ObamaCare: Walmart can't fill perscription until doctor talks to insurace company !??!!??!

Went to Walmart yesterday to refill my mothers prescriptions, she has been on the same medicines for 6 years, was told that one prescription couldn't be filled until the doctor talks with the insurance company. I asked why and was told that all "High Dollar Cost" prescriptions are being flagged and the insurance companies want to talk to the doctor to see if they are really needed and/or a cheaper alternative can be prescribed.
Pharmacist said this is happening a lot, insurance companies are trying to cut out the Higher Cost drugs... Thanks ##snipped##

I don't see why this should be a problem (apart from the waiting time).

A lot of medication have their licenses expired, and are as such manufactured by a lot of different companies under different brandnames (generic brands), but with the same molecules.

In Belgium a pharmacist has to propose the cheapest alternative to the medicine the doctor prescribed.

Example: Prozac is a name everyone knows, but the active molecule is fluoxetin. There are at least 10 companies in Europ producing fluoxetin under different brand names. Price difference can be up to 70%.

Greetz,

P.

Originally posted by RocksFromSpace
to see if they are really needed and/or a cheaper alternative can be prescribed.

To see if they are really needed? Really? WTH!

Obamacare. Why not just kill everyone that needs medicine, THEN it'd be affordable!
(no disrespect to your mother)

Originally posted by RocksFromSpace
Went to Walmart yesterday to refill my mothers prescriptions, she has been on the same medicines for 6 years, was told that one prescription couldn't be filled until the doctor talks with the insurance company. I asked why and was told that all "High Dollar Cost" prescriptions are being flagged and the insurance companies want to talk to the doctor to see if they are really needed and/or a cheaper alternative can be prescribed.
Pharmacist said this is happening a lot, insurance companies are trying to cut out the Higher Cost drugs... Thanks OBUMMER

Did you try a Walgreens??? Or is this across the board? Jewel Osco, Meijer et cetera??? I can understand the high cost prescriptions, you can obtain a Generic brand for half the cost and 9/10 is worth it because the premier drug is identical to the generic minus the name and branding company... So it s the high cost drug really worth it???

Without getting into details of the drug you were filling with your mother, I care less, I don't see why this would matter.

Furthermore, there are several times where the pharmacist has to contact and confirm the prescription with the doctor to ensure the medical prescriptions was from him and not a forgery.

Best of luck~

reply to post by RocksFromSpace


Oh good lord!

It's been that way for years! Insurance companies have dictated what your doctor could do since forever.

My husband was denied an MRI that the doctor ordered, an MRI that would have found his spinal cord injury in '04 when mr. wonderful was in the WH.

Ten years before that my insurer listed a mastectomy as 'elective' surgery.....but the boss's wife got her nose job paid for.....

Please don't misunderstand me, I fully understand that your mother was on this drug for 6 years. I am in agreement with that. And if she's been filling this drug at that Walmart for 6 years there should be no reason for it as well. I'm just trying to see the whole picture is all.

Best wishes~

reply to post by iamborg

I don't see why this should be a problem (apart from the waiting time).

I find the waiting time to be long enough at a pharmacy, thank you.

And that is plenty enough of a problem for me.

This has got to be Obama's fault. It just has to be! I mean, since when has the rising cost of medicine dictated policy of the insurance companies and the pharmacists?! When?

Oh... always? Really? Still... it must be Obama's fault. MUST BE.

Originally posted by beezzer

Originally posted by RocksFromSpace
to see if they are really needed and/or a cheaper alternative can be prescribed.

To see if they are really needed? Really? WTH!

Obamacare. Why not just kill everyone that needs medicine, THEN it'd be affordable!
(no disrespect to your mother)

edit on 12-7-2013 by beezzer because: (no reason given)

I guess they figure maybe the Doctors are prescribing these things without knowing what they're writing or ..maybe they're just kidding and a phone call can clear it all up, eh?

I kinda thought the Rx scrip WAS the statement of the Doctor saying it is really needed. lol... Here I've been thinking that when it seems it was merely a suggestion for office workers to ponder and approve.

Wal-Mart is a big chain that has to follow set rules for set reasons.
Big government likes big chains that follow big rules but that's one of the reasons we're in this mess.
Individuals and private companies have been removed from the picture.

I used to go to Wal-Mart pharmacy. I thought they would be the least expensive.
I now go to a privately owned pharmacy that actually takes care of it's customers.

I was paying $600+ a month through wal-mart for my meds and I have good insurance.

I found another place.
My new pharmacist called my doctor and they did some swapping of meds. Then they got me some discount cards directly from the drug manufacturers.

Now I pay a total of 49 dollars a month. My meds work. I am using that extra 550 a month to cover some of my gas costs for the 16 hours of commuting I have to do for work now.

I wish they had generic gas.

Originally posted by RocksFromSpace
Went to Walmart yesterday to refill my mothers prescriptions, she has been on the same medicines for 6 years, was told that one prescription couldn't be filled until the doctor talks with the insurance company. I asked why and was told that all "High Dollar Cost" prescriptions are being flagged and the insurance companies want to talk to the doctor to see if they are really needed and/or a cheaper alternative can be prescribed.
Pharmacist said this is happening a lot, insurance companies are trying to cut out the Higher Cost drugs... Thanks OBUMMER

There seems to be a lot of missing information and maybe incorrect information here.

Did they say the "doctor" or the "pharmacist" has to talk to the insurance?

Was this a refill or a new script for the same drug?

This has more to do with your mom's insurance than anything Obama did (but go ahead, be the meme). It was the insurance company that told the pharmacy that they won't pay/cover it until they talk to the doctor.

I have zero idea how you got that it was Obama's fault, except that some people seem to blame him for everything.

Originally posted by iamborg
I don't see why this should be a problem (apart from the waiting time).

A lot of medication have their licenses expired, and are as such manufactured by a lot of different companies under different brandnames (generic brands), but with the same molecules.

In Belgium a pharmacist has to propose the cheapest alternative to the medicine the doctor prescribed.

Example: Prozac is a name everyone knows, but the active molecule is fluoxetin. There are at least 10 companies in Europ producing fluoxetin under different brand names. Price difference can be up to 70%.

Greetz,

P.

I see a problem....What happens if the pharmacy doesn't carry the "cheaper" alternative? Do you have to wait until it is special ordered in?

reply to post by RocksFromSpace


Your situation, and the situations of the millions of Americans in the same boat genuinely makes me sad. I know the it's certainly a 'first world problem', but when it gets to the point where you're simply unable to pay for the more expensive medications (which, coincidentally, tend to treat more terminal illnesses - funny, that) you know things are generally quite bad.

I picked up a prescription this AM for my brother who a myriad of mental health issues as well as cancer - he (and much of my maternal family) have a rare genetic defect which often leads to cancer, as well as a host of other ailments, called MEN-1. He has two tumors in his brain, one on one of his kidneys, and one on his thyroid. He doesn't work, though he would love too, but for him, its simply an impossibility with his illnesses. The script I picked up this morning for him at Shoppers Drug Mart (picture a Canadian Walgreens) cost me zero dollars and zero cents, full cost would have been close to a thousand bucks.

Granted, the scrips cost nothing because he's on government assistance, but even without it, much of that cost would have been covered by various federal and provincial programs.

Our system sure as hell isn't perfect. That's not my point. But I firmly believe that the day the USA embraces a true social safety net in terms of health care is the day America evolved as a nation.

I read something in somebody's sig the other day that really resonated with me - socialism for our needs, and capitalism for our wants.

Though I'm not an overly religious man, I feel like thanking the lord every day for being born in a nation for a family member coming down with a terminal illness doesn't mean going bankrupt.

Originally posted by RocksFromSpace
Went to Walmart yesterday to refill my mothers prescriptions, she has been on the same medicines for 6 years, was told that one prescription couldn't be filled until the doctor talks with the insurance company. I asked why and was told that all "High Dollar Cost" prescriptions are being flagged and the insurance companies want to talk to the doctor to see if they are really needed and/or a cheaper alternative can be prescribed.
Pharmacist said this is happening a lot, insurance companies are trying to cut out the Higher Cost drugs... Thanks OBUMMER

I know this doesn't fit you narrative that this is a result of Obamacare, but this type of thing has been going on for at least a decade. I have been on the same medication for over 10-years and every time I need a refill, my Dr. must talk to my prescription insurance company and justify the continued use of it. This applies to any medication you are on "long-term" (i.e., more than 90 days). Furthermore, I must purchase my medication via mail-order exclusively from my Rx insurance company.

it sucks, but it's not Obama's fault.

And this the fault of the Aca how? Sounds like the insurance company to me.

reply to post by RocksFromSpace


This is government insurance......Not Obamacare yet!

I am glad they do this, MY freaking money helping pay for it I want it as cheap as possible......You don't want this to happen, looks like a job is in your future.....

Sorry I am being harsh, but government assistance should be regulated as much as possible.....People running around with the same insurance as me when I actually pay for mine is not right.

Walmart was doing this even before Obamacare came out. So your whine about Obamacare is just that another another attempt to place blame where it doesn't belong.

reply to post by Chrisfishenstein

This is government insurance......Not Obamacare yet!

From what I hear out of Doctors and med people I go to school with right now? Almost nothing is happening anywhere in the U.S. medical system, on any level, which isn't somehow related to the Affordable Care Act. Either preparing for the impact of the ACA or preparing to meet the requirements and be in compliance to it.

The war on pain medication came in January and that came by way of flyers actually posted in the rooms and down the hallways of the offices my Wife goes to saying NO chronic pain meds could be dispensed or even DISCUSSED with anyone but the primary physician under any circumstances. She was cut from her pain meds within a very short time of those flyers appearing and told to do the best she could ....after being on opium based meds for years without break.

If you've never seen someone go cold turkey and suffer through breaking opium pain med addiction? It's not an experience you ever want to go through. She survived it ...but wished she wouldn't have, literally, at several points during that month.

Her doctor as well as one on the site I work at in Texas and am able to converse freely with both said this was a 100% direct result of new 2013 regulations implemented as part of the phased application of the Affordable Care Act.

So..right now? There is no "Government Insurance" or Medi- program truly separate and stand alone from ACA being rolled out. ACA overtakes EVERYTHING else ..and it's phased implementation means we'll be seeing it in large and small ways during the whole process.

I don't understand why America doesn't just implement a service like Health Canada or the UK's NHS. Certainly, from the outset, there would be a certain segment of the population that would fight it tooth and nail, calling it 'communism' or whatever verbal diareah those sorts spew forth. We Canadians and those from the UK saw all of that in our nations, too, but after a generation or two, people couldn't imagine a world without it.

Again, let me stress that in Canada at least, our system is far from perfect. But what is? Certainly not wallet biopsies by paramedics for the benefit of unscrupulous insurance agencies, or elderly people wasting away along at home with terminal illness because he/she simply couldn't afford to visit a doctor.

The idea of being presented with a bill for a completely necessary hospital visit is so foreign to me, that it's verging on culture shock territory.

I wish the nation which considers itself to be the best, most free country on Earth would take a little bit better care of each other.

You know, I'm ashamed to admit that up until a year or so ago, I bought the line that Obama would fix everything. I don''t mind admitting not that I was fooled. I'm only 25, and in 2008, I was 19 and idealistic and bought the 'yes we can' BS hook, line, as sinker, as did so many young idealists at the time.

Back then, I didn't imagine that Obama could possibly be worse than Bush, but here we are in 2013 and it looks for all the world like he's trying his damnedest to earn that title.

From his dogged pursuit across the globe of a young man who did nothing more than expose a vast and illegal worldwide evesdropping program, to the framing of wikileaks founder Assange for 'sex crimes', the murder of Michael Hastings, his ramping up of targeted assassionations - including the murder of al-Awlaki's son, who grew in Colorado and had absolutely no ties to Islamic extremist beyond his father, essentially meaning he was killed for the crimes of his father.. I could go on and on, I've made my point.