This is just soooo not good...m...
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| Sat, 12-17-2005 - 11:09am |
My psych from the IOP which I attend gave me an Rx for Paxil, something new to me. The 100mg of Prosac was doing NOTHING, NADA, and she said that the Paxil would be somethinmg good to try, it is used for PMDD.
Well... I rushed to the pharmacy last night tight before they were closing only to find out that my insurance (Health America/Health Assurance) does NOT cover the drug, it's not on the formulary list. The specific Paxil that Dr. Z wants me to have (is it CR? I don't know the letters) doesn't come in generic. If it DID, then I could get it. Otherwise, it's $57 for FOURTEEN PILLS.
ARRRGHGGHHHHHHHHHHHHHHHHHHH.
I have still been taking the Prozac, but needlessly, until I get the Paxil. So, essentially, I'm really not on an antidepressant now for a whole week or so. :( I can't do anything til Monday about this.
I'm sooooooooooooooooooooo frustrated.
Vida


Hi,
I am new on here...well, I left and now I'm back. I know from having worked in the medical field and with all of my mental health issues, psychotropic medications can be a pain to get filled due to insurance. However, I do know that if you doctor prescribed a medication for you that is medically necessary and it does not have a generic for it currently, then your insurance, at least where I live I was told this was a Federal Law, that an insurance company was required to approve the medication. If they don't, then they are denying you your right to medical treatment and could open themselves up for a lawsuit. I have been down this road so many times. You probably want to mention this to your doctor and it may be that your insurance company may just want something documenting that the drug he has prescribed for you is medically necessary due to your illness, and there is not another drug he can prescribe that will do what your doctor wants this particular medication to do. I just know that has been my experience and I would fight my insurance company on this one all the way. They don't like to hear that they could be denying you medical treatment. I am not sure if this will help you or not, but I just thought I would give you the information I have based on what I have experienced. Hopefully you can get something from this. Best of luck. "Stupid" KP
Thanks for the advice, that's what I plan to do, talk to the psych about the situation and I know that she will take action. This is just plain ridiculous, it really burns me. I NEED the med, then GIVE IT TO ME, COVER IT.
I already left a message for the psych Friday night, and then on Monday I have to go to IOP, so I'll bring it up to my clinicians as well. And, I will certainly be giving Health America a call and letting them know how I feel about them!!
Vida
Hi Vida,