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I got issues with scripts

Well I have temp ppo and I got medicine Friday for copay 40 brand name duregesic well next day pharmacy called and said I met my max which didnt know I had for prescriptions they said I owe 650.00 but I called ins company why it go through if at Mac I don't have 650.00 and went through for copay not my fault when called ins guy suppose to call pharmacy never did called next day now lady saying working on it also ins company messed up my pre existing wasn't suppose to have it and put it on me had ins July 2013 and didn't see doctor til dec 2013 but got cocc and just waiting. I have new script nucynta never tried I'm scared take it same pharmacy then it'll be another 650.00 added or won't go through so I'm in alto of pain don't know what to do call Tuesday doctor tell her all that.
Jennifer Neal


  • dilaurodilauro ConnecticutPosts: 13,525
    but I am not sure if your issue is with the price , the insurance company, the pharmacy or the medication?
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • what would my issue be sir
    Jennifer Neal
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  • they are suppose to call me tomorrow. in my above post I said all that was going on I don't get post under mine. I thought u could tell what's going on and see what others been through if same or what I should try.
    Jennifer Neal
  • Jenjcjess05JJenjcjess05 Posts: 20
    edited 05/28/2014 - 4:20 PM
    My insurance file brand name patch duregesic first time brand name went through for copay 40.00 then next day got phone call from pharmacy that I hit my max for prescriptions I owe 650.00 when never knew had max. And because this I haven't been able fill other medicine on insurance scared owe same or less. I don't have that money. Called insurance and no word on if they recovering it and I called doctor they said most all medicines Are costly to call them see what we can do. Someone help idk what to do I hurt so bad even with patch needed break through and sleep. What do I do
    Jennifer Neal
  • You will have to contact both the insurance company and the pharmacy to get it straightened out. We can't help fix the problem. If I understand your post correctly, you have a cap on how much money you are allowed for prescriptions through your insurance each year and you have reached that amount. So the pharmacy says you now owe them 650.00 . You also have a prescription for Nucynta as well and are afraid to fill it because you don't have enough money under your insurance to cover it? Is all of that correct? If so, you need to work with the pharmacy and your insurance company to figure it out.
    I would also find out about any other policy limits you have under your insurance to avoid this happening again.
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  • I called at 7 insurance and they said since never told me anything I can change policy for a more maximum prescription coverage and will cover the 622.00. I always thought medically lower deductible so do laser surgery and it is best but with them messing up doing pre existing ive had do get medicine to live half way out of pain. she said upgrade coverage higher deductible is where u get more help prescription and my C.O.C.C. for other insurance should fix pre existing. I'm praying. so once I change policy keep ppo but raise maximum prescription limit and help. when I got policy all I wanted to do is get fixed and didn't happen now take longer for surgery to save moneymoney
    Jennifer Neal
  • Well I did a circle of calling now left up to insurance supervisor because they won't let me change coverage til November so I won't have prescription help til sign up nov 15 for jan 1st. Now got to pay cash for all medicines idk what to do I will tell dr June 12th and go backwards or new cheap nedicine
    Jennifer Neal
  • sandisandi Posts: 6,269
    edited 05/31/2014 - 4:45 AM
    Talk to your doctor about applying for and getting your prescriptions through the companies who manufacture them. There are programs with all of the drug companies for people who need medications but can not afford them. Your doctor can fill out the paperwork for the patches from that company and the nucynta from that company and you can bring the forms with you for him to fill out.
  • at my pain doctors the office keeps little cards that let people get meds at a lower cost. you pick up the card, call the number to be registered and one can get meds at a lot lower price. some insurance companies have things for people with limited monies and will let them get scripts for a lower price also. you can contact your insurance to ask them or ask the drs office if they have set up a system with a company to get meds at a lower cost for low income patients. there are all sorts of things a person can do on limited income. ask your doctor and insurance company or research the internet. one has to be proactive about some things. sitting there doing nothing will not get the problem solved. i am not saying you are sitting doing nothing, it is just an expression. so anyone sitting doing nothing will not get the problem solved. be proative and call and research to see what can be done
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Nucynta was a medication my doctor had sample packets of. I tried it for a couple of months without having to fill a prescription at a pharmacy. Maybe if you discuss your current financial predicament with your doctor he can help you avoid some costs for a little while. My doctor has a lot of titration packs & samples for different medications. I also have cards that look like credit cards from the manufacturers, you phone to activate them & they state a maximum amount I should pay..usually $20 - $25 per med regardless of insurance coverage.
    Osteoarthritis & DDD.
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