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Old 11-27-2012, 05:37 PM   #7
tortoisegirl tortoisegirl is offline
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Re: Question about insurance and what they will pay for as far as my pain meds

From how I understand the question, it is an insurance formulary list issue, not a pharmacy stock issue (since Pandie is able to pay cash). If its Oxycodone (not Percocet), there is no Tylenol. Its likely easier to have your doctor write it to take two of the 5 mg pills then deal with the insurance to cover the 10 mg ones. Although with some phone calls / forms that could be done, its likely that would have to be renewed at certain intervals such that it would be a pain.

I'd just discuss with your doctor that your insurance doesn't cover the 10mg ones so you've had to pay cash at $X per month, and you've discovered the 5mg would be covered. S/he will probably offer to write it that way.

Only issue I could see is that it is then 8 pills a day, which is 240 if you get a 30 day supply. Per my pain doctor, anything over 200 pills gets flagged by the DEA, such that some doctors avoid writing any CII script over 200 pills. Because of that my doctor writes my methadone script in two week increments, where one has a "fill after" date, since otherwise it would be over 200.

If you end up staying on the 10mg and not dealing with the insurance, definitely shop around for the best deal. Its common for the list price of meds to be quite marked up. Sam's Club or Costco is usually the cheapest (you don't need a card to go to the pharmacy), followed by Walmart. Most pharmacies will price match (excluding Sam's & Costco), so you can just call up Walmart or wherever and ask their price for what you take, then when you drop off the script at your pharmacy, ask them to price match that pharmacy you called (they will call and confirm the price).

I'd be cautious of discount cards as some are scams, or at the very least, they get your personal info and will send you junk. The manufacturers of brand name meds often have discount programs (reduced copay for 12 months or similar) and patient assistance programs (free meds if you are low income), but there won't be anything for generic oxycodone. Best wishes.
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Kate
constant headache since 2006

Last edited by tortoisegirl; 11-27-2012 at 05:45 PM.

 
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