Pre-Authorization for Medication

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DON'T PANIC, but:

I just got notified I am not only going to be required to get pre-authorization for a long list of medications, prior to my insurance paying for them, but it includes that I need to do that for any prescription I'm already taking, if it is on the list.

Next, the list is hard to use, as it lists a "condition", then an alphabetical list for that condition. There are lots and lots of conditions, and you have to figure out what is the "proper" name for your condition. Ugg.

Next, one mediation for your condition may show up on a different condition, not "your" condition. An example that may apply to us/me:
There is a single drug under the heading of "Incontinence" = Solesta. However, for another condition with a "moderate" drug list, it listed Botox, which people on this forum use. Now you know another reason this list is hard to use.
Diabetes, as a condition, did not appear, but if you have it, you probably know what Insulin costs. Yuck.

DON'T PANIC! This may only apply to "my group" of retirees from one employer.

Criteria they list: (1) If the drug is expensive. (2) If the drug requires special shipping (I'd guess if it has to go via something like FedEx and is in a cold-pack. I get one of those, but it wasn't on the list. On the other hand, they don't pay for that one, anyway. (3) The last one sounds like the sort of drug the pharmacist has to make up from 2-or-more other ingredients, by hand. That usually means at a "compounding pharmacy", which are few and far between. Not every state has one, so you deal with them via mail. I've have one of those. (see # 2) Not expensive, as such things go. It goes smoothly. I pre-pay. Some regular pharmacies do a small list of them, the more common ones, I suspect. Cheaper, probably.
Does this list include Chemotherapy? Who knows. I was in a Clinical Trial. The experimental med had a horrendous price, but the trial paid for it. (Phew!) That was 2003, and I'm still being a thorn in my employer's side.
This applies even if you already get your prescriptions by mail. The regular ones just keep coming. Phew.

To get these, the Doctor has to fill out detailed explanation of why, and probably forms. And probably hire another secretary, so the cost of medical treatment can go up, yet again. Ugg.

DON'T PANIC, but the Town Hall the employer held on this issue, today, (8/19/21), mentioned Medicare, as if they had something to do with it, but didn't clarify that. Now, our policy is better than Medicare, but the vast majority of us are over 65, and Medicare is thus legally our Primary Insurance, and our retiree insurance is
Secondary. Think of it as taking up where Medicare leaves off, mostly, and not completely. Still: Very Good. We are very lucky.

DON'T PANIC, but there was some other B.S. that I probably don't need to list. You might ask your doctor or insurance company or medicare if this is even planned for you. I have to log into my employer website, so you can't see the list they gave us. The list may be different for you, or may not even apply. Probably doesn't apply. So, Please Don't Panic. This is just a heads-up.

I'm depressed, for me and my former shipmates.

 

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The last thing older people who need medication for ailments is to become immersed in figuring out medical codes

Is it possible to take the list of meds you are on and a tablet which you can pull the screen with the list of conditions to your next doctor visit and have the staff help check the boxes and then do a print out for you to use in the future when you submit this at home
8 would even rope the doctor in saying you are prescribing this I NEED YOUR STAFF TO COMPLETE THE SURVEY SO I CAN ACTUALLY GET MY MEDS.

 

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I know I am depressed myself over all the bullshit, the red tape is terrible. I wonder with all the red tape if they actually end up saving money.

 

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a article about UT infections from Harvard Health-Just a few sentences.- I don't want to get into any trouble posting this all-I have enough trouble in my bag. I learned a few things-anyone want the more of the article send me an email at bdrabek1970@gmail.com. Please tell me who you are, your group name is enough. Barb few sentences of article are as follows: If you haven’t experienced a urinary tract infection (UTI) before, take note: while the infections are uncommon in older men, they can be common in older women, occurring in 10% of women ages 65 or older, and in 30% of women ages 85 or older. For up to a third of women who have a UTI, the infection comes back within six months.

"E. coli bacteria [which live in the intestines] cause approximately 80% of all recurrent UTIs and continue generating microbe strains that are resistant to antibiotics. The ability of the bacteria to stick to the urinary tract can sometimes make them very difficult to eliminate," says Edward Doherty, who spent 10 years working on potential vaccines for recurrent UTI and other conditions at Harvard’s Wyss Institute and is now CEO and co-founder of vaccine maker Attivare Therapeutics.

 

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May941: It's not a survey with check-off boxes, or something. It's lengthy, makes my posts look short.
We just went hunting for our meds. Not a complete hunt, yet. We went through until we found a catagory that matched one of our conditions, the others that might, checked those. Diabetes wasn't there, which as I explained doesn't mean some of the drugs don't appear under a different catogory. Or maybe some drug we take are "off-list" or whatever it is properly called, where the Doc prescribes a drug for something it isn't listed for. Gabapentin, for example.
I suspect the Docs will get the list. What I'm trying to do is develop a way to search the list with the computer's "find" function. There is a way to put it in "M.S. Word", I think, and turn it into a list, or even a table, but it requires a long and steep learning curve because I do it once every 2 years or less, and this one has several other challenges. I think we have until Jan 1, 2022.
Barbara. Yes, they do. An alarming number just give up fighting them. And they hold on to our premium longer and invest it - for their profit, not ours. It's called Predatory Capitalism.
Diabetes, and thus Insulin (criminally exspensve) was not on there, either as a condition or a drug, but I haven't finished looking.
Blood thinners (anti-coagulants), were, but just 4 and they are ones I've never heard of. But what do I know?
We didn't find "High Blood Pressure", and searched the "catagories" for another wording.
It's a weird list. Further, they don't list both the brand name and the generic name. I suspect the ones with brand names (thus a monopoly, still) are more expensive, newer ones. Once other drug companies are allowed to make generics, the price drops.
I'm real nervous about this. I don't want to screw it up. Also, I'm not a medical person, thus not qualified.
Our insurance is unique. No drugs, so far, are on an official "no list.but what do I know
We don't have a list at all, as in "you have to take a drug on the lost; they nare they only ones covered. There is a name for that. We can be forced into a higher cost if we go to out-of-network medical providers or pharmacies. That's how they get out of being accused of not letting us pick our doctors. That screws any of us living "in the bush" - off the road system, anywhere. The employer has actually made some exceptions, for that. If you live foreign, you have to use mail delivery.
When they do something like this to us, it often means they are lowering costs - for them.
But they just added the pneumonia shot to our benefits - finally figured out the shot is cheaper than paying the hospital bills. Well, duh.
Please have mercy on me.

 

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Hooo boy @AlasSouth!!! The hoops they make you jump through!!! Hiding in all of that garbage there is probably something so simple and basic it's really laughable!!!
It's like I said in one of my posts today that doctors' offices probably have a pitchfork as part of their array of implements because they need to use something to stack up all of the paperwork they subject all their patients to, as well as pay those to come in and file (or pitch) all of that paperwork. And people wonder why medical costs are skyrocketing???? So why has nobody said "This far and no farther???"
I mean enough already!!! The medical providers just need to cut all the crap and just get down to basics!!!
And reading what you're going through the thought occurred to me as to why you can't find "high blood pressure" listed. Did you try "hypertension?" In other words you've got to fight fire with fire, or use medical jargon to get where you're going.
Of course most of us have never taken a course in medical terminology which is something that sounds like you need when dealing with this edict that just got handed down to you.
Well good luck with all of that and hopefully there will be a bright spot somewhere! And I got a pneumonia shot just a few weeks ago myself. Hopefully one less thing to worry about!!!

 

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I had a talk with a hospital administrator last fall and he told me that have an entire department to deal with insurance companies, workmen comp and Medicare. etc. They don't want to pay out and they constantly give the patients and staff a hard time. Too much red tape has changed this for all of us The drugs are worse big pharma is awful. WE pay more for the drugs here than any other country I believe. I am sure when they decided to become doctors they haver though that they would have to deal with all the paper work-etc. Besides the liability issues0etc, I just had to sign some papers today with you health system that I cannot sue over $300,000/ the lawyers get a third [;us their expenses, so that is is today. Can't even by a house with that anymore or pay for a college education.

 

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Billliveshere: We went through all "catagory names" looking for anything that might be high blood pressure, hypertention, etc etc. There was nothing, from which I conclude that high blood pressure doesn't have an exspensive drug? Well, okay, maybe. None of ours are
Boy, did I like the "pitchfork idea! You dreamed up a good one.

Barbara: Yes, we do pay more, and we aren't talking a measely 10%. Why do you think some people pool together to get a bus or a van load of people, go to Canada to buy Insulin. It's an OTC, there. Even with the tranportation and time, you still come out ahead. Customs has been ordered to take any Canadian medication away from you when you cross the border on the way home. "It's not safe, it doesn't come from America." What a crock. It comes from the same factory, the same company, the same vials or pills or whatever, the same method of production. The only difference - and this isn't always true - is the packaging's fine print - the U.S. ones says "prescription only".
So why is this? Well, where do you think all those senators and Representatives are getting their campaign money?
Buying from Canada by internet needs care, as there are scammers. But, you can look for not only the certifications from the Canadian Government, but there are certifications for the associations of companies that are selling to you. It takes due care, yes, and then the drug costs so much less.
I did research for one of my drugs, back when I wasn't on the insurance I have now. But it needed refrigeration, and the pharmacist himself told me he wouldn't like to risk that one to the mail, or something, and have it spoil. I only needed that med for a relatively short time.
So, how do you think the drug companies make money in other developed countries like, say, Germany & Japan & France. That's an easy one: they just make an ordinary profit instead of an obscene one. They also don't have all that money going out the door to the legislature, so their overhead is so much lower.
I don't know what the answer is, but there has got to be one.
You do know Congress passed a law prohibiting Medicare from putting medicine out to bid? I've seen how much it is estimated Medicare would save without that law.
Sorry.