Prior Authorizations for your Meds?

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Anonymous (not verified)
Title: Member
Prior Authorizations for your Meds?

Anyone out there have the same problem as I have just recently encountered? It's having to get a prior authorization every three months for my Avinza script. I am just curious if anyone uses AvMed and has had this problem? I have never run across this before until January of this year and now I just had to go through it again this past week. I've been taking this med for about 3 years now. What happens is the pharmacy goes into your profile and sees that you need a prior authorization before they can fill your script. They then tell you to let your Dr. know so that they can call the Insurance Company and tell them whatever it is that they need to know. You then have to wait anywhere from 3-4 days up to 2 weeks before the approval comes in. I went through it in January and it took 4 days but luckily I had enough left over from the previous month. This last time, (April 24) I asked the Dr. for something else to take the place of the Avinza while I was waiting for this to happen. He gave me a script for 30 MS Contin 100 mg. to last 6-7 days. On the seventh day, I called the Dr. and they wrote me yet another script, for this time, 60 of the MS Contin 100 mg. Reason it took longer was because I did all of this on a Friday so we had to deal with the weekend too. To make a long story short, when I walked into the pharmacy to fill it, they told me that my Avinza was ready. I said how's that possible? They said the insurance co. called them about 2 hours ago to let them know that it was approved. They are supposed to call the Dr. office but they called the pharmacy instead so the Dr. office really didn't know anything about this until the next day when they checked up on it. Either way, I found out that I have to go through this every three months. The reason is that I take 4-120 mg capsules per day and the recommended dose is 1-120 mg per day. So now I need to get an approval every three months. Anyone else with the same problem? Please let me know if you do.

hopeless-in-mn's picture
Last seen: 2 years 9 months ago
Title: Member
Joined: 11/12/2008 - 11:28am
i have

needed this for the first time when starting a new very expensive med, but not then with every refill! it does not maake sense that you should have to keep doing it every time! but very little in this spinal journey is making much sense to me any more...

herrball (not verified)
Title: Member
Opana ER ?

So, now because of this pre authorization biz every three months, I have to ask the Dr. for a week's worth of MS Contin each time to get me through the first week while the authorization is being done. Because it's such a royal pain in the butt, I was thinking of possibly switching to Opana ER instead of my Avinza 120. I checked on my conversion chart and said that I would need 160 mgs of the Opana each day to equal the 480 mgs of Avinza. I think that the highest strength Opana comes in is 40 mg. The only reason I would ask about switching is because I take 4 pills a day and I thought, hey why not try something that you don't need so many of? Looks like I'm in a quandry. Somewhat of a pickle, I would say. The Avinza lasts almost an entire day, these other meds are only good for half of that at best. Any suggestions? I tried the MS Contin and don't really like it that much. Something in it that makes me queezy. I really would like some thoughts about switching to something that I could take less of. Anyone?

Last seen: 1 year 9 months ago
Title: Member
Joined: 02/02/2009 - 7:21pm
Prior Authorization


I to am having a hard time with a prior authorization for Lyrica. The insurance company denied my prior authorization for Lyrica so my husband and i our paying out-of-pocket for me to get my Lyrica. A months supply is $200 and something dollars. I am in the process of appleaing the prior authorization for Lyrica. they say I need to have tried anti-depressents(which I can't take because they mess me up to much) and that I need to try Neurotin first(Well I have been on Neurotin for 3 years and it stopped working for my nerve pain. Wouldn't the insurance company records show that I had been on neurotin for 3 years? This whole process of getting prior authorizations is very frustrating and stressful. I am glad your new pharmacy is having good customer service for you. I hope the new pharmacy works for you. It is amazing you have to go through this every 3 months. I don't understand why they can't give your a prior authorization for a year, since they know(insurance) you take this med. Good luck.


REMZY (not verified)
Title: Member
1 time

i had to have dr call ins co. once for authorization, for an expensive med that i was prescribed for off label use. dr said it was a pain in butt, cuz it meant alot of paper work for his office, but he is super cool and handled it right away and i got meds the next day.
hope u all get the meds u need and deserve. and hope u feel better baseball...huggs...

patwhite101's picture
Last seen: 6 days 1 hour ago
Title: Member
Joined: 04/04/2009 - 5:25pm

Yes I have had to do this several times and it can be a pain. But every 3 months!! That is really a pain!!
It is not uncommon for them to let the pharmacy know first and then write you and the Doctor to let you know the approval has gone through.
What happens is, when you give the druggest your script and they get on the "pooter" to charge the insurance co a notice pops up that you must have prior authorizion for that med. It isn't the Doctor that needs the approval but the druggest, the person charging the co. It IS up to your Dr. to call the insurance co and let them know that it is medically neccsary for you to be taking that med.
I use to have to wait a couple of days or so for the approval to go through so i called and ask why it was taking so long and they gave me a number for my Dr. to call and get instant approval. By the time I made it back to the drug store the approval had gone through.
That was a few years ago, now no problems.
If you are waiting for the Dr to let the druggest know the approval has gone through I am sure the druggest already know it.
I hope this has helped.
Patsy W