OP  Senior Patient Advocate Patient Advocate (old timer, 2000 posts)
Joined: Sep 2006 Posts: 8,311 | OK so here's what happened. I called my PCP who called the pharm guy who said the PCP had to call the ins co and complain. PCP called ins co and they said pharm had to fax their denial to PCP who then had to write a letter to ins to appeal their decision by claiming (and you're going to love this) that his prescrip was MEDICALLY NECESSARY!!! WTF, I kinda thought that was the whole purpose of a prescrip in the 1st place. So I guess doctors should have a check off on their prescrip pad; check here is medically necessary and check here if not medically necessary! I would have to pay full price for the pills until the appeal was decided. So I asked my wife to pick up the remaining 5 pills at a cost of $89 and when she got there the pharm said "why don't you renew your Discount Prescrip Card for $20 (annual) and then you will only have to pay $20 for the 5 pills." What's further amusing is that after arguing over this for 3 days, paying $4 a pill with Walgreen's discount card is $10 a pill cheaper than what my ins discount was!!
Anyone calm has been restored in my world and now I can concentrate on getting rid of this burning crap.
David
Age 58 at Dx, HPV16+ SCC, Stage IV BOT+2 nodes, non smoker, casual drinker, exercise nut, Cisplatin x 3 & concurrent IMRT x 35,(70 Gy), no surgery, no Peg, Tx at Moffitt over Aug 06. Jun 07, back to riding my bike 100 miles a wk. Now doing 12 Spin classes and 60 outdoor miles per wk. Nov 13 completed Hilly Century ride for Cancer, 104 miles, 1st Place in my age group. Apr 2014 & 15, Spun for 9 straight hrs to raise $$ for YMCA's Livestrong Program. Certified Spin Instructor Jun 2014.
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