Who is controlling what meds we take?

[Bailey_Texas]

My insurance company has determined that the Prescription for Requip "is not medically necessary" and have refused payment for the med.

Hard to believe some one i never met can determine this.

I just don't know what to think.

[Hikoi]

I've read similar comments from others in the US Bailey. Its beyond belief. Would one of the national organisations take this on?

[stevie3]

Good heavens, Bailey. I'm astonished. I don't know what to say either, except that wnen I hear of things like this, I'm so grateful for the NHS in the uk. I'm really sorry.

[laglag]

That is hard to believe. Wish whoever determined that could walk in our shoes for awhile. I will do some researching to see if there is an organization we could talk to. What insurance company is refusing to pay? Have you talked to your doctor about it?

[Bailey_Texas in reply to laglag]

ambetter superior health plan

Obamacare

[racerCP]

Have you asked your doctor to give you a prior authorization form to justify your need for this medication? That has worked for me. How are you doing? I miss hearing your many feats and your inspirational spirit. Email me if you want. [e-mail]

[Bailey_Texas in reply to racerCP]

On appeal.

[Bailey_Texas in reply to racerCP]

I am doing well but slowed down and just in maintain mode. Not trying to improve i feel strong enough.

[Motherfather in reply to Bailey_Texas]

hi my friend I'm now in china getting stem cell treatment,8 more days to go.

[racerCP in reply to Bailey_Texas]

Glad to hear you are fine. I am just completing my 4th year post diagnosis. They say after finishing year five one can predict the course of the disease. I am experiencing changes, none holding me back from my busy schedule. Stay in touch.

[texasL]

The reason your insurance does not approve this medicine is because they want you to get a generic version - Rupinirol. A lot of insurance companies are doing this now. If generic is available, they do not want you to get brand name.

[Bailey_Texas in reply to texasL]

It is generic i just used the brand name.

The generic is $8 a pill. I am paying out of pocket $500 a month.

If approved they will reimburse all i have spent.

[Juliegrace in reply to Bailey_Texas]

I just looked up the cost of ropinirole at Costco's online pharmacy and none of the strengths are listed at anywhere near $8 per pill. Is it possible you've been buying the brand name?

[MBAnderson in reply to Juliegrace]

Goodrx really does save big $$. Thirty 1 mg tabs Ropinirole = $6.90. Also, 90 day prescriptions save even more. I saved 85% with Goodrx on 90 day prescription of Isradipine vs 30 day from Walgreens

healthwarehouse.com/ropinir...

[pbacon2549 in reply to texasL]

It may be true. Our experience is it does not matter. In the states many companies are increasing the generic cost astronomically . Corporate greed

[camper1]

Try using an Prescription plan blink that my neurologist told me about. Free for anyone to use, some meds are much cheaper. Hope this helps.

[NanCyclist]

I expect that for some reason you are still getting ReQuip. I switched from ReQuip to Ropinerole and the price dropped dramatically.

[texasL]

I just googled Rupinirole prices, even if you do not have any insurance, the price is nowhere close to $8 a pill. Very strange pricing $8 a pill. There is an RX card, I think it also gives you a discount.

[honeycombe3]

Please be very careful about changing from any med to another form especially Requip. I was given a generic form of Ropinirole & spent 4 days unable to get off the bed. When my blood was finally tested for Ropinirole there was none present. I am just 1 of 9 patients my consultant identified - so far.

I have had other experiences with different meds & it is often not the drug which causes an adverse reaction but binding agent used in pill making or the membrane of slow-release meds.

The NHS here in UK has recommended/advised that GP surgeries use generics but in a clear cut case like this where the reaction can be demonstrated in several patients your insurance should cover the cost.

[Bailey_Texas]

The Repinirole is 24 hour extended release i guess that explains the price.

The person who reviewed the RX for Repinirole is a Doctor who's Specialty is Emergency Medicine

Subspecialties: Undersea & Hyperbaric Medicine, General Emergency Medicine

This seems strange to me.

What do all of you think.

[MBAnderson]

Doesn't surprise me any. It's a good example of why healthcare shouldn't be controlled by the insurance industry. A public option or single-payer would solve that problem. Personally, I think most insurance companies are criminal enterprises.

[Bailey_Texas]

I have come down with Pneumonia. I feel good no fever no other symptoms other than a cough that can put me on the floor. I have coughed for 2 minutes straight.

Damn it is terrible getting old.

[Beckey in reply to Bailey_Texas]

Keep your chest warm and get up and walk around some if you can. About the meds, ask your doctor for a prior authorization, and if that doesn't work, go straight to the manufacturer's patient support department.

[arwenmark]

did you check your insurance companies Formulary before you had the medication perscribed? It may just be one of the medications they don't cover, without a specific exception. The other possibility is that your doctor has not put enough info in your records. I would say that you need to contact your doctor and have him write a letter to the insurance company stating that you DO need the medication and why and asking for an exception.

[pbacon2549]

Yes in the USA insurance company plus federal Medicare can determine. Better chance of approval if not on Medicare. The VA had extremely strict requirement including age. Try GoodRx (Walmart has best pricing so far) and Heathwarehouse (online ordering). Good luck. My partner is having much better results. He take 12 mg long acting with 8 mg daily

[Serenity_finaly-1]

youtu.be/I3IxMQsazAM(Not working as expected?)

[wifeofparky]

you can file an appeal with the insurance company. Speak with your physician to help you do so

[Bailey_Texas in reply to wifeofparky]

been there doing it now.

[Allyn]

Order it from Canada

[Joanne_Joyce]

I know how you feel, Bailey. it makes me furious too. It has happened a number of times but each time my neurologist writes saying this drug is necessary I get approval. Right now I have an appeal pending for Xadago and I sure hope it is approved.