Paying the "correct" amount for prescriptions

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Paying the "correct" amount for prescriptions

Postby dm200 » Thu May 09, 2013 4:00 pm

Usually, in my experience, prescription drug coverage (including Medicare) seems to pay for a certain number of "days" -- not number of pills. So, for example, if the physician prescribes 1 10 mg pill of xyz for 90 days, then you get 90 days and pay the 90 day price. If the prescription is for 2 pills a day of xyz for 90 days, you get 180 pills and pay the 90 day price.

What, then, if the physician prescribes 1 or 2 pills a day (as I tolerate xyz), and wants 90 days, how is that done? Or, do I get 90 pills, which seems to shortchange the insurance reimbursement if I ever take 2 pills per day. NOTE that I am not asking about twisting the rules, or do9ng anything at all improper -- I just want to get 90 days medication for 90 day price.
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Re: Paying the "correct" amount for prescriptions

Postby gerrym51 » Thu May 09, 2013 4:15 pm

you get 180 pills IF the doctor wrote for 180. the doctor cannot write 1-2 pills a day but then write 90 pills if he writes 90 pills with those instructions you get 45 days woth at 2 per day.

some insurances will NOT pay for 2 a day of certain drugs-thats a different issue
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Re: Paying the "correct" amount for prescriptions

Postby dm200 » Thu May 09, 2013 10:13 pm

gerrym51 wrote:you get 180 pills IF the doctor wrote for 180. the doctor cannot write 1-2 pills a day but then write 90 pills if he writes 90 pills with those instructions you get 45 days woth at 2 per day.

some insurances will NOT pay for 2 a day of certain drugs-thats a different issue


This is a recent conge that I discussed with physician by secure email. I will see how it is filled/charged, then discuss the issue with her for the next time.

A few years aoo, different drug - different physician - different insurance, I was taking 50 mg/day of a drug. I was charged brand name for the drug. I asked the ins co why I did not get a lower price. The said there was a generic. Then I asked why I did not get the lower rice generic, then. They said all they had in generic was 25 mg pills. Then I aid, then give me 2 25 mg pills at the generic price. No, they said, it wasn't written that way. SO, I just asked the Dr to write the Rx for 2 - 25 mg per day, I got the generic at the low price ad everyone was happy. The ins co rules, Rx rules and other rules can be very puzzling.
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Re: Paying the "correct" amount for prescriptions

Postby gerrym51 » Thu May 09, 2013 10:23 pm

dm200 wrote:
gerrym51 wrote:you get 180 pills IF the doctor wrote for 180. the doctor cannot write 1-2 pills a day but then write 90 pills if he writes 90 pills with those instructions you get 45 days woth at 2 per day.

some insurances will NOT pay for 2 a day of certain drugs-thats a different issue



This is a recent conge that I discussed with physician by secure email. I will see how it is filled/charged, then discuss the issue with her for the next time.

A few years aoo, different drug - different physician - different insurance, I was taking 50 mg/day of a drug. I was charged brand name for the drug. I asked the ins co why I did not get a lower price. The said there was a generic. Then I asked why I did not get the lower rice generic, then. They said all they had in generic was 25 mg pills. Then I aid, then give me 2 25 mg pills at the generic price. No, they said, it wasn't written that way. SO, I just asked the Dr to write the Rx for 2 - 25 mg per day, I got the generic at the low price ad everyone was happy. The ins co rules, Rx rules and other rules can be very puzzling.


i'm a pharmacist and work for a national drug chain. pharmacies enter the info from a script(brands get changed to generics if there is one) exactly as written then transmit to the insurance companies computer. thats when the insurance will either let it go thru as a paid claim or reject because of various reasons-drug not






covered/days supply not correct etc. then they re-transmit based on what insurance says to tell it to do. the pharmacy does not decide-your insurance does.they all have different formularies and rules


ps differnt strengths of a drug can go generic at different times say a drug comes out at 1 strength and a new strength of it comes out 2 years later. the patent on the second strength will also expire 2 years later
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Re: Paying the "correct" amount for prescriptions

Postby LadyGeek » Thu May 09, 2013 10:37 pm

This thread is now in the Personal Consumer Issues forum (prescription pricing).
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