ObamaCare: Walmart can't fill perscription until doctor talks to insurace company !??!!??!

Walmart is literally a governmental agency .
Everything it sells is backed by big pharm and Monsanto .
This is not a big surprise in my opinion .
I wouldn't buy anything from Walmart if it was the last store on earth.
We are fighting to keep them out of nyc .One wants to open in Brooklyn . Not if we can help it .

The biggest problem with opiods is not the medications but the fact 98% or doctors were never trained in other non opiod ways of controlling pain.
and now instead of getting that training 90% try to send there patents to pain management specialist.only to have the insurance companies turn down the pain management specialist.

There are ways to control pain without
Transcutaneous electrical nerve stimulation
botox
nerve blocks.
ECT ECT

I have had chronic pain since 2002 and have it under control without any opiod meds
I use two Transcutaneous electrical nerve stimulation units and antiseizure meds(gabapentin (Neurontin))
and i had to do my research and ask for both.

I know many more people are proscribed tens units because i find new unused ones at thrift stores all the time.

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 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.

I'm thinking that even though PA is nothing new, the fact that I need PA on some of my medications just recently, and after receiving notices in the mail about certain medicines and treatments no longer being covered (and this is happening now-under Obama Admin.), that yes, it has something to do with ObamaCare.

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.

That's odd, but is wherever you work at contracted with either ins company?

I run eligibility claims all day for a pharmacy where I work, and we deal with a sizeable chunk of BCBS, UHC & Caremark (among others) but we never really have to do any PA's unless the person is a Medicare Part B recipient.

Wow, and to think,

Supreme Court just ruled generic drugs can't be sued/held liable if they kill you or give you flesh eating disease,

Hmmmm,

Think homeopath may be the way to go.

As for one who keeps posting they pay for all the free care, etc., Many in Medicaid/Medicare WORKED and PAID into that same system. It's a tad bit snit to slam folks on either, just saying...a tad bit in the little "snit" side.

reply to post by ANNED

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

This is wrong. Pain doesn't even become 'chronic' for six months. Meaning a person has been in pain of the same kind/type for six months.
Many opioids aren't RX'd for acute pain at all, but only for long term (chronic) pain, an example would be MSContin, Durigestic patch, or OxyContin (not to be confused with Oxycodone). Opioids have no time constraints and even no ceiling in strengths. And most people who take their pain medication/s as prescribed never get 'addicted' to these medications. There is a difference between tolerance/dependency, and addiction.

For a person living with real CP, there is no shame in taking these pain medications on a daily basis. Whereas, the medication that you listed to treat your own pain (anti-seizure meds(gabapentin (Neurontin), has many terrible side effects, and not all people can take Nsaids which itself can have terrible side effects.

There are many medications and treatments for CP, but so far opiates are superior to all day 24/7 type of pain. Even the Tens unit cannot be used 24 hrs a day. Also, one cannot meditate 24 hrs a day, or acupuncture, or massage, hot tub, shower, ice, etc.,etc.,etc............

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)

As this has WHAT to do with the Affordable Care Act?

I'm sorry I missed the part how this is Obamas fault? This has been going on for years now so is the conspiracy that Obama had something to do with this 10-20 years prior to his presidency? I'm confused

What the OP is describing is called a prior authorization and its a trick the insurance uses to get doctors to rewrite prescriptions to generic drugs which cost then less. The alternative is the PA procedure: I fax your doctor the PA, he calls your insurance and explains WHY he put you on drug X and not drug Y, if they're satisfied they'll put the override in the system, then your doc has to call me to tell me it's ok to fill your Rx, an if the ins system has updated then your copay will appear. The process averages 2-3 days if your doctor is good. There are one time, 3 and 12 month PA's I've seen, it all depends on the company and drug/situation.

Now be fair, I hate Obamacare as much if not more so than the next guy seeing as I work in a medical field, but this has been around for YEARS. Understand something before you blindly blame it on something. It is happening more frequently though and with the new Supreme Court ruling I see a lot of brands being dropped from formularies in the coming quarters.

The anger should be directed at insurance companies, no one else. Why do the peasants always want to blame each other? (Blaming the president is blaming democrats. -the ills of a two party system, and if it were a republican in the seat, same thing would apply for dems moaning)

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.

I don't know why people are that surprised really. Insurance and prescriptions have always been a scam for someone. For example - I had been purchasing a certain brand of med for my wife for a couple of years. I forgot my card one day.. they usually don't ask for it.. but they did that day. They said I could either pay full price, or get my card. I asked how much it cost. They said 4.99 - not even five bucks. That was the total cost of that med. I was paying 15 bucks copay for 2 years on those. I was paying 150% of the cost for 2 years because of insurance. I never bought those again under insurance.. and it is always wise to ask them what something is without insurance. It may actually be cheaper.

They've always made out with insurance.. it's one of the biggest scams in American history. The entire system needs a massive overhaul. When you take your kid into the hospital to check up on a cast on a leg, and wait 40 minutes.. and the doctor spends literally 3 minutes, just watching her walk and saying "does it hurt when you walk?".. and you pay 150 bucks for that 3 minutes.. something is terribly wrong.

That is.. I payed the copay of 15 bucks.. the insurance paid 135. Insurance is a scam on many levels.

reply to post by Chrisfishenstein

Insurance companies (misnomer) both private (CIGNA, AETNA, BCBS, COVENTRY, et al) and government issued (Mail Handler's, BCBS Federal, Medicare, Medicaid, Tricare, et al) determine the level of care you will receive. Which physician will be "in network", whether an MRI, CT Scan or other procedures recommended by your physician are approved or denied, if the medications that your physician prescribes will be covered, and then how much they will choose to pay for your care - enter the pesky deductible/coinsurance combo.

They currently get away with selling major medical coverage under the guise of standard health insurance coverage. For those of us who are of a certain age, the difference is clear.

If you receive health insurance coverage through your employer, normally higher ups in the totem pole will receive a better policy for the same price as the lowly hourly employees, as an enticement for the company to attain coverage through a specific company.

To top it all off, if you think your physician is raking it in, think again. They get paid cents on the dollar, and they are unable to find out what other physicians in the area are getting paid by the insurance companies (it's illegal- pffft) so, at contract negotiations, they are pretty much at the insurance company's mercy.

ACA/Obamacare/whatever you want to call it, is a misguided effort to correct a problem that can only be solved by wiping the slate clean and starting over again.

And to everyone that is opposed to single payer/universal coverage, let me assure you that under the current system, every citizen of these United States would be better off on Medicaid. Only one healthcare related payment, a stark contrast to, policy premiums, copays, deductible, coinsurance, out of pocket AND taxes to cover Medicare/Medicaid.

IMHO.

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.

why...because America is a capitalist nation, profits come first, not people. corporations run our government, don't think so?....look at income distribution, taxation, subsidies, etc..... the most effective legislation is where regular people get JUST enough to keep them coming back to work the next day, and investors get the rest.

One day I am going to make a topic about this but for anyone wanting to understand the true issues with the mandatory health insurance in America I would highly recommend this article...I don't agree with some of his deductible amounts but then again they would more than likely be lower in the free market....

www.theatlantic.com...

I think it has to do with the recent Supreme court ruling that generics can't be sued for side effects. Reuters article on it states:

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)

16 hours of commuting?! what do you do for work, SLEEP?! hahahaah! Good grief move closer to your job or do you need help from professionals to work that out for you?

reply to post by Xcalibur254


I guess my pharmacist was lying to me when he told me that the reason prescriptions are not monitored is because new guidelines under Obamacare.

If is the insurance then this worst, because now they can still gouge the consumer under mandate of buying insurance with the lowest quality of care money can buy so they can maximized profits.

I am still loving this Obamacrap more and more.

reply to post by marg6043


It is the insurance companies and it is nothing new. As has been stated time and time again in this thread PAs have existed for a long time now. Also, if you think insurance companies are in it for anything more than maximizing profits then I've got some beach front property to sell you in Kansas.

reply to post by Xcalibur254


I will not take Kansas but the moon beach front sounds very good.

Still for our experience with our Humana Tracare that we have since 98, we never have an issue with prescription drugs until last year in October when the government change providers and we got our first hold up on one of my husbands medications.

So I can only talk from experience and to this day this started just recently for us.