Prior Authorization (PA) for Pharmacy?

[Kirk Freeman]

Here at Target attempting to pick up pills for a nasty rash that I picked up at jail/yoga/martial arts (unsure where) and am told that the pills are a "PA" item.

I asked "What is the Prosecuting Attorney doing with my pills?" Blank stares, but apparently the insurance company (Blue Cross) has to approve this now?

Why didn't the doctor tell me this, or would he not know? He asked me if I wanted pills or the gel; I told him pills, kill it with fire internally.

I am waiting for this shower gel junk now. Ketaconazolee or something.

What is the dealie-o?

 

[hoosierdoc]

PA is something your insurance sets up. We have no idea about the myriad of policies out there and what restrictions are on it. You have some sort of fungal rash in skin folds or some such thing? Oral anti-fungals can get pricey and probably why they want to make sure it's used appropriately. Topicals don't have the "hurt your liver" side effect either. Good on you for staying out of CVS/Walgreens too.

Insurance companies put the PA in place to restrict non PCPs from writing for tests/meds that may not be needed. I need to get a PA to see most medicaid patients in the freaking ER (well, only if I want to get paid). I can't order an MRI on you as an outpatient many times because insurance questions why an ER doc orders an outpatient imaging study. Regardless of me trying to save you and them $$$ by doing it outpatient rather than in the ER with the "Stat" upcharge.

Many people are locked down by Medicaid for their rampant abuse of the system and they cannot fill meds by anyone other than their assigned PCP.

 

[Kirk Freeman]

ou have some sort of fungal rash in skin folds or some such thing?

Not on the folds, right on the skin, neck and upper chest. I look like an Appaloosa horse with my shirt off. Itches like mad when I get hot and sweaty.

Good on you for staying out of CVS/Walgreens too.

Was told long ago to stay out of these places.

locked down by Medicaid

Yes, I know that is coming soon for us all.

 

[woowoo2]

It's cooties, kill it with fire.....

 

[9mmfan]

And to make matters worse, our office has had to do PA'S drugs that have been generic for years
PA's are really a pain in the **s. Can easily take 30 to 40 minutes to get some done.

 

[Dead Duck]

I read the whole thread.

Now I need a shower.

 

[Lectric102002]

Sounds like tinea versicolor. I had the same thing a while back. The dermatologist wouldn't give me the oral because of the liver damage potential. Had to do a topical and the shower wash thing. It eventually cleared up.

Tinea versicolor

 

[Bucko]

Good on you for staying out of CVS/Walgreens too.

Ok, so why the stay out of CVS/Walgreens? Is it because of robbery issues, or something else? Had never heard of this before.

 

[hoosierdoc]

Ok, so why the stay out of CVS/Walgreens? Is it because of robbery issues, or something else? Had never heard of this before.

They are the Don's Guns and Gander Mountain of pharmacies. I'm referring to price and nothing more.

 

[Kirk Freeman]

hey are the Don's Guns and Gander Mountain of pharmacies.

Thanks a lot, now INGO will be bombarded by 14, 838 threads about "dem prices at da Cee Vee Ess".

 

[Rookie]

They are the Don's Guns and Gander Mountain of pharmacies. I'm referring to price and nothing more.

What if your copay is the same no matter where you go?

 

[hoosierdoc]

What if your copay is the same no matter where you go?

Then you are paying a lot for your policy and you should get an HSA

 

[Rookie]

I'm not paying anything, it's wrapped in my benefits...

 

[snorko]

They are the Don's Guns and Gander Mountain of pharmacies. I'm referring to price and nothing more.

Had the same thing happen to me with one of the five prescription drugs (generic Plavix) I now take due to my recent stent. I bit it and paid for the full cost for the first month but got it straightened out with the cardiologist.

I recently began taking prescription drugs for the first time in my life so I didn't even think about comparison shopping. If I walk in to Target or Walmart with a list of what I take and show it to the pharmacist with my Insurance info, would they be able to give me an estimated cost? I assume switching the prescription to another location is just a phone call to the doctor?

 

[KLB]

They are the Don's Guns and Gander Mountain of pharmacies. I'm referring to price and nothing more.

With CVS and Caremark being one company, a lot of people get their prescription coverage from them.

 

[DoggyDaddy]

Ketaconazolee - Isn't that some ancient Mesoamerican "bird god"? Seems like I saw a sci-fi flick about him once...

 

[looney2ns]

Had the same thing happen to me with one of the five prescription drugs (generic Plavix) I now take due to my recent stent. I bit it and paid for the full cost for the first month but got it straightened out with the cardiologist.

I recently began taking prescription drugs for the first time in my life so I didn't even think about comparison shopping. If I walk in to Target or Walmart with a list of what I take and show it to the pharmacist with my Insurance info, would they be able to give me an estimated cost? I assume switching the prescription to another location is just a phone call to the doctor?

Yes Snorko. Lots of times you can do it online yourself. Price check that is.

Family member was taking Warfarin after a stroke. The weekly lab check was costing them $85 at the local Hospital. Come to find out, it was actually being sent down the street to an independent lab. Long story short, they started taking the test down to the local lab themselves and it cost them $10.00 instead.

 

[Clay]

If you have to get a script fill, please use a local pharmacy.

 

[9mmfan]

Had the same thing happen to me with one of the five prescription drugs (generic Plavix) I now take due to my recent stent. I bit it and paid for the full cost for the first month but got it straightened out with the cardiologist.

I recently began taking prescription drugs for the first time in my life so I didn't even think about comparison shopping. If I walk in to Target or Walmart with a list of what I take and show it to the pharmacist with my Insurance info, would they be able to give me an estimated cost? I assume switching the prescription to another location is just a phone call to the doctor?

Some places have generic meds cheaper than your insurance co-pay will be. For instance, I go to K Mart Pharmacy for two of my meds that cost me $15 for three months apiece; that is cheaper than my insurance mail order pharmacy. There is a yearly $10 fee.
Wal Mart had one of the biggest $4 medication lists around but overall their service is not up to par.

 

[Kirk Freeman]

Shower gel stuff is working. Rash is in retreat and it did not itch after last night's run.