally had to get the Dr to write an special form whose name escapes me that says he is SURE he meant 8x a day .. That form lasts a year

Doug

[jvetter18]

Shall i draw up a court order to get the strips? Or perhaps a nice panty hose over the face w/ a side of smith & wesson?

The world is coming to an end.....we're just trying to get better, and the gate keepers make it so **** hard to reach the promise land.

My wife needed Sudafed the other day, and i had to fill out a form and log my license # in order to by SUDAFED. Because they think i'm going to cut crystal meth w/ the sh**. Are you kidding me?

Pharmacists suck. They're wanna-bees. And i don't wanna-be-likin-them anymo.

[Injecto]

Take away her jellybeans!

:hmmmm2: .

[xMenace]

:hmmmm2: .


http://www.diabetesforums.com/forum/type-1/18103-high-blood-glucose-sex-2.html#post217501

[tanyatype1]

When I read threads like this I feel so very lucky to live where I do! I never have a problem getting strips! I go to the grocery store, (Canada Safeway) to the pharmacy, and I can get as many strips as I want with no questions EVER asked. I ususally get 200-400 at a time. I wish that it was the same for everyone! It's bad enough that we have to live this way, let alone having to BEG (practically) for lifesaving/preserving supplies! :(

[xMenace]

Ditto

I asked Blue Cross if there was a limit. The person said I was limited to a 3 month supply at a time. When I asked how many that was, I only got a shrug. There's a Shpper's next door to it, so I stop there, buy whatever I need, get in line next door, and 1/2 hr later I have a cheque in my hand for 100%. The most I've ever bought was 200 at once, but I may start stocking up for the BD going out of business event.

[Funnygrl]

In defense of pharmacists:

A. CVS is my favorite pharmacy by far. They are way more willing to work with me than Rite Aid or Medco.

B. The Sudafed thing is a law. Trust me, the pharmacy staff is NOT enjoying having to document your liscense to get your business.

C. Pharmacist's can't help if your insurance has crappy policies. Insurances are in the business to make money. So are pharmacies. It's in the pharmacy's best interest to sell you as many strips as possible, however, if insurance won't allow it, they can't help that, unless you want to pay out of pocket.

[kidvid]

Weid - I have UHC thru my employer. Perscriptions are subbed out to MedCo, but processed thru UHC. I just got my strips renewed and received a 10/day supply - with no copay.

Joe

[andypoo]

I just received a little box of my supposedly 90 day supply of test strips and lancets,I've always gotten a 90 day supply from Wright and Fillipis,through UHC(,my husband retired from Daimler-Chrysler).For testing only 5 times a day,which isn't enough,really. I opened the box and there was enough for 1 test a day for 90 days,I thought.Well I called them and found out UHC is only letting us have a 30 day supply,which is fine ,but everything is getting cut back,so watch out!

[ladytaz]

GAH! Cyborg!! How was there an 'insurance flag' when the insurance company previously approved it??

Andypoo, that's just wrong!! WRONG WRONG WRONG! Are your premiums going down, since they're cutting back on your allotments?? Doubt it!!

I swear, you'd almost think that there is a conspiracy somewhere to kill all of us Diabetics off!

I realize (more than most, since I have to pay for ALL my strips MYSELF - No insurance) that test strips are EXPENSIVE, but good gawd, they're an integral part of Diabetes care!!

And honestly, it's the test strip manufacturers who are causing ALL of this, since they insist on setting the price so outrageously freakin high for them!

They outta be ashamed of themselves! LOL Really tho, they should!! They're taking advantage of us!! And we don't even get a hug when they're done! ;)

[cat_collector]

I have to stick up for the Pharmacist here , they can not give you the test strips if your ins doesnt pay them . Although he /she should not of given you an opinion on how many is enough . I work in a pharmacy and deal with this daily , ins comp want to have the say on what meds you can take and how much its a big pain in the butt . As far as the sudafed it is the law and yes the staff hates it worse than you do . I would suggest calling your ins company and ask about the prior auth they gave if it was good for a year then why is it changed this mth . Then you will know if it is the ins or the pharmacist that decided .
Tracy

[Injecto]

I would suggest calling your ins company and ask about the prior auth they gave if it was good for a year then why is it changed this mth . Then you will know if it is the ins or the pharmacist that decided .
Tracy


You see, that is what I did exactly. Called my insurance and they told me that they have no limit on strips, so I went back and had an argument with the pharmacist. I now get 300/month. It was the pharmacist. When my prescrip is up I'm going to the diabetic pharmacists.

[jeggeman31]

I but to get the pharmacist's opinion on how many test strips is enough does not please me...


That would have been enough for me to take my scrips and find another place to fill them.

[SueM]

Is the ins company medicaly qualified to say how many tests a day you need to do?
I would have thought as your Dr had writen the script for your individual treatment plan, the ins company has no say in the matter. I also wonder if it is legal for them to alter the treatment/drugs prescribed by a qualified Dr.
After all would they not leave themselves open to being sued if you had a seizure due to not being able to monitor and control your blood sugars?

[Funnygrl]

Actually, the company has a lot of say in the matter. Insurance companies in the US employ doctors to try and save them money by deciding if they can possibly get by with cheaper alternatives. I've had insurance companies deny countless prescriptions until I've submitted oodles of paper work. Think of CGMS- your doctor can prescribe a CGMS, but insurance doesn't have to pay for it.

[ClaireZk]

Insurance flagged #300 for 30 days, only will pay for #250 for 30 days - which is enough.


That is what bothers me about it, it is the pharmacist.

All they had to say is that there is an issue with the insurance, they didn't need to put in their stupid 2 cents. :secruity:

[lilituc]

My insurance just cuts out the middleman (pharmacist) and only allows strips up to five times a day. So every month I go to the pharmacy and pick up my 150 strips, then go home and order another 300 online, out of pocket. I'm so much luckier than... hey, wait a minute. ;)

[Cyborg]

Is the ins company medicaly qualified to say how many tests a day you need to do?
I would have thought as your Dr had writen the script for your individual treatment plan, the ins company has no say in the matter. I also wonder if it is legal for them to alter the treatment/drugs prescribed by a qualified Dr.
After all would they not leave themselves open to being sued if you had a seizure due to not being able to monitor and control your blood sugars?

This problem was actually a manufacturer's maximum daily limit issue, which requires a seperate override each month. The pharmacist simply makes a quick call to the pharmacy help desk of the insurance company (if they know what they are doing). The manufacturer can actually dictate how many times a month you test.

[gettingby]

The manufacturer can actually dictate how many times a month you test.
That is absurd and the most assinine thing I've ever heard. :mad:
My gawd, this is OUR lives we are talking about, not theirs. I wonder if it would be different if any of these manufacturers had our condition? Or if a member of their family did?

Sorry........... Rant over !!

[poper77]

Have you tried to order your test strips thru one of the mail away programs? My current (and previous) co. had a deal where you can order a 3-month supply and only pay for 2 months AND neither company ever once hassled me for the 12x a day testing....

[Kay2]

We have a PPO through hub's work. At first, the booklet stated that they only pay for insulin and needles with copay.

So I went to WalMart Rx and talked to the pharmacist there. She recommended a ReliOn Ultra meter kit ($8.88) exactly the same as the Contour, with backlight, very small sampling, memory/averaging, date/time, etc and the strips were less than half the cost of the same amount for the Contour. $22/50 - $43/100.

Since then, I found out that BCBS-PPO will pay 80/20 for 100 test strips a month and a meter every 36 months AFTER I meet the annual deductible.

Since I already pay out well over $300 a month in Rx copays, this was a good solution for me but I know is not for everyone.

Hope it helps, though.:confused:
Kay

[Cyborg]

Have you tried to order your test strips thru one of the mail away programs? My current (and previous) co. had a deal where you can order a 3-month supply and only pay for 2 months AND neither company ever once hassled me for the 12x a day testing....

I was getting my strips along with my insulin from my pump supply company, Advanced Medical, but they kept running short of strips when it was time to fill my order. I wish I could get all my scripts filled through the mail. I belief Medco, which administers for UHC, has a mail based prescription plan. That would be interesting...

[JediSkipdogg]

That is absurd and the most assinine thing I've ever heard. :mad:
My gawd, this is OUR lives we are talking about, not theirs. I wonder if it would be different if any of these manufacturers had our condition? Or if a member of their family did?

Sorry........... Rant over !!

Exubera is that way I think. They limit it to one "box" per prescription. They will allow you to get 10 boxes, but only if you have 10 seperate prescriptions. They say it's a manufacturer/FDA rule.

I was getting my strips along with my insulin from my pump supply company, Advanced Medical, but they kept running short of strips when it was time to fill my order. I wish I could get all my scripts filled through the mail. I belief Medco, which administers for UHC, has a mail based prescription plan. That would be interesting...

Is Advanced Medical the mail order specified by your insurance company or one that you chose? I've NEVER had a problem with mail order not having supplies or being delayed and I always use the one specified by my insurance company. Heck, my current one even automatically renews my prescriptions for me when they are about to expire. 2 years with them and I have never had to get a new script.

[Cyborg]

What supply company do you use? Advanced Medical has an office in my Endo's office and I've always used them.

[Chris Graham]

Cyborg,
I would call the pharmacy manager and complain.

I would also tell them that you are considering taking your business to another pharmacy. I know that everytime I go into the pharmacy, I end up with at least $20.00 in non-presctiptions in my cart. (This is why I go to the drive thru!) I'm sure they would hate to lose your business.

[JediSkipdogg]

What supply company do you use? Advanced Medical has an office in my Endo's office and I've always used them.

It use to be Walgreens Mail Order now I'm on Humana RightSource. Both are directly through the insurance company and therefore if there's ever a problem, they correct it instantly and have the package shipped the next day. I find the less people that need to be involved in a process, the better off I am, especially when it comes to anything medical insurance wise.