I am wondering if anyone has cone across the problem......
I have been on the same medication for over a year now without an issue. I was able to go t the pharmacy and turn in the prescription and pick it up with out a hitch. The only "issue" was that I had go to my physician each time sand pick a physical prescription up to take to the pharmacy. However, they suddenly decided that starting November 1, 2014 that they were going to change the process of getting regulated neuron-stimulants, like Adderall, from not feeding a prior authorization to needing one.
That doesn't sound so bad, just a bit of an inconvenience; right? Not even close! I turned the prescription in over a week ago. The pharmacy faxed over the request multiple times, which I was thinking the issue was on my doctors end. So, I called them and they said that the authorization was in progress. After a day or two I called them again and they told me they were waiting on the insurance company and that the nurse would call me when it was ready. This was yesterday that I was told this; sometimes in the morning.
Yesterday afternoon/early evening, I got a phone call from that nurse. My insurance DENIUED the authorization for my Adderall. They said that they did not see Adderall as the "rRIGHT" medication to treat MY Narcolepsy. What in the world is this? Who are they?
I have been on this medication for over a year. I have tried other medications and have been allergic to them. I cannot take Xyrem. I am at a completely loss. I cannot function without medication to treat my Narcolepsy. I will only be a shell of a human being. I will literally just exist and I am a single mom. I am absolutely disgusted with this!
What would you do? My doctor made me an appointment on Wednesday (earliest he had available) to discuss what to do next. I am just at a completely loss.
I take Adderall also along with Nuvigil. I hope they don't cancel my Adderall also. My suggestions, if you haven't already done it;
1. Call the insurance company and find out the basis for their denial. Hopefully you can work around it.
2. If the insurance company still won't help, call the pharmaceutical company and explain your situation and ask for "compassionate care" (see note 1 below) to give you the med for free or at a low cost.
3. Also, sometimes the pharmacist understands the "system" well and can help understand what the issues are.
4. Your doc may have samples he can give you while you sort this out or your doc can refer you to a doc that has some.
NOTE 1: My cousin works for a pharmaceutical company and she told me to call the pharmy company and use the term compassionate care when they first denied Nuvigil for me ( I don't yet have an "official Narcolepsy diagnosis). Then out of the blue Carefirst approved it. I'm making an appointment to get an "official diagnosis." asap.
I wish you the best and hope you will keep us updated.
My fiance has to deal with the insurance every single month for the xyrem bc when the company goes to fill it, it gets denied bc of the cost of the meds. So every month Nick has to call his docs and nurses so they can get a hold of his insurance company to prove that its medically necessary for him to have it. But this causes his meds to get delayed 3-5 days. So when You go a full month on meds then are forced to go without a fews days. Takes a toll on him bad. But we found out that we will have to fight this every month. So now nick has to call a week in advance to prepare everything so instead of 3-5 days without its only 1 or 2. Either way hes still going without and it doesnt help with his moods either. I cannot imagine what you are going thru mentally. But know you are not alone.
lI am sorry that you are going through all of this, I have insominia/Ambien CR and then I also have narcolep/Nuvigil, Adderall, & quart of Diet Coke which helps a lot.........but I have Chronic Anemia/wkly. Procrit shots. I could not work parttime or drive. Dr. tried not giving me the shot this wk. and I fell asleep while singing in choir practice and dropped my music and had hard time staying awake to drive.........went in to see dr. and like always the red blood count was down/so they gave me the Procrit shot. I have had my rows with drs. and ins. just keep trying! It is not easy. I do not want to sound like a pity party, but I also have Sjorn. Synd. and Lupus/meds & monthly Benlysta infusions. I take 23 pills a day. I am blessed and thankful to have a loving husband and 2 daughters and their families. I am a Secular Fanciscan and thankful to God for the medical care that I have rec'd. I am a volunteer usher for my local university for events, concerts, plays, etc. When I am able I help the community, Church, choirs and all of these are like shots in the arm for me. I feel that I have a limited amt. of time so I try to live my life to the fullest when possible. I wish you the best of luck. Peace. Thanks.
Call customer service file appeal..if expedited appeal is an option request that.Since you have been on this med for a year a medical exception might be possible..Sending prayers your way ..
It's 11 pm for me and yes I' tired :-) I have some thoughts and ideas I'll compose and send in the am. Meanwhile, if you don't mind sharing, which insurance company do you have? I have Carefirst and may have some tips for Carefirst.
I was approved for Nuvigil even though I haven't been "diagnosed" with Narcolepsy, MS or Nigh Shift Disorder as required by my insurance. An RN at my doc's office got it approved - she worked some kind of miracle. I also take Nuvigil and Vyvanse.
My sister has Lupus also. She's in remission - yay ! I have another auto immune disease and not sure what causes my daily fatigue and hypersomnia.
helena said:
lI am sorry that you are going through all of this, I have insominia/Ambien CR and then I also have narcolep/Nuvigil, Adderall, & quart of Diet Coke which helps a lot.........but I have Chronic Anemia/wkly. Procrit shots. I could not work parttime or drive. Dr. tried not giving me the shot this wk. and I fell asleep while singing in choir practice and dropped my music and had hard time staying awake to drive.........went in to see dr. and like always the red blood count was down/so they gave me the Procrit shot. I have had my rows with drs. and ins. just keep trying! It is not easy. I do not want to sound like a pity party, but I also have Sjorn. Synd. and Lupus/meds & monthly Benlysta infusions. I take 23 pills a day. I am blessed and thankful to have a loving husband and 2 daughters and their families. I am a Secular Fanciscan and thankful to God for the medical care that I have rec'd. I am a volunteer usher for my local university for events, concerts, plays, etc. When I am able I help the community, Church, choirs and all of these are like shots in the arm for me. I feel that I have a limited amt. of time so I try to live my life to the fullest when possible. I wish you the best of luck. Peace. Thanks.
Tell the pharmacist he accidently dropped some pills down the sink and ask for an override for some more pills. Hopefully, that will fill the gap during your monthly waiting periods. I really opened a bottled of medicine once and spilled pills down the drain and got a refill this way.
Cayleigh said:
My fiance has to deal with the insurance every single month for the xyrem bc when the company goes to fill it, it gets denied bc of the cost of the meds. So every month Nick has to call his docs and nurses so they can get a hold of his insurance company to prove that its medically necessary for him to have it. But this causes his meds to get delayed 3-5 days. So when You go a full month on meds then are forced to go without a fews days. Takes a toll on him bad. But we found out that we will have to fight this every month. So now nick has to call a week in advance to prepare everything so instead of 3-5 days without its only 1 or 2. Either way hes still going without and it doesnt help with his moods either. I cannot imagine what you are going thru mentally. But know you are not alone.