ritalin Rx and insurance policy

[redbird]

The pharmacist and I have, I believe, fought the insurance company to a draw: they won't be paying for the prescription, but I will be paying about the same amount as my copay would be if they were covering it.

As far as I can tell, the insurance company decided it doesn't like the way the doctor sent in three consecutive 30-day prescriptions, even though it worked last time. In fact, they covered the first and second of these three.

I discovered this because the CVS robot said the prescription would be ready today at noon, and then I got a message saying they were reaching out to my doctor for an alternative medication, so I called the pharmacy. The pharmacist told me that the problem was with the insurance company, and I asked him to check what it would cost me if I didn't have insurance. He said he thought it was over $100, but checked, and said it would be $49. I told him to go ahead and fill it, and he did something at his end and told me had found a coupon and I'll be paying $20.40 (or thereabouts).

I am noting this partly to remember to tell Carmen about it next month and ask if we need to do something different next time.

Comments

[otter]

Insurance companies are horrible. In general.

[hrj]

I'm going to go all cynical -- and I say this as someone who works in the pharmaceutical industry. The fact that it's frequently possible to get coupons, discounts, or similar price breaks when the alternative is "I'll buy something different" supports the conclusion that the drugs are artificially overpriced in the first place. Of course, it's much more complicated than that (and I imagine that there are a lot of inequities in who gets offered coupons).