When you’re sick and it’s not cancer.

[Denzie]

As you move forward in recovery you will once again have to deal with things like colds and bronchitis and other problems that have nothing to do with your cancer.

After a recent (benign) skin biopsy I was having pain at that biopsy site. I went back to the dermatologist and was told it was due to scarring. I could have steroid shots to thin the scarring and ease the pain or I could have a steroid cream to use for 3 months. I chose the shot but the dr sent in an Rx for the cream as back up. It’s not in my Part D plan formulary. So it’s $287. No thanks.

Yesterday I took my cousin to the dr for an exacerbation of her COPD. 2 of the drugs she was written were not on her Part D formulary. We’ve decided we are taking copies of our formulary with us to all dr appointments to check before the dr leaves the room. Order yourself an extra copy for your car!

[Feelingblessed2013]

That is a good idea. So far I have been lucky, only had a script for something not on the formulary once, it was a new rescue inhaler. My medical covered it as a courtesy, but sent me a notice that I would need to change to something else if I needed a refill.

[Denzie Moderator Volunteer in reply to Feelingblessed2013]

Mine has filled some as courtesy as well and I’ve done appeals. This just feels like less trouble.

[Feelingblessed2013 in reply to Denzie]

I agree, and less trouble is always a good thing

[anrean]

There is value in appealing the insurance formulary - I've had to do it, and had mixed results, but it is worth a try. Also, like KatherineK I've received a "courtesy" fill that lasted a month and allowed the doctor to find a med on the formulary.

[Denzie Moderator Volunteer in reply to anrean]

I had to appeal my pain meds this year already. What a headache. A 72 hour patch is not on the formulary so I put them through their paces and had them research what I could substitute. The response I received included 6-8 hour injectibles, pills that I could take every 8 hours, methadone, and similar suggestions. The purpose of the patch was that it’s 72 hours no change, no missed pills, miscounted pills, fewer mistakes. And it’s only once every 72 hours. Did I mention it’s nice to only have to worry about that pain thing every 3 days?

Sorry for the rant.

[Feelingblessed2013 in reply to Denzie]

Rant away, I think you have earned that right

[anrean in reply to Denzie]

Has your dr written to them?

I have had to have the dr write a letter with the appeal - just another hoop to jump through, but it might help

[ynkefan08753]

No joke. It seems every other medication I’m prescribed is either not covered or my copays are outrageous. My feeling is if a doctor writes you a script that they feel is necessary then your insurance should have to cover it. If they want to argue about it they can take it up with the doctor. Thanks for sharing 😊😊

[Denzie Moderator Volunteer in reply to ynkefan08753]

I feel your pain.

[JeanE41]

Good advice. It seems the insurance companies make things more and more complicated and confusing for us and our doctors. Too bad part D is not standardized.

[Denzie Moderator Volunteer in reply to JeanE41]

It would be great if it was standardized wouldn’t it. Of the three we had problems with two were opiates and that’s messed up because of the crisis. So I can’t blame all of our issues on the insurance companies but they do put up obstacles. We cancer patients are the ones those meds were created for and now have extra hurdles tossed into receiving the pain care we need.

[JeanE41 in reply to Denzie]

So true. Most of the opioid deaths are not those who take prescription drugs under a the supervision of a physician, but from those who get the drugs from unauthorized sources which might be contaminated and are not monitored. We are suffering from the greed and stupidity of those who illegally make and sell addicting drugs.

[Feelingblessed2013]

I agree with jeanE41, it is a shame that part D is not standardized.