Originally posted by Xcalibur254
As someone who works in a pharmacy I can tell you that prior authorizations are nothing new. The insurance company wants to make sure other alternatives have been tried first before paying for a new drug that is only brand name at the moment. Depending on the insurance company they will also require it for certain controlled substances or many other things. For example we have a patient whose insurance requires a PA for their Adderall because they're over the age of 18. Once PA is given it is only good for a year so you may need to get multiple ones for the same medication over and over.
In regards to generic vs. brand, every generic must be bioequivalent to the brand. If a generic exists a pharmacy is most likely going to dispense that unless the doctor or patient specifically requests the brand. This is due to the fact that the pharmacy will most likely get a larger profit percentage from the generic than the brand. It's also the law to do it this way in a few states.
In conclusion prior authorizations have nothing to do with Obama.
That's odd, but is wherever you work at contracted with either ins company?
Originally posted by Xcalibur254
reply to post by ArrowsNV
I agree it's not all that common. I may send one or two PAs a day. However it's more than just brand names and expensive drugs. I just had to do one on generic Ambien and the cardholder had either UHC or BCBS. In fact I find most of the PAs I have to send are for generic mental health drugs (trazodone and ADHD meds probably being the most prevalent) along with brand name acne creams. I will say something that annoyed me the other day is when Medicaid completely paid for a 60 strip Suboxone script without even requiring a PA.
Opiods are for acute pain and should not be used for over 30 days.
And new chronic pain they should not be used for over 30 days while phasing in non opiod pain treatments
Originally posted by RocksFromSpace
Went to Walmart yesterday to refill my mothers prescriptions, she has been on the same medicines for 6 years, was told that one prescription couldn't be filled until the doctor talks with the insurance company. I asked why and was told that all "High Dollar Cost" prescriptions are being flagged and the insurance companies want to talk to the doctor to see if they are really needed and/or a cheaper alternative can be prescribed.
Pharmacist said this is happening a lot, insurance companies are trying to cut out the Higher Cost drugs... Thanks ##snipped##edit on Fri Jul 12 2013 by DontTreadOnMe because: Reaffirming Our Desire For Productive Political Debate (REVISED)
Originally posted by scotsdavy1
i am glad we in the UK have our own NHS and dont rely on insurance companies to argue whether they will pay for treatment or anything. when i was very young, i was involved in a accident when a truck hit me when i crossed a road.
i had a brain scan, plus operations that left me with a fractured skull, broken leg and arm, internal bleeding and everyone including doctors thought i would die.
took a long time to recover but didnt cost me a penny or anything.
have been left with osteo arthritus and severe backache and i get strong painkillers for that which again costs me nothing.
cannot understand why such a nation like America cannot look after its own with free medical aid for everyone regardless of who they are.
In a 5-4 vote, the court ruled for Mutual Pharmaceutical Co, owned by Sun Pharmaceutical Industries Ltd, overturning a multimillion-dollar jury award to a badly injured patient in New Hampshire who alleged a generic drug she had taken was unsafe based on its chemical design. The majority opinion, written by Justice Samuel Alito, said the state's law could not run against federal laws on prescription medicines whose design has been approved by the Food and Drug Administration. A Supreme Court ruling in 2011 found that pharmaceutical companies that make branded drugs are liable for inadequacies in safety warnings of a medicine's label, but not the makers of cheaper copies of those medicines. Consumer watchdog group Public Citizen said the Supreme Court decision on Monday undermines patient safety at a time when about 80 percent of U.S. prescriptions are filled with generic medicines. "Today's court decision provides a disincentive for generic makers of drugs to monitor safety of their products and to make sure that they have a surveillance system in place to detect adverse events that pose a threat to patients," Michael Carome, director of Public Citizen's Health Research Group, said in an interview. He pointed out that, in many cases, the potentially dangerous side effects of medicines have not come to light until decades after they were approved and often after there was no longer a branded version on the market.
Originally posted by badgerprints
Wal-Mart is a big chain that has to follow set rules for set reasons.
Big government likes big chains that follow big rules but that's one of the reasons we're in this mess.
Individuals and private companies have been removed from the picture.
I used to go to Wal-Mart pharmacy. I thought they would be the least expensive.
I now go to a privately owned pharmacy that actually takes care of it's customers.
I was paying $600+ a month through wal-mart for my meds and I have good insurance.
I found another place.
My new pharmacist called my doctor and they did some swapping of meds. Then they got me some discount cards directly from the drug manufacturers.
Now I pay a total of 49 dollars a month. My meds work. I am using that extra 550 a month to cover some of my gas costs for the 16 hours of commuting I have to do for work now.
I wish they had generic gas.
edit on 12-7-2013 by badgerprints because: (no reason given)