I don't know if this will help. You need to call your insurance that you go through for prescription and ask them why they are doing this. Also, find out if it's being coded wrong and what code needs to be used so you can inform your doctor's office. I know you might not understand the code but the doctor's office will. You can also ask for a insurance advocate to help you get to the bottom of this. I hope this helps. Please put an update to what you find out. Good luck!
I am not sure what sort of issues you have been encountering, but I have also run into some problems in the past year or so.
I had been receiving my immunosuppressive medications for years through the online specialty pharmacies associated with my insurance carrier(s). Typically, I would receive a 90 day supply and be charged the standard copay (whatever that was at the time, depending upon the carrier). When I transitioned to Medicare, I took a Medicare supplement plan; the drug benefit was still covered by my carrier, and there was actually no change in the dispensing of the medication.
Things changed after Congress passed a law in the fall of 2022 requiring Medicare part B to cover "life saving medications," which includes immunosuppressives, plus the fact that my supplemental insurance no longer handled the pharmacy benefit (I had to sign up for Medicare part D, which, as it turns out, is actually irrelevant to the immunosuppressives).
Beginning January 2023, I began running into obstacles when trying to receive refills of my prescriptions (specifically, the immunosuppressives). I could no longer receive a 90 day supply - not only do I have to order refills each month, but the prescriptions must be written for a one month supply. In addition, although the medications continue to come from the same online specialty pharmacy I had been using for years, I can no longer place a "standing order" for them (i.e., have the refill orders filled automatically according to a schedule, as I had done previously). Most months, I am also required to speak to a pharmacist to ensure that there have been no changes in my condition. These are all a result of the switch to Medicare part B coverage. One positive: the copay is $0.
One additional potential complication: Travel. I have been told that one can make a special request for additional doses for travel that extends beyond one month. I am not sure what is involved, as I have not yet tried this yet.
Thanks for the information. I was not aware the changes were made in 2023. I have had prescription insurance since before I retired. The plan provides for all my other prescriptions, except the anti-rejections meds.
I am hoping that sooner or later Medicare will stop this nonsense and realize that these are not street drugs and that someone would be crazy to take them if they do not need them, given the side effects.
Although, I have to fight every month, I am grateful that I am able to do so and I worry about those who can't fight for their meds.
Just so you know it's not just Medicare that is making prescription only be monthly and not allowed to be on auto fill. Also, I am not on Medicare but everytime I get my immune suppresent the Pharmacist would have to speak to me and he didn't know anything about transplant medication. He would tell me I must follow what is says on the bottle. I told him know we don't we follow what our Transplant center tells us because our prescription can change. I stopped arguing with him and just said yep whatever you say sir. For me I kept bouncing between taking 3 pills am /3 pills pm than 2 pills am /2 pills pm so I was given a script for the bigger dose so I would always have pills. I am a MA and know billing and coding. It's also the goverment that has put restrictions on how prescription can be written and even how many per month. You might try seeing if your doctor can do a authorization to get your script for 90 days. He might be able to just fill out a form telling why 90 days is better for you and the insurance will allow it. Call your insurance and ask if it can be authorized for 90 day and get your doctor to do it. Good luck
How far out from transplant are you? I learned that Medicare won't cover the entire cost of anti-rejection meds if we are more than 3 years out since transplant, and that sometimes they need a prior authorization to cover the cost. I'd recommend that you and anyone else in this situation look into supplemental insurance if you haven't already to offset that cost.
Ynnep, When we had our pre-transplant education at the transplant office the financial gal who reviewed our insurance and monthly financial costs. She also indicated if at any point you have any issue please let us know so we can help resolve it. My husband isn't retired, although I am we use his insurance as Primary and Medicare secondary with minimal co-pay. So that may be a resource, if you go in or do it on the portal youn may want to send copies of the pages with charges from Medicare so they can verify diagnosis codes as well. Hope that helps..
Thanks for the information. I was retired before I had the transplant and Medicare was paying for anti-rejection meds. In the last 2 years, I have had to fight for every refill. Someone told me that Medicare changed the rules (late 2022 or early 2023) and that why I have to just thru hoops for each refill. Thanks for for help!
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Prayers For all the transplant patients in Gaza who lost access to all anti rejection meds.
retiring: Anti-Rejection Megication Questions
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Insurance struggles!!
