Why is CVS limiting my prescription meds?

[Kroze]

I have a prescription for ambien for a while now. The first 3 refills, they refilled it to the prescribed amount (30 pills for 30 days).

But now, even though i have a prescription for 30 days, they only give me 12 pills and told me that it's suppose to last me 38 days

WTF?! anyone ever have this same problem?

 

[Bateluer]

I have a prescription for ambien for a while now. The first 3 refills, they refilled it to the prescribed amount (30 pills for 30 days).

But now, even though i have a prescription for 30 days, they only give me 12 pills and told me that it's suppose to last me 38 days

WTF?! anyone ever have this same problem?

I'd question your doctor about it.

 

[Kroze]

I'd question your doctor about it.

The doctor is the one who prescribed me the correct amount, 30 pills for 30 days. She didn't write anything different such as 12 for 38 days on the prescription.

 

[Capt Caveman]

Why didn't you ask? It's not the pharmacy but your health insurance.

 

[pcgeek11]

I have a prescription for ambien for a while now. The first 3 refills, they refilled it to the prescribed amount (30 pills for 30 days).

But now, even though i have a prescription for 30 days, they only give me 12 pills and told me that it's suppose to last me 38 days

WTF?! anyone ever have this same problem?

Ask for the head pharma... And ask them.

 

[AlienCraft]

I'd question your insurance about it.

Fixed it for you. Insurance can overrule a doctors rx.
Everyone knows this.


Easiest way to practice medicine? Become a claims agent for a Health Insurance provider.

 

[Gooberlx2]

More likely the insurance is restricting the rx. Find out the procedure for your doc to contest it with them. My wife has had to do this a number of times.

Or pay out of pocket. Ambien is generic as zolpidem. Not totally sure how expensive it is though.

 

[pcgeek11]

Fixed it for you. Insurance can overrule a doctors rx.
Everyone knows this.

No they cannot. All they can do is not cover more than they allow. He would then have to pay out of pocket for the remaining part of the script.

 

[AlienCraft]

No they cannot. All they can do is not cover more than they allow. He would then have to pay out of pocket for the remaining part of the script.

My insurance will not allow for 2@75mg, but will pay for 1@150, overrulling the Dr.'s Rx. happens every time.
Somehow, I don't believe you.

 

[Kroze]

Fixed it for you. Insurance can overrule a doctors rx.
Everyone knows this.


Easiest way to practice medicine? Become a claims agent for a Health Insurance provider.

I'm going to CVS and ask them tomorrow. I checked my receit and it shows that i paid the full amount and the insurance doesn't pay a single penny.

If that's the case, the insurance shouldn't have a say on how much i can buy since they're not paying a single penny for this prescription.

 

[Kroze]

More likely the insurance is restricting the rx. Find out the procedure for your doc to contest it with them. My wife has had to do this a number of times.

Or pay out of pocket. Ambien is generic as zolpidem. Not totally sure how expensive it is though.

The prescription cost me $2.46 and the insurance isn't paying any. That's what it said on the receipt anyway.

So that mean that I SHOULD get 30 pills/days supply instead of 12 pills and expecting to last me 38 days.

 

[pcgeek11]

My insurance will not allow for 2@75mg, but will pay for 1@150, overrulling the Dr.'s Rx. happens every time.
Somehow, I don't believe you.

The Ins cannot over ride shit. All they can do is refuse to pay for what the Dr scripted. Just like you described above. You can get 2@75mg but you will have to pay for it out of pocket.

Oh and I don't care what you believe. You are wrong anyway.

 

[Kroze]

So the problem I'm having is not normal for a pharmacy to do?

It pisses me off to no end. If i'm prescribed 30 days supply, who are they to say that I can't have it. On top of that, who are they to say i can only get 12 days supply that suppose to last me 38 days?

 

[Gooberlx2]

The prescription cost me $2.46 and the insurance isn't paying any. That's what it said on the receipt anyway.

So that mean that I SHOULD get 30 pills/days supply instead of 12 pills and expecting to last me 38 days.

It would be helpful if you could post the relevant details of the recipe and/or rx summary paper (usually stapled to the rx bag, details the amounts for the rx to you and your insurance, etc...). Or post pics with the sensitive info and rx number redacted.

It may not be CVS saying "it should last you 38 days", but rather that you're not allowed to fill ambien again for 38 days according to your insurance. Maybe your insurance only allows so much in a X month block of time.

Also, I'm fairly certain even just 12 pills of generic would usually cost more than $2.46 out of pocket.

 

[Gooberlx2]

My insurance will not allow for 2@75mg, but will pay for 1@150, overrulling the Dr.'s Rx. happens every time.
Somehow, I don't believe you.

Probably because the 150mg size saves them money and you can just use a pill cutter. It's not changing the effective prescription.

 

[Hail The Brain Slug]

It would be helpful if you could post the relevant details of the recipe and/or rx summary paper (usually stapled to the rx bag, details the amounts for the rx to you and your insurance, etc...). Or post pics with the sensitive info and rx number redacted.

It may not be CVS saying "it should last you 38 days", but rather that you're not allowed to fill ambien again for 38 days according to your insurance. Maybe your insurance only allows so much in a X month block of time.

Also, I'm fairly certain even just 12 pills of generic would usually cost more than $2.46 out of pocket.

#30 should be around $40-60 depending on the pharmacy, and $2.46 is less than any pharmacy software would charge minimum.

You need to call your insurance company. Chances are all they are getting from insurance at CVS is that they can only bill for #12 now, and they won't pay for more for 38 more days. Sometimes the insurance rejections that are received in the pharmacy are less than specific. On Zolpidem, it seems like quite a few companies limit it to #13/23 days, or #23/30 days, etc. although a hard number limit in 180 days or so happens, too.

 

[mcmilljb]

So the problem I'm having is not normal for a pharmacy to do?

It pisses me off to no end. If i'm prescribed 30 days supply, who are they to say that I can't have it. On top of that, who are they to say i can only get 12 days supply that suppose to last me 38 days?

Talk to the pharmacy first. Don't talk to the cashier or the pharmacy tech, ask for a pharmacist or manager. If they can't provide a satisfactory answer, then talk to your insurance provider. Explain the situation to them and ask them to explain the benefit per your agreement with them. You can read the agreement yourself if you have the paper or if it's available online.

My mom works for an insurance provider and explained to me that there are some new changes in the industry. If you exceed or outside the typical dosages, you can get these types of situations where you have to have your doctor document with your insurance provider why you need the prescription. This is why you should talk to the pharmacist and your insurance provider. Being calm, polite and patient will help you get the best result.

 

[MentalIlness]

My sister was once addicted to pills. Percs.....she was overtaking them, and they started to limit her scripts.

Are you "overtaking" the intended dosage ? My sister was also selling half of her scripts. They she would call and try to get a refill, and it was denied. And when she did get it, it was only half.

And I believe the pharmacy tech contacted her doctor. And somehow the Doc told them to do this.

And yes, they do.....do this....

 

[Hail The Brain Slug]

My sister was once addicted to pills. Percs.....she was overtaking them, and they started to limit her scripts.

Are you "overtaking" the intended dosage ? My sister was also selling half of her scripts. They she would call and try to get a refill, and it was denied. And when she did get it, it was only half.

And I believe the pharmacy tech contacted her doctor. And somehow the Doc told them to do this.

And yes, they do.....do this....

Percocet is a different story. In a lot of states, the doctor has to write a new hard copy every single fill. The doctor knows you're overtaking it when he gets a call for a new 30 day prescription every two weeks.

 

[Gooberlx2]

My mom works for an insurance provider and explained to me that there are some new changes in the industry. If you exceed or outside the typical dosages, you can get these types of situations where you have to have your doctor document with your insurance provider why you need the prescription.

I'm fairly certain this is exactly what's happening. My wife has had to deal with this kind of thing a few times, like changing insurance providers. It's definitely a pita.

So yeah, talk to the pharmacist first, and he/she will probably tell you to have your doc sort it out with the insurance.

 

[MentalIlness]

Yes, And I agree with you. However.....each script she received, contained 3 refills. She went back to the Doc every 90 days.

 

[Kroze]

In the blue box with the amount listed $2.48 is what i paid out of pocket.
The circled "INS: $0.00" is what i presumed the insurance payment portion, which is $0.

 

[MentalIlness]

Perhaps the Doctor lowered your script and didn't tell you ?

Either way, The only way to find out for sure is to ask. But yes, be nice....otherwise they may think your some drug addicted person irritated by your lack of pills.

 

[Kroze]

Lol no i'm not addicted.

 

[Dr. Zaus]

Lol no i'm not addicted.

No... your not addicted.. you just NEED the pills one day after another sometimes... but it's all OK, its not addiction.