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Unread 12-02-2011, 01:46 PM   #1
TooshyToScream
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Default Prior authorization and suboxone

So my insurance makes me go through a prior authorization process the first time I get suboxone. Which means the doctor has to verify that I truly need the medication and I have to have a clean drug test, and then they give it to me for free. In the meantime though, I did get 10 of them for the first 5 days while I'm waiting for the prior auth to get done. Doctor prescribed me 16 for a week though and I need my other 6 soon. I've never done this prior auth crap before though so I don't really know what I'm supposed to do. The last time I talked to my doctor (2 days ago) he said that everything should be good in 24 hours. The pharmacy said that supposedly my insurance will call me and let me know when they approve it but I haven't gotten a call so I don't know whether I should go to the pharmacy and see if I can get the rest of my medication or call the doctor or what.
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Unread 12-02-2011, 02:02 PM   #2
NancyB
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Hi TooshyToScream, you could call your insurance company and see what's going on. Maybe they neglected to call you. Or give the pharmacy a call and see if it came through. Fingers crossed that you're all set. Let us know.

Nancy
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Unread 12-02-2011, 02:21 PM   #3
tlg
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Prior authorizations are a pain in the butt...back when I had insurance, it seems like every time I wanted to fill something I needed prior auth...I've always had luck calling pharmacy and they can tell you where you stand (if they're waiting on your doctor or the insurance company) and then go from there. I have personally never had my insurance co. call to tell me I'm good to go, I've always had to play phone tag with the doctor and pharmacy.

On that note, you may want to see if this is only a first time thing since it's a new med, or if they will require it each time, or every 3 or 6 months. Some insurance companies only cover certain meds for so long, or have to have it authorized again after so long. I have been there when I was out of a medication and my appts were always on Fridays...sucks having to go a whole weekend without a medication like Sub just b/c the insurance company feels the need to double check that you really do need the medication...b/c a script from your doctor isn't good enough. Just a thought, it's better to know in advance and not be surprised on a Fri afternoon when you're out of meds and wont be able to get it filled for 2-3 days!

IF by chance you end up having to pay out of pocket b/c you are still waiting, try printing out the coupon for the film and see if they will let you use it. My pharmacy allowed me to use it on a partial refill which helped a lot, but I had to ask them to try and and run it on the partial since I was only waiting for the free med program to kick back in.

Hope you are able to get it all worked out and doesn't end up being a long drawn out process.
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Unread 12-03-2011, 11:13 AM   #4
TooshyToScream
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Called pharmacy, they said no, the prior auth hasn't come through. My doctor's out of town this weekend, so the only other thing to do is to call the insurance company and find out why. I did smoke weed like 2 weeks ago so I'm afraid they denied it because of that if it was still in my system. Thing is, I have social anxiety disorder and for me to call the insurance and argue with them about this is a huge deal to me. I could try to suck it up and do it today, or I could wait til tomorrow and make my fiancee do it for me. I don't really know what I'm going to do I can afford to pay for 6 of them out of pocket but they're so expensive and I wouldn't be able to afford my next 16 out of pocket anyway. I do suppose I could try to use the coupon but again, it would only help me this particular time.
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Unread 12-03-2011, 04:18 PM   #5
tlg
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Sorry you're still waiting...it really sucks that they tend to take their time with these things...but try the insurance company and see who/what they are waiting for...

There are a lot of different things out there to help for people who have to pay out of pocket...and hopefully you only have to do so this time and everything will be worked out by the time you get your next script...be sure to ask how often they're gonna require prior auth to hopefully try and save you from a headache in the future!

Hope you get it worked out soon!
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Unread 12-04-2011, 12:50 PM   #6
TooshyToScream
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Tlg, since you seem to have gone through this process before, if they deny the prior auth the first time, what happens the next time you get prescribed medicine? Will they give you any temporary medication for the time that they try to do the prior auth again or no? Cause see, technically if they just give me 10 8's at a time and I never end up getting the rest, that's still enough for me to not feel sick because I can get down to about 2 mg/per day and feel fine. I was only taking more because the doctor prescribed me more.
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Unread 12-04-2011, 07:23 PM   #7
tlg
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The prior auth is only something your insurance is making you do...so as far as the meds go, you can get them when you want/need but have to pay out of pocket until the insurance gets the approval they need. Until they get what they need, they wont cover your meds. You will have to talk to ur insurance company about why it's taking so long and how ofter they will require you to get a prior auth...which as I said before would be a good thing to know so you don't find yourself here again, expecially if you really need the medication...As far as paying out of pocket, take a look at the link Nancy posted for ways to save money on the script our of pocket, and you can do partial refills thru the pharmacy, so you can get a few days or a weeks worth while you wait for approval, and then you don't have to go broke trying to keep yourself from getting sick...If you can take 2mg/day and feel fine then that is the dose you should take...the best dose for someone if the smallest amt they can take without having any wd's or cravings. If you are taking too much, you may end up feeling tired or nausea, not have any energy, things like that...as far as Sub goes, less is best...it's not like when we were on our doc.

You have the option of just getting what you need right now and saving money if you're paying for it yourself, or start a back up supply incase something ever happens and you end up without
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Unread 12-14-2011, 12:05 PM   #8
TooshyToScream
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Hey tlg. They finally accepted the prior auth. It took a long time for the dumbest reason in the world. They wanted to confirm that I was seeing a psychiatrist/therapist before they approved the medication, which I was, and my addiction doctor sent them like 10 different faxes telling them that I was and they kept saying the same thing every single time for some reason. Then finally on the day of my second appointment with the addiction doctor, they approved it and I only paid $3.00 co-pay. I thought it was because I still had marijuana in my system or something like that, but apparently not. It was because they were totally stupid and blind. Nevertheless, my fiance was paying $119 for 90 of them which is crazy expensive (and he can't use the $45 coupon again until the 18th) so I still consider myself rather lucky. Hopefully from now on, there won't be any more problems.
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