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Latuda - High Cost Medication
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mercygive posted:
I found out 2 days ago that my insurance company denied the claim for a 90-day script of Latuda "claim cost exceeds maximum limit" after I was told by the mail order pharmacy that my 90-day script had shipped last Friday. It took me an hour on the phone to unravel the confusion. Neither the pharmacy nor the insurance company notified me (big surprise) so I had to scramble to get more free samples from my doctor. This is not a medication that can be stopped abruptly. The service I received was unacceptable. I am not getting what I need or want for the excessive cost of insurance which should more than cover maximum limits since I rarely use the insurance I pay for.


The insurance company told me that they would fill a 30-day script which is doable but inconvenient through mail order as it appears I would always be behind a week for refills and must use mail order to use my regular co-pay. If a 90-day script is approved, my doctor would have to repeat the FDA approval process to refill a 90-day script and it has nothing to do with there not being a generic available for Latuda. I don't get it. I have never taken a medication that was subject to an approval process and the pharmacy could have given me a heads up.


I will continue to take free samples of Latuda to get me through the chaos and hope that Latuda continues to be available to me through my insurance company because my income disqualifies me from getting drug discounts through the manufacturer. I hope my 90-day script is approved.





A little yoga goes a long way
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ddnos responded:
Insurances can sometimes be a pain in the behind!

So let me see if I'm understanding you correctly - your insurance will pay for Latuda, but will only pay 1 month at a time rather than 3 months? BUT, they will approve the 3 month script if your doctor fills out a form every 3 months?

This may sound insensitive to your doctor, but frankly, sometimes that's part of his/her job and not your worry. If that's the only way for you to get your meds this way, then so be it and don't worry about the little extra work your doc may have to do for it. That's not your concern.

If, on the other hand, your insurance is saying they won't cover that med any longer, then your doc can request an "exception" be made, and the insurance company will typically approve.

It's also possible that your doc request a one-year authorization from your insurance that would make it so that he/she wouldn't have to fill out the form every 3 months, but only once a year - if you are still taking that med at that point. Maybe you could ask your insurance about that. I had to have that done with one of the meds I take and every year, my doc basically just tells them to continue and I'm authorized for another year.

There are ways around their crap, you just have to talk to the right person sometimes. lol

Good luck!
Debbie
Forgiveness is letting go of the hope that the past could have been any different --Unknown
 
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mercygive replied to ddnos's response:
I don't want to worry about it but I am. I don't like surprises with medications. My doc should know what to do and I want someone to communicate with me without my having to make multiple phone calls. Since she has prescribed this medication before, I wonder if she could have made a call to the insurance company first to see if there was an approval process of any kind required for Latuda. The approval process will take longer and the more people involved in filling a script the more chance there is of it getting delayed or lost altogether. If they do not approve the 90-day supply, then I will mention the "exception rule" to her to see if we can get it pushed through. But, you're saying she should already know about the "exception rule" right? I don't trust people.
A little yoga goes a long way
 
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ddnos replied to mercygive's response:
The "Exception" rule is used when an insurance company no longer covers a medication that you are on, but I'm not 100% sure if there's any other reason. So, if your insurance is still covering Latuda, but just have to go through the ropes to get more than 1 month supply at a time, that would normally not qualify for an "exception."

However, the 1-year authorization is a possibility in your case. I can't say that it's a guarantee because all insurances are a bit different, but it would be worth asking your insurance about. If they DO have that as a possibility, then you could ask the person you are talking with to send a form to your doctor. If he/she won't do, ask the person what steps are the best and quickest steps you need to take to get this done. He/she may just send you the form to give to your doc, or ask you to have your doc contact them.

If none of the above are accepted, and you only get 1 month at a time - can you just have those meds called in to a local pharmacy rather than mail order? That way you wouldn't have to worry about possibly running out of meds before the month is over - you just pick up the next months supply 3-5 days before they run out and that's it. If you're like me, you'd rather have your meds sent because it's more convenient, but sometimes it's just not possible, as is this case. But unless you don't have a pharmacy relatively close by where you live, I would think that getting your meds 1 month supply would be Ok. Not as convenient, but Ok.

So now re your worrying! You may not like to hear this, but we all can choose to continue to worry about certain things or not. Try to focus on the facts and reality of the whole situation so that you can COGNITIVELY see that there really is nothing to worry about. But if you focus on what is NOT real, then your worry will only increase. So control your feelings with your mind because I know you can do it!

Debbie
Forgiveness is letting go of the hope that the past could have been any different --Unknown
 
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mercygive replied to ddnos's response:
Okay. The "exception rule" has not come into play yet because the insurance company did not tell me they were not going to cover Latuda. There is a pharmacy nearby. I will ask again, I think I have to use mail order for 30-day supply. That doesn't sound right. If my doc chooses the 30-day script this time around for time sake, I hope she doesn't phone in the 30-day script to mail order and not ask if she can fill through my local pharmacy.

You're so good!!! Thank you so much for this information. I want to be ahead of the game so, unintentionally, I am cognitively destroying my outlook today because I am focused on things that haven't happened yet and possibly feeding myself disinformation as well. Thanks for the reminder. I do this a lot. When will I learn? But"026but"026but there is no excuse lol


A little yoga goes a long way
 
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ddnos replied to mercygive's response:
We all need to remind ourselves all the time re our thinking!

Mail order places usually prefer 90 days as opposed to 1 month supply. What I would do is call your pdoc right now and leave a message for her. Tell her that you want your script called in to (your local pharmacy name and number) and to NOT call it in at mail order place. That way you can "rest assured" in knowing that she will get the message on Monday. Be sure to give her the phone number AND fax number so she doesn't have to look it up - saves her time.

Toodlelooooooo

Debbie
Forgiveness is letting go of the hope that the past could have been any different --Unknown


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