FUDiabetes

Insurance now requires pharmacies to pick SHORT end of prescription range?

insulin
#1

this seems to be commonplace now. Our son’s Vimpat (his anti-epileptic drug) is in liquid form and the prescription was written for 300 mL per month. Since the bottle only comes in two sizes (200 ml and 450 ml) they were consistently giving us the 200 mL, leaving us scrambling for the last 10 days of the month. I spent New Year’s Eve in the pharmacy, calling the on-call pediatric neurologist multiple times, trying to figure out the right “formula” to get him his . medicine before it ran out. Same story 20 days later. I think this is some new thing in the way insurance or PBMs manage prescriptions. But it’s very very scary.

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What Success Looks Like - Nagging Issue Solved
#2

Isn’t it grand! Just another hoop to make the poodles (or lion’s depending on preference) jump through. Insulin is one thing, but for something that is harder to obtain like Vimpat that would be downright scary, and frustrating. Also, since you were prescribed the 300 mL per month, it almost seems like pharmacy malpractice to give you an amount smaller than was prescribed.

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#3

If it’s written for 300 per month they have two choices, give you 2x of the 200 or 1 of the 450.

Anything else is not acceptable and you should argue that with the pharmacist. I would not sign for a 200 as having received the prescription.

It might help to have them write it as “take 10ml every day”

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#4

We have sorted it out now (I think?) but it was pretty terrifying for a good three months. I think part of it is that the rules are more stringent because it’s a drug that in some study produced a mild high if you take a TON of it, and so theoretically some deluded soul could abuse it (though I’ve never heard of anyone actually trying that with this drug). So it’s “schedule V.” Now we have it on autorefill with a mail-order pharmacy and they sent us multiple months’ worth at once, and send us the correct size bottle.

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#5

the thing is, when you’re completely run out and the bottle says “missing a dose could lead to a seizure that doesn’t stop” you take the medicine that’s offered in the moment and tell yourself you’ll deal with it as soon as you get home. But agreed, that should NOT be acceptable.

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#6

My Major Pharmacy Chain tech told me they’ve been told they’ll be fired if they overfill a Rx. So based on how the math for my insulin works out, I have to get partial fills every 20 days so they don’t overfill.

Note: this was a policy change this year

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#7

And that is why we are mail ordering. Having to go in every 20 days is crazy. Why can’t they fill 40 days, and make it happier for everyone?

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#8

Yeah. My mail order place is a separate plan and emphasizes Humalog which I don’t currently use. They made that switch last year and I had a friend on the same plan switch from Novolog to Humalog bc of it. I don’t trust them enough to go thru the hassle with them of getting Novolog covered even though it would be cheaper for me. At least my pharmacy is close.

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#9

I get my insulins thru/from the VA. They recently CUT BACK on what they send me now. For Lantus they send me only 3 vial for 90 days. So, I run a few days short, or have to use each vial for 30 or 32 days, except Feb (non-leap yrs) I can get by usually bt taking a couple extra units of Lantus, when past 28 days, or correct with Novalog if that did not work.

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#10

Makes no sense really to short someone insulin. But here we are.

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#11

Easy to avoid this predicament… ask your doctor to prescribe you exactly the quantity that works out to the packaged quantity.

Eg use 33 units per day (for a 10 ml vial 30 day supply)

Use 50 units per day (for a box of u100 pens) etc

(Also, might pay off to look into their mail order options… sometimes it works out far better for the customer, sometimes not)-/- eta I just looked up and saw that had already been covered.

Anyway, just ask for more to be prescribed than you actually need. I’m surprised not everyone is doing that already it’s always just been a given for me…

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#12

I do. The doctor will only go so far, though.

If the Rx doesn’t get within insurance tolerances (or whatever it is) for being a complete vial in the prescribed period, the pharmacy will not round up. I guess that’s considered insurance fraud now? Not sure.

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#13

Definitely not.

BTW - Our pharmacy rounds up.

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#14

Well, whatever changed with my pharmacy chain was significant enough to scare the heck out of the techs. They’re splitting insulin pens out from boxes now which they never did before. They always rounded up on that before.

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#15

As we only use vials, I will wait until they start splitting up vials.

ha ha ha
EDIT: Totally not laughing at you. I had a mental picture of the Pharmacy Techs trying to split up vials. if you could see inside my head that was hilarious.

BTW - Does your prescription when multiplies out for the month come out to an exactly even number of pens or is the script rounded up to the nearest whole pen? And just no longer rounded up to the nearest whole box?

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#16

I still use both.

I’m going to talk to them about alternating months where they give me two vials one month, one vial the next. My prescription is written to account for waste in pods, etc…but it is robust enough to get me squarely at 1.5 vials per month.

Back when pods were in boxes of 10, my 3 month 45 pod RX would get filled with 5 boxes one quarter and then 4 boxes the next quarter. Hopefully I can do the same sort of alternating through my pharmacy so I’m picking up once per month instead of every 20 days.

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#17

It was previously written as a range…and pharmacy filled to the lowest end of the range and would only give me three pens a month. Now my prescription is written for the high end of the range only, so that gets me to a full box now.

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#18

I have no idea why Docs write a script for a range.

I think that is just stupid.

The Doc should write the script so the Pharmacist can easily fill the script without having to make an independent decision as to what the Doc MIGHT have been thinking in terms of the quantity of medication they wanted dispensed to the patient.

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#19

And for further example of how times have changed (as far as my personal experience goes)…

When I was on Lantus, I used 13 units (average) a day. And the prescription was written that way. The pharmacy would never fill that for less than an entire box of five pens for one month. And I filled it every month and had a good stockpile for a while back then.

If I had that prescription now, they’d give me two pens in a pharmacy bag. I don’t even think the medication insert from the box would be included. When they were just giving me three Humalog pens a month last year, I don’t recall any of the literature from the box being included in the pharmacy branded ziplock they gave me the pens in. That seems shady to me.

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#20

I knew that! I thought it was funny, too!

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