So, it has been approximately 40 days since we refilled an insulin scrip, I trundle down to the pharmacy and get told that despite my son using 1800 units per month, that our insurance will only let us fill the prescription for two vials every 6 weeks…Then the pharmacist pulled out the calculator and says you should have x units left since the last refill and Friday is the earliest we can get the prescription refilled…
It took a fair amount of self control, but waiting until Friday, I will be armed with the actual scrip and some pent up emotion…
That bites. Maybe have your son’s physician write a new scrip along the lines of “take 70u insulin per day, as directed” so that the insurance company’s calculator will bump up the number of vials you get per month. It’s not clear that yelling at the pharmacist can fix the insurance company…
This is key. Also may be worth looking into your pbms mail order provisions… I manage to build up a nice stockpile by getting my rx written to just barely bump be into the next box on day 85, and refilling it every 90 days.
Im their world it doesn’t matter how much you use, it matters how much was prescribed and how often you can fill it
Yeah, that is the issue, I didn’t have the prescription number on me, and the pharmacist claimed they couldn’t see it, only the insurance company mattered. That is why I was so angry. We already went to the trouble of having the prescription increased, and it was definitely two vials a month, then to have to fight to get that…the mail order route is probably the best, will see what they offer. Of all of the issues that we had with Kaiser, their online ordering system and mail order delivery was great.
Well that is certainly odd. The prescriptions we get have what the Doc writes reprinted onto the prescription label. This sounds like a disgruntled pharmacist having a bad day.
I had a somewhat similar interaction with a pharmacist recently. I realized I need a little over 3 boxes of Afrezza every three months. I called the nurse at my doctor’s office, and she acted all frustrated and said she didn’t know how to alter the prescription so that I could get 4 boxes instead of 3.
When I called CVS to see if the pharmacist could provide some insight on how the prescription could be adjusted, she said that it depends on the amount I use each day. When I tried to explain that it varies a bit from day-to-day, but it was clear that 3 boxes were not quite sufficient, she said that I didn’t know what I was talking about and should be taking the same amount every day…
I called CVS back the next day, and a different pharmacist told me exactly what needed to be on the script, and I left the nurse a voicemail with the information. She sent the prescription to CVS the next day.
Some pharmacists seem to be much more helpful than others. You may have better luck if you just speak with a different one!
@Chris the same issue exists with test strips. My local pharmacist who I have a great relationship with still has to get the calculator out. It’s not anything personal, it’s the limitations the PBMs place on reimbursements for Rxs already in a patient’s hands. If the pharmacist makes an error, it comes out of their end financially which is why I suspect many will not stick their proverbial neck out.
While I may disagree with the concept/implementation - the reality is the reality. Seems time and time again it appears the PBMs to be significantly more of a problem than the often blamed insurance companies.
In any event, how would this explain the pharmacist claiming not to be able to see the prescription? That part makes no sense without assuming bad faith on the part of the pharmacist.
EDIT: In terms of insulin, our prescription is specifically written by the doc as: “Up to 150 units per day. Please dispense vial.”
Clearly 30 days times 150 units per day is 4500 units and no half vials can be given out, so we always get 5 vials with a refill. I don’t refill every 30 days but rather when I open the last vial so it seems to work out pretty good. There obviously can be significant changes in how much insulin we go through.
While my frustration is just a small frustration, and it is tiny in relation to the frustration that being a diabetic every day brings about, I just feel like the system ought to be a little easier to navigate once you have the diagnosis…
if it isn’t enough that my son has to be a diabetic everyday, when he heard my frustration, he said “Dad, can I come along with you when we pick up the prescription and navigate this, it seems like something I will have to learn how to do.”
Of course he is right, but it is just another small piece of my heart breaking for him…
Yes I’ve had issues with afrezza quantity too, it is more complicated with afrezza bc of the way it’s packaged than it is with liquid insulin… and the prescriber has to take a few minutes to figure out how to write it correctly; which it seems they’re fairly unwilling to do generally
I certainly don’t disagree with any of the above statements, and I occasionally struggle to understand why something was done the way it was. I think as pointed out by @Sam that not all pharmacists are willing to figure it out. Maybe it’s a comfort zone thing, maybe it’s legal liability problem, or maybe it’s a financial problem. I certainly don’t have the answer. I do know that when I use my local independent pharmacist, he will tell me to have the Dr re-write an RX a specific way to keep in line the PBMs and Healthcare companies.
Example - I had an RX for strips and another for insulin. Strips said 4-6x daily as needed dispense up to 400/30 days. I ended up having to fight to get 200/mo. The PBM said 150 strips/26 days, so that is what I got. Once the RX was rewritten as 12-15x daily dispense up to 400/30 days, I got 400 strips every month.
I keep a spreadsheet of my daily dosages of Novolog, Novolin R, and Lantus/Basaglar.
It didn’t take more than a month worth of data to give me the justification to ask my PCP to change the dosage directions on my insulin scripts.
I continue to log these doses on a daily basis, just so I have the non-arguable ammo to get the dosing adjusted as needed.
Generalized guidlines are fine, as far as setting a baseline dosage amount. But real world dosing, which includes clearing needle tips at 2U+ per shot, higher carb meals when circumstances like dining out make that inevitable, increased needs due to stress, and a variety of other factors, are what real dosage ranges should be based on.
And that can only be determined by the patient, NOT the physician, pharmacist, or insurance company.
The bottom line is that the patient invariably has to fight for what they need, and being able to provide solid statistical facts helps tip the scales in your favor.
In fact, I’m in the process of moving all of my scripts from my current pharmacy to a new one, because the pharmacy manager of the one that I have been using for years has recently taken it upon himself to arbitrarily remove prescriptions from my refill queue, because of his ‘opinion’ that certain ones won’t be refilled as requested by the insurance company, when in fact, they were filled, no problem, went I went in and demanded that he process those scripts in spite of his ‘opinion’.
He is a pharmacist, not an insurance arbitrator.
His job is to fill scripts, not try to save money for the insurance company.
He has lost sight of the fact that I am his customer.
Hopefully the next pharmacy manager won’t make the same mistake, because over a dozen scripts/month from my household is nothing to take lightly.
So I now have a copy of the scrip and intent to challenge their math when we pick up the scrip on Saturday. He has been prescribed (two thousand units) two vials for 33 days of use. No ifs and or buts…Any issues, and we change pharmacy.
It only takes me a phone call saying “please bump up X insulin to Y units/ day”
Yeah, well, my PCP is next on the list of people that need to be reminded that I am the customer.
And I can take my business elsewhere. Just like auto mechanics and appliance repair, there are far too many other service providers out there to tolerate poor service.