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medicare/medicaid scripts.....please help if possible

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Posted 9/2/2008 11:55 PM (GMT 0)
I just came from the pharmacy.  they rejected my refill for generic brand prilosec.  First it was Nexium, and then prilosec was the only thing medicaid would pay for. Now they have rejected this prescription also.

I have a huge hiatal hernia, and get heartburn drinking a glass of water.  Acid reflux is sometimes a daily/nightly happening.

Have any of you had these same problems?  Do you know what to do about the scripts not getting processed.  I realize that many if not most of you are much younger than I am, and may not have come against this problem before.

The pharmacist said I would have a better chance of getting a narcotic drug,  than I can get prilosec or its generic.

is there something that i do not know, that you do know that would help me to get this medication.

thanks

Hester

Posted 9/3/2008 12:47 AM (GMT 0)
Sometimes if the doc calls to file an appeal that helps. I was on medicaid when I first got sick and was having dozens of lab tests every month-way beyond the medicaid cap (I used a years worth of office visits and lab tests in 30 days) my doc just kept filing paperwork for exemptions and extra tests and they kept paying. The doc also has to code things correctly-everything must be labeled medically neccessary rather than preventitive, diagnostic or ruitine.
Also, they may have changed their approved drug list and they may have something else in the same class that they are willing to pay for now.
Good luck I hope you find a way to get the meds you need.
Posted 9/3/2008 12:54 AM (GMT 0)
I decided to look it up.  If you type in the name of your state and Medicaid prefered drug list, it will give you a link to the list of prefered drugs in your state.

In Maryland Nexium and Prevacid are prefered prilosec and others require prior authorization-which means your doc needs to call and explain why you need that drug and not one of the prefereds.

Hope this is helpful.

Sj

Posted 9/3/2008 1:20 AM (GMT 0)
Hester, I can't help you with your original question, but I've battled a hiatal hernia for 38 years and have finally come up with a solution that works. Whether or not your doc will prescribe and medicare or medicaid will accept is another question. I take aciphex twice a day plus my magic potion which I take whenever my hernia acts up is called Green Lizard. It's a prescription liquid and is a combination pain killer/antacid/anti-spasmotic. It works wonders and has an instant numbing effect.

Good luck getting your scripts filled.
Posted 9/3/2008 1:23 AM (GMT 0)
Hi hester,

One thing I can also tell you is it depends on your medicare part d plan you are on. you need to look up your plan and see which meds your plan will require prior authorization. There should be a number on the back of your medicare part d card. If I can be of more help let me know. Then if I am correct medicaid should pick up the rest of the balance since it is through the state. What state are you in?

Leta
Posted 9/3/2008 1:42 AM (GMT 0)

I looked for this preferred prescription plan in my state, and could only find NC medicare part D (a prescription plan).  I have been in this scuffle about Nexium, aciphex, prilosec, etc. for a couple of years.  Prilosec was the last med in this category that I could get that medicaid would pay for, and now apparently they are no longer paying even for this one.

 the pharmacy said, that the reason they rejected my prescription is because the need for prilosec should have been met by a ninety day supply of prilosec.

But thank you so much for trying to help me.

I will keep looking and see what I can come up with.

Hester

Posted 9/3/2008 1:50 AM (GMT 0)

Hey Leta and all,

I live in North Carolina, and have the medicare part D program, and selected silver script as my preferred plan.

I wonder if I went to a gastro/intestinal doctor, if they would then cover the meds that I need.  I think my doctor also got tired of having to call silverscript to get me authorized, and simply is not calling them. 

I may ask for some samples tomorrow and see if they have any, and maybe I can go to a specialist, and maybe get the meds that way.

thank you for helping.  Sure wish I could take aciphex twice a day.

Hester

Posted 9/3/2008 3:07 AM (GMT 0)

Hi hun, sorry you are having trouble with your insurance. I have medicaid and champva. There have been a few times medicaid didn't pay and champva would only pay 75% of it. Which sounds pretty good unless you get a scrip that cost ya 300 dollars or somthing. I'm like Patty I take aciphex too. But only once a day. I have a hiatal herniaas well but fortunately I havn't had a lot of problems with it. (fingers and toes crossed). I thought they had prilosec otc out there. I have no idea how much it costs or how it works.

Hope you find something they will pay for. As for your doctor I'm sure he doesn't make the calls himself.  My doctor always asked me what insurance I have because she knows after seeing other patients what co. takes what

Anyway looks like you'll be on the phone tomorrow. Good luck!

hugs

Posted 9/3/2008 1:58 PM (GMT 0)
medicare/medicaid scripts.....please help if possible ... Sep 2, 2008 ... Email Address Not Available Personal Homepage Not Available ... First it was Nexium, and then prilosec was the only thing medicaid would pay ...
www.healingwell.com/community/default.aspx?f=29&m=1229824 - 34k - 12 hours ago - Cached - Similar pages

The above is interesting.  After reading Okie's response to me, I went on the internet looking for "medicaid not paying for nexium".  and this above was one of the websites it took me to.  And clicking on the site took me to the first email I sent yesterday about nexium.

'

But going to call the doctor today and give them the number doctors should call, and ask them to reauthorize prilosec or nexium for me.  I won't hold my breath while I am waiting.  but will also try to get some samples for now.

Just a down day.  We move along doing the best that we can, and then the best we can do is not enough.  privatizing  a medicare prescription plan was the worst mistake that was made for people on the recieving end of this plan.

I am glad that you have Champa Okie.  At least you have a backup.  I thought that medicaid was a backup for me.  Apparently I was so wrong.

Hope your day will be good to  you

Hester

I  

Posted 9/3/2008 2:30 PM (GMT 0)

I called the pharmacy to see how much I would have to pay myself, and it costs $120.00.  but I also learned that Kay one of the pharmacists is calling the doctor for me.  Now that was way beyond my expectations.  Even if she is not successful in getting anything done, the fact that she would do this is enough to lift me out of the depression hole I was headed for.

I did find in the formulary that prilosec is only allowed to be covered for 90 days.  No reauthorization as far as I can tell.   I will wait and see what Kay gets done for me.

thanks to all of you for your support.  and many thanks to this forum for existing.

Hester

Posted 9/3/2008 3:06 PM (GMT 0)
I have Illinois medicaid and my dh has been on ranitidine for years - they cover that. I think it is generic for zantac? it's mild but he does better with than without it
Posted 9/3/2008 7:49 PM (GMT 0)

SpinningMawmaw thank you.  I will see if the doctor would prescribe this for me.  the difference might be medicaid in a different state.

Hope the day is good to  you.  you made mine a little better.  yeah

Hester

Posted 9/4/2008 1:56 AM (GMT 0)
Hey Spinning Mawmaw

I looked online to find the ranitidine, and found 195 tablets, nonprescripion levels, and I ordered it.  It cost 11.95, and seven dollars shipping.  That is way cheaper than here where even nonprescriptin prilosec is over $40.00.

I will talk to my doctor before I take it, but it sounds like the others.

Thank you for sending this idea to me.  Ranitidine was not in the formulary, so they do not even list it as a drug that they use.

Hester

Posted 9/5/2008 11:36 AM (GMT 0)
I'm glad I was at least a little help. In my first post I said I wanted a shoulder to lay my head on. I needed comfort and found it. As I check in here daily, I have found that I now want to take you all in my arms and comfort you. I may not have many answers, but I suddenly found I care deeply about you all. Thank you.
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