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  • Anyone else have problems getting their meds approved by Medicaid?

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    Old 12-13-2005, 07:41 AM   #1
    momchelle
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    Angry Anyone else have problems getting their meds approved by Medicaid?

    I am getting so frustrated with Medicaid...here in Ohio we just changed providers a few months ago, and the new one is awful. They require prior authorization for refills of medicines I have been taking for months, and they just flatout deny some of my medicines. It is ridiculous!

    Like today--I take Morphine 60 mg 3x a day. My sister picked up my prescription from my pain management center yesterday morning and dropped it off at Walgreens to be filled. Then I get an email from Walgreens at about 6 pm, saying my insurance denied it. I took my last pill yesterday morning, so I haven't had any since then and I am so afraid I am going to go through withdrawal. I went through that around Thanksgiving when they changed me from 100mg 2x a day to this 60mg 3x a day, and it was awful--shaky, chills, nausea, diarhea (sp?), etc., etc. So for them to just deny it yesterday was a big blow. I'm so upset by this, and I'm still waiting to hear from my doctor about what to do.

    I'm just so frustrated...the Medicaid has done this with my depression/anxiety medication as well--I had been taking Lexapro for about a year, then my doctor switched me to Cymbalta to see if that would work better for me. After a month, we decided to switch back--and suddenly my Medicaid needed an authorization (and these authorizations can take several days).

    *sigh*

     
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    Old 12-13-2005, 10:48 AM   #2
    Fabrashamx
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    Cool Re: Anyone else have problems getting their meds approved by Medicaid?

    Hi Momchelle, I also have medicade, although I am in Oregon and we have the Oregon health plan which is a subsidized version of the federal program. I have been lucky getting my medications paid for, but for two of them my doctor had to write a letter to the insurance company telling them she wanted me on these specific meds and in her opinion, there was not an equiatble alternative on their list of 'approved' medications. It took about a month to go through. Once we lost our benefits for 6 months, because of an income issue, and as my husband is bipolar and I have CP, it could have been a disaster! Our medications together would be well over $2000 a month, which is more than we make right now. I spent days on the phone, and what I found out with my DH's pschy meds was that I could go directly to the manufaturers and request a 'scholorship' and they sent us coupons that paid for some of his medications. I found that the county health building has a sliding scale pharmacy for some others, And the rest I went to our doctors, and was able to get samples. Maybe your doctor has some samples, If not of that medicine, of a similar one that could get you through until you can resolve your insurance issues. Best of luck to you, and please let us know how you are doing. ~Fabby

     
    Old 12-13-2005, 11:03 AM   #3
    curiousforever
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    Re: Anyone else have problems getting their meds approved by Medicaid?

    good idea Fabby!

    Call the doc and ask for samples!

     
    Old 12-13-2005, 06:47 PM   #4
    Fibbles
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    Re: Anyone else have problems getting their meds approved by Medicaid?

    Have you looked into a Health Insurance Pool? They're setup for people that can't get "normal" health insurance. Getting on mine required a notice of rejection from another provider and I pay $195 for my $500 deductible. The higher ones are cheaper and by next year I'll be on the $1000 plan. I only pay $69 for my avinza (30 60mg and 30 30mg tabs - no pharmacy here carries 90's) and generic Oxycodone is only $10 for 30 (brand name is $60), plus all the other stuff totals around $150 to $200 a month out of pocket for the meds I need (not the ones I use optionally).

    Last edited by Fibbles; 12-13-2005 at 06:49 PM.

     
    Old 12-15-2005, 12:50 PM   #5
    momchelle
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    Re: Anyone else have problems getting their meds approved by Medicaid?

    Thanks for the replies! I will ask my doctor for samples, but I don't think he has samples of Morphine or my Percocet. He probably has my Imitrex, though...

    I would have responded earlier, but I went through a very rough couple of days. I started going through withdrawal because of the Morphine and it was horrible. Shakes, chills, hot flashes, running to the bathroom (if you know what I mean), giant headache...you name it, I had it. And it lasted up until the Medicaid provider decided oh-so-generously to let me have 16 pills. After a couple of pills, I was almost completely better, just exhausted (and, of course, still dealing with my pain problem).

    My doctor then told me that my insurance decided that as long as I take 68 or less pills of Morphine a month, they will (supposedly) approve it. I'll believe it when I see it. But, the doctor said that he will decrease me back to 2x a day of the 60mg Morphine and increase my Percocet from 5/325 to 10/325 to deal with the pain better. Hopefully it will work, I don't know because I have to wait for my sister to pick up the new Percocet for me.

    I haven't looked into a health insurance pool, though that would be a good idea if we had enough income. Right now my husband just went back to work after about 1 1/2 years of being layed (sp?) off and not being able to find work. He isn't making all that much at all, so we still get food stamps and Medicaid. Frankly, at the moment there isn't much left over after paying the bills, so we wouldn't be able to pay for any kind of health insurance. And if I had to pay for my prescriptions I wouldn't be able to get any of them. But, I'll tuck that idea away for the future...

    Thanks for the support! It really means a lot!

    Michelle

     
    Old 12-15-2005, 02:55 PM   #6
    Fabrashamx
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    Re: Anyone else have problems getting their meds approved by Medicaid?

    Hi again Michelle, glad you are feeling a bit better! I know what a nightmare it can be dealing with bureuracracy when you are suffering, Sounds like your doctor is wonderful and trying to help out. You can always ask about the opiate samlples, My doctor has given me samples of opiate medications before, It might be a brand you have never heard of, but it's worth a try. I know this time of year is stressful on CP patients in so many ways, all the extra activities and when you add money stress on top of that its not fun. We are also on a very limited income, and if we had to pay for our meds we would have to do without. try and remember to be kind to yourself, give yourself the gift of letting go of any chore that is not essential and take a bubble bath or curl up with a good book. When our stress goes up, our pain goes up, so let someone else be Martha Stewart, LOL! Hope all your troubles are resolved quickly, let us know how it comes out. Your Friend, Fabby

    Last edited by Fabrashamx; 12-15-2005 at 02:56 PM.

     
    Old 12-15-2005, 04:54 PM   #7
    momchelle
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    Re: Anyone else have problems getting their meds approved by Medicaid?

    Thanks for the support, Fabby! I will ask my doctor if they have any samples like that--doesn't hurt to ask, right? (At least that's one thing that doesn't hurt, LOLOL!)

    I can definitely relate to the stress...this time of year is just full of it! I've been trying to take it easy and not wear myself out, but I sure wish I could get my husband and stepson (age 14) to help out more. My husband just started a new job about a month and a half ago, working nights, and he hasn't been getting much sleep, so I feel guilty asking him to do a lot, you know? And my stepson is a whole other story...he never has had to do too much, and now he is just plain lazy--and I can't go asking him to do a million things without being the wicked stepmother. *sigh* Oh well, at least I don't have any company coming over for the holidays, so I don't have to worry about how the house looks, right?

     
    Old 12-15-2005, 05:35 PM   #8
    Fibbles
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    Re: Anyone else have problems getting their meds approved by Medicaid?

    I should have added that a lot of pools have options for low income families/people. Mine has one, but I don't qualify since they base it on household income. The low income options can get premiums cut in half or even up to 90% covered. It depends on your total income. It never hurts to ask or find out.

    Last edited by Fibbles; 12-15-2005 at 05:36 PM.

     
    Old 12-16-2005, 09:03 AM   #9
    momchelle
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    Re: Anyone else have problems getting their meds approved by Medicaid?

    Quote:
    Originally Posted by Fibbles
    I should have added that a lot of pools have options for low income families/people. Mine has one, but I don't qualify since they base it on household income. The low income options can get premiums cut in half or even up to 90% covered. It depends on your total income. It never hurts to ask or find out.
    That's true--I should check it out to see if I keep having problems getting covered by Medicaid. Can't hurt to find out, if not for right now, at least for the future. Thanks!

    Michelle

     
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