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Norco no longer covered?

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Chronic Pain
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Posted 3/19/2019 4:41 PM (GMT 0)
Just picked up my regular Norco (Hydrocodone-Acetamin 5/325 mg) script and it seems it's no longer covered by Medicare Part D insurance. Just wondering if anyone else has run into this or if perhaps the pharmacy made an error in processing?

My insurance is a Humana PFFS Medicare Advantage Plan.

Thanks in advance.
Posted 3/19/2019 4:46 PM (GMT 0)
I would go online to Humana & check this out. If you can't find any information there, give them a call. This does happen with insurance from time to time.
Posted 3/19/2019 5:17 PM (GMT 0)
Yes, of course I'm doing that, Susie.

Just wondered if anyone else was having issues getting Norco paid for.
Posted 3/19/2019 7:20 PM (GMT 0)
I use Silver script for my Medicare Part D. I take a medication that it doesn’t cover but there is a form on their web site that I printed out and I gave to my prescribing doctor. They filled it out requesting that the medication was needed, and it was approved by Silver script for one year. My rheumatologist submits this every year and I haven’t gone without the medication ever. So be sure to thoroughly check out Humana’s web site.

I did go to Humana.com and found this that might be helpful to you.

Drug coverage determination
If you need to request us to cover a medication that’s not on the list of covered drugs, contact Humana Clinical Pharmacy Review (HCPR) at 1-800-555-CLIN (2546), TTY: 711, Monday – Friday, 8 a.m. – 6 p.m., in your local time zone.

Sherrine
Posted 3/20/2019 1:48 AM (GMT 0)
Perhaps they no longer cover the 5 mg.. I remember one plan did not cover 7.5 Percocet. But they covered 5 mg & 10 mg.
Posted 3/20/2019 8:25 PM (GMT 0)
I don't know if this is correct; however, my PCP told me they will only cover opiates every 90 days. I also have Humana Advantage. Hopefully, you can afford to pay out of pocket.
Best
Zen
Posted 3/20/2019 8:44 PM (GMT 0)
Zen Hen, do you mean they will only pay for a 90 day supply at a time ? That means you have to get it through mail order. I know insurance companies strongly encourage it. But I have never known of a company only paying for opiates that way. That means if you do not get a 90 day supply through mail order. You cannot get them.
Posted 3/20/2019 9:59 PM (GMT 0)
As far as I know, you can't get opioids thru mail order, no matter what strength or quantity.

My script is a rather small quantity, to be taken as needed over a rather long period, as needed. Also not that high a strength. I don't think the insurance not covering them has anything to do with strength or quantity, I think it's something Medicare changed.

Unfortunately I accidentally disposed of the actual paperwork saying it was denied.... which is kinda' why I was asking if anyone had run into a similar issue.
Posted 3/20/2019 10:38 PM (GMT 0)
You can appeal the denial. A friend of mine takes Norco 10 mg. She has Medicare. She has not had a problem getting hers filled.

It might be the insurance company thinks the prescription is for acute pain. If that is the case. It has nothing to do with it being written for Norco. Medicare only pays for opiates for acute pain for 7 days.

You need to call your insurance company and appeal the denial. Your doctor will also have to fill out a form or talk to them.
Posted 3/21/2019 2:15 PM (GMT 0)
Just thought it was odd. Have had the exact same script and insurance for over 3 years with it being covered.
Posted 3/21/2019 6:15 PM (GMT 0)
Silver script doesn't cover it either, but it's only 28 bucks for 7.5 x 60 at my little pharmacy.
SS also doesn't cover tramadol or ondansetron.

Check around at other pharmacies.

Get the SingleCare Card!!!! Make sure it is the one for Walmart only! It's way cheaper for meds than other free cards.
There is a price break on some meds at 42 pills. Ask the pharmacist to check!
Posted 3/23/2019 11:31 PM (GMT 0)
Alcie, I thought you might find this interesting.

https://www.singlecare.com/blog/walmarts-new-opioid-policy/
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