Insurance denied coumadin....

[Sunshine susan]

I'm just wondering if anyone else has ever run into this situation. I have been taking coumadin for 4 years now and am always in the habit of refilling my prescription when there are a few pills left--4-5 maybe. Also making sure I have an ample supply if I am going to be traveling. So I called in my number and got a call back from the pharmacist that there was a problem. I instantly figured it was just "new year" stuff. I have had the same group insurance for years. So when I went to see what the problem was, the issue was that it was TOO SOON for me to be getting the next prescription according to the insurance and I had to wait a week before they could fill it--unless of course I paid for it out of pocket. If I had had to wait a week, I would have been without coumadin for 3-4 days at that point. Taking pity on me, they sold me some individual pills to "tide me over". It is just plain weird--I get a prescription for so many pills every refill and the scrip is for several months. Such a scenario has never happened before. But as everyone on coumadin knows, the dosage can change thus using more pills or less just depending as it is not an exact science. Just wondering if anyone else has ever been caught in this trap ,as if coumadin is something anyone would want to get "high" on!! Just venting on the bureaucracy! Susan

 

[LUVMyBirman]

Hi Susan,

Some insurance companies are keeping real tight control on refills. Making it difficult for you to refill anytime sooner than 1-2 days prior to your 30 day supply. There is a way to get around this. Ask your doctor to write your Rx directions as directed. This works better at times. Though, I have seen them look back and figure out I am not taking 100 tablets in 30 days.I am not trying to cheat anyone.... I also don't mind paying extra to have more medication on hand. Especially with all that is going on in this world. It's just plain scary when your about to run out and your hands are tired. I have a PPO and have issues with prescriptions at times.

 

[Gail in Ca]

I order my long term RX's from prescription solutions and they give plenty of time to refill, not just a few days.
I also have my Dr write take as directed, but am able to get a 90 day supply thru the mail. It works out just fine, but I get a warfarin made by taro, not barr as I did with my other plan.
So far my inr still is stable with the new generic.
I called them about a RX my husband takes which is not covered under our plan and their price was less than 1/2 the pharmacy price near our home. It's good to check on prices.
Also, I used to work for pharmacies and we gave our patients enough to last a few days if it was important medication that they should not run out of and didn't charge em for it. Maybe you would want to check out other retail drug stores.
Gail

 

[Ross]

I've had that happen also. My solution is as Gina stated, have the Doctor state "Take as directed" and give me 2 times (60 pills instead of 30) as much as I really need. That solved that problem.

 

[Guest]

From a pharmacist's standpoint, I can tell you exactly how this works. When you get a prescription filled for any prescription with a standard set of directions, "1 daily", " tablet 3 times daily", etc. the computer is programmed to give exactly 30 days supply. Then it will not give you a refill before a certain due date. But when you get a prescription with a set of directions such as "1 daily except 1/2 on Mon and Fri" this is a non-standard set of directions. Then the computer is not programmed to figure a 30 days supply. (As directed works for the same reason.)

What has happened is that as your dose has been tweaked, your doctor has not given the pharmacy new prescriptions. Thus you suddenly fell outside the rules.

 

[ILoVeNY25]

Hey Susan, Wow! Does that story sound all too familiar, This happened to me last month when I went to fill the prescription. I was furious...The pharmacist was like Sorry and I was like if you know what you're doing, you know I'm not abusing Coumadin. My dosage changes weekly and his response was Miss, I know how the drug works. Any pharmacist that you go to regularly should/can offer you pills to hold you over. I called my doctor and he prescribed the Coumadin as 2-3 4mg tablets daily, So this problem won't occur again. And here I am with 3 pills left and today is exactly 30 days. Gotta go call the pharmacy...Let your doctor know. Take Care!

 

[Guest]

Most states will allow pharmacists to dispense enough medications to hold you over until they can contact the prescriber. If they are not controlled drugs -- addicting.

There is also a little known variation to the computer program called a vacation override. This will allow a fill if you are leaving on a vacation, just before your prescription could be filled.

If you go to an independent, owner-operated pharmacist they will usually do these things for you. Many times, a chain-store pharmacist will not. They seem to have the attitude, "I get paid by the hour. Let somebody else do it tomorrow."

IloveNY's example is another of those non-standard sets of directions that the computer cannot calculate 30 days supply.

 

[Christina]

Hi Susan..

Hi Susan..

I've had similar problems in AZ. They are very picky about refilling my prescription even a week early. I often call it in during the evening when I have the time and can do that without speaking to anyone in person. Now I know not to do this because I've gotten a call the next day saying it's too early for the refill.
Right now I pay $20.00 for 90 pills through the regular pharmacy, and if I buy through the mail I also pay $20.00 for 180 pills.
When I wanted a three months supply (180 pills) because I was going to Europe, I wasn't able to buy it through my regular pharmacy. I had to ask my doctor for a new prescription and had to get it filled through the insurance company's pharmacy. They first sent me Warfarin instead of Coumadin, but corrected it by sending me the real thing a week later.
I am still taking 20mg a day.
I wanted to have plenty on hand in case the war started and I wasn't able to get back home in time.

Christina
Tucson, AZ

 

[ccrawford]

Yet another way--

Yet another way--

One more way to beat the system is to purchase a small transitional supply out-of-pocket so you don't run into the problem. My pharmacy (a chain) typically uses an 80% refill rule, but the problem is not the pharmacy, its your insurance provider. The reason they do this, is that many people (actually their doctors) change the medication they take for whatever reason. One reason might be side effects. The larger the supply that is issued, the more that is wasted anytime a presciption is changed.The insurance provider, then, uses this rule to keep the costs down. It does really make sense, but I agree - it can be very frustrating. By the way Warfarin and Coumadin are the same thing.

 

[Christine]

I too ran into similar situations.. but now my doc writes the scripts so that i always end up with an extra week or so left over.. my insurance will refill usually after 21 days..

note: in response to the previous post.. warfarin and coumadin are not created equally.. normally generic and name brand can be switched interchangably.. not so with coumadin.. it's not a major difference, but what ever you take is what you need to continue to take.. unless your doc changes you.. if you normally take warfarin than you should not just accept coumadin or even tell the doctor you take coumadin.. you take warfarin..

take care.
christine

 

[ccrawford]

YUP

YUP

Christine - you are absolutely correct. I didn't know if you knew this or thought we were talking about two totally different drugs. Glad you clarified it. Chris

 

[Sunshine susan]

Thanks everyone!

Thanks everyone!

I appreciate your responses and it does all make sense. I'm sure I will have no problem getting the Coumadin Clinic to write the prescription in such a fashion that the "30-day rule" doesn't kick in. Just not something any of us thought of as it hadn't been a problem in the 4 years since the surgery. Thanks mucho--you guys are great!! Susan