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How to advise you Dr. to write a Rx!

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Posted 11/19/2007 2:32 AM (GMT 0)
For those of you that have BCBS insurance and are on Humira...I found out something interesting this weekend!  I was taking the injections biweekly at the cost of $100.00 per box of two pens.  Well my script came up for a "new" refill and my GI's nurse inadvertently faxed over the script to the pharmacy on the "old" dosage schedule.  Anyway, the pharamacist called BCBS to do an override so I could get my shot this weekend and BCBS processed the script...Thank God!  The new dosage is for once a week.  The pharmacist said she'd get the script straightend out with the Dr.'s office on Monday.  When my daughter so kindly stopped and picked up the Rx the script had been filled based on a monthly dosage and I paid $100.00 for 4 pens!!!!!!!!!!!  HURRAY!!!!!!!!  Just thought you may want to know!

There have been no changes in my insurance so I am sure it was the way the dosage was indicated on the script!

Posted 11/19/2007 4:02 AM (GMT 0)
Yes, I've been guilty of asking my doc to write a script for double the dosage, just so I can halve the pills and thus halve my pharmacy co-pay...and some docs will do this if they know you're having financial difficulty, but they are also warned repeatedly about insurance fraud and can get in trouble when this happens.  It's one of those sketchy areas, because there's some ethical dilemmas there, although most docs are on the side of their suffering patients and not some multi-gazillion-dollar drug company...it's still something to take into consideration.
Posted 11/19/2007 4:12 AM (GMT 0)
Hmmm...never though of that! I didn't ask them to write it that way...my dosage went up unfortunately.
Good point though! I was just happy to save the extra $100.00 bucks a month it was going to cost me!
Posted 11/19/2007 4:43 AM (GMT 0)
Hey, if it happens accidentally, by all means!  Always a nice surprise :)

Posted 11/19/2007 10:48 AM (GMT 0)
Hi Broom, I also have BCBS insurance. they usually pay 100% of any of the meds. It maybe the
samething with your Humira.
Posted 11/19/2007 2:46 PM (GMT 0)
Hey Broom, as long as your not asking for more than a months worth scripted then it isn't fraud. When I started entocort my doc wasn't sure how long he wanted me on it so he was scripting me 1 weeks worth at a time. I would have to pay my copay every week. When I told him he prescribed me for a month instead and then he could still adjust my dose as he wanted and I would use the stock of pills I had to do that with. I do know if doctors are technically supposed to rewrite script every time they have you decrease a dose but from what my doc told me they can prescribe up to a months worth at a time. It sounds like yours was being written weekly instead of monthly and that makes a HUGE difference.
Posted 11/19/2007 4:30 PM (GMT 0)
They are probably billing you for the max per prescription copay.  I have BCBS and pay $250 per script.  That can be 90 days (mail order) or 30 days worth of meds.  Either way, everytime I fill a script it's $250. 
Posted 11/19/2007 10:00 PM (GMT 0)
Holey schmoley, I guess I have a good deal. Assuming that my insurance would even ok humira for me, I would pay $30 (since its probably a third tier drug) for a months worth. I think its going up to $40 in January. If I do mail order, I get 3 months for the price of 2 months copay. So I get 3 months of pentasa for $40 ($50 in January) Its a second tier drug. To be honest, I'm not sure about the humira but it probably works the same way as pentasa, which I am sure about. I did get stuck paying $89 for one month of brand name zoloft recently

Thanks for pointing this out, Broomhilda as I have never had a script for anything I inject before. Not that I will be getting humira anytime soon.
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