# Insurance denied prescription to force to use their mail order service?



## mattech (Mar 8, 2019)

Is this actually legal. I've been on protonix for years for heartburn. Went and had my annual refill today, I stopped in to pick it up and was told the insurance denied it an they want me to use the mail order syatem For this. I'm not against it if it's the same or cheaper out of pocket, but how can they force me to use them. BTW I have United healthcare with a CVS prescription card with it.


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## NOYDB (Mar 8, 2019)

Call and get another operator, you'll get a different answer.


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## Crakajak (Mar 8, 2019)

I was eating tums like candy. The Dr. Prescribed protonix.After 6 months it really didn,t do all
 I needed it to do.I now sip 1 Tablespoon of organic vinegar and only take tums after eating  something hot( spice)


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## tr21 (Mar 8, 2019)

yep, united healthcare is slick. they used to call me trying to tell me they could save me money on crestor. when I told them that I paid (I think it was 34)for 90 day supply with my crestor card, they said OH! so then they quit covering crestor unless it was the generic. now I pay $120 for 90 generic pills, NOW THAT IS SAVING ME MONEY . Reminds me of when my employer was going to stop paying my short term disability and instead pay my long term. when I asked about the cost they said "about the same". that's when I learned that a $50 bill and a $100 bill are about the same!!!


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## Milkman (Mar 8, 2019)

It’s a for profit company that people voluntarily choose to do business with. I would say they can do that legally.


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## JohnnyWalker (Mar 8, 2019)

The insurance premium is only part of the cost of that insurance coverage.  If you have the option shop for better coverage.   BTW:  Check out goodrx.com you might just be surprised and it costs nothing to join.


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## poohbear (Mar 9, 2019)

I was being pushed the other day to use CVS mail order for my meds and I was checking the prices and it was going to cost me $ 75 so I went to Walmart , they have alot of meds that are $5 so I checked and mine was on the list so I got it for $5 don't stop looking at other options.


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## PappyHoel (Mar 9, 2019)

poohbear said:


> I was being pushed the other day to use CVS mail order for my meds and I was checking the prices and it was going to cost me $ 75 so I went to Walmart , they have alot of meds that are $5 so I checked and mine was on the list so I got it for $5 don't stop looking at other options.


This depending on your plan.  Also my wife does mail for her migraine medicine through cvs and it’s probably 75% cheaper than ordering through pickup.  I guess it depends on the plan.
Have you tried opeamazol?  That’s generic and works great, I get it from Costco.  I also have very bad acid reflux


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## dslc6487 (Mar 9, 2019)

Next election, all of this will be solved.  The cost of medical care, prescription drugs and the "hassle" of dealing with both insurance companies, big pharmacy and local pharmacies is going to "drive" people to vote democratic because al of this will be "free".  And, those that vote this way will not even stop to consider the long range consequences of their vote, which will lead to socialism.  All that they will see is the word "free".  I will never vote democratic because I DO realize the long term consequences of such a vote, however, I will admit that the hard working American public is getting the "shaft" from insurance companies, big pharmacy, and drug companies.  Plus, who regulates "big pharmacy"?  Anybody?  I don't think they are regulated so they can charge whatever they want and the costs come right on down to the American citizen through the drug store.   Rip Off and way out of control..


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## 280 Man (Mar 9, 2019)

mattech said:


> Is this actually legal. I've been on protonix for years for heartburn. Went and had my annual refill today, I stopped in to pick it up and was told the insurance denied it an they want me to use the mail order syatem For this. I'm not against it if it's the same or cheaper out of pocket, but how can they force me to use them. BTW I have United healthcare with a CVS prescription card with it.



 I understand your frustration. Most times insurance companies want you to use mail order when it comes to maintenance meds. They say it's cheaper for you but insurance companies are not in business to "save" you money. It's all about them.

You really don't don't have any choice. You could petition the insurance company but that's a crap shoot. Either pay for it yourself or use their recommendation...

One other thing, have you ever thought about checking "Good RX" prices on your meds. My wife uses it on her meds. It may or may not help but it' worth checking..

Good luck with these "legalized organized crime" units called insurance companies


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## DannyW (Mar 9, 2019)

JohnnyWalker said:


> The insurance premium is only part of the cost of that insurance coverage.  If you have the option shop for better coverage.   BTW:  Check out goodrx.com you might just be surprised and it costs nothing to join.



This.

I have acid reflux and for years paid something like $100 to get a 3-month supply from my insurance company mail order program. Then I finally checked around and found I could get the same medicine from Publix for $7.50.

Try GoodRX...you will be surprised. To give you one specific cost...I used to pay $119 for one prescription and using GoodRX I get it for $7.72 at Kroger. (Those are exact costs for the exact same medications...I just looked them up to be sure.)

Now I get all my prescriptions on paper from my doctor and shop them around. I literally save thousands each year.


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## NOYDB (Mar 9, 2019)

DannyW said:


> This.
> 
> I have acid reflux and for years paid something like $100 to get a 3-month supply from my insurance company mail order program. Then I finally checked around and found I could get the same medicine from Publix for $7.50.
> 
> ...



Like everything  - SHOP - No one will protect your money like you.


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## Artfuldodger (Mar 9, 2019)

280 Man said:


> I understand your frustration. Most times insurance companies want you to use mail order when it comes to maintenance meds. They say it's cheaper for you but insurance companies are not in business to "save" you money. It's all about them.
> 
> You really don't don't have any choice. You could petition the insurance company but that's a crap shoot. Either pay for it yourself or use their recommendation...
> 
> ...



Express Scripts is #25 on the Fortune 500 company list. I would agree that insurance companies us a mail order company such as Express Scripts to save them money.

My insurance company didn't force me to use mail order. They just persuaded me to by paying less and less of my prescriptions at CVS. They will pay at CVS pretty good for non-maintenance meds.

I kinda like the convenience of it. I always had a bit of trouble communicating my needs at CVS. Then having to wait in line. They never could get my three maintenance meds to come out on the same day. So I'd have to go back the very next day to get another one or maybe in three days.


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## Ruger#3 (Mar 9, 2019)

You have to be very proactive with your own care. Express Scripts denied my doctors script for a maintenance med. The alternative offered required a higher dose to work and had horrible side effects. I kept inquiring about it and finally found an agent who fessed up I had met the trial requirement of the alternative med and was eligible for the med my doc wanted me on. After informing my doc he ordered addition test to prove the med he wanted me on worked and fight the insurance company wanting to change my med in the future.


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## ClemsonRangers (Mar 9, 2019)

it is probably in your plan details, i get 3 maintenance drug refills at the pharmacy, after that i have to use mail order or pay out of pocket


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## Rivershot (Mar 10, 2019)

Ruger#3 said:


> You have to be very proactive with your own care. Express Scripts denied my doctors script for a maintenance med. The alternative offered required a higher dose to work and had horrible side effects. I kept inquiring about it and finally found an agent who fessed up I had met the trial requirement of the alternative med and was eligible for the med my doc wanted me on. After informing my doc he ordered addition test to prove the med he wanted me on worked and fight the insurance company wanting to change my med in the future.



 Repatha?


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## Ruger#3 (Mar 10, 2019)

ClemsonRangers said:


> it is probably in your plan details, i get 3 maintenance drug refills at the pharmacy, after that i have to use mail order or pay out of pocket



Yep, that’s how mine works.



Rivershot said:


> Repatha?



No, Breo


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## Oldstick (Mar 10, 2019)

ClemsonRangers said:


> it is probably in your plan details, i get 3 maintenance drug refills at the pharmacy, after that i have to use mail order or pay out of pocket



This right here.  Our plan made me choose either CVS/Caremark mail order or go directly to CVS for the same co-payments on all the meds I take on an ongoing basis.  For one or two time fills, I can go to any of their "preferred" pharmacies.  It was either that or pay the entire cost out of pocket.


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## transfixer (Mar 12, 2019)

You could always check the cash price at the same pharmacy or a different one,  I recently discovered the five prescriptions I take on a daily basis are actually cheaper if I pay cash outside my insurance,   than if I paid the co-pay through my insurance !   Talk about a rip off !    my insurance company was basically making money off of my prescriptions !


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## gobbleinwoods (Mar 13, 2019)

I think/believe that the insurance companies have purchased the mail order drug companies thus they are trying to get you to go that way.   I agree that goodrx is beating the mail order on some of my scripts.   But they are usually generics.


But my tinfoil hat might be on a little tight.


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## Oldstick (Mar 13, 2019)

transfixer said:


> You could always check the cash price at the same pharmacy or a different one,  I recently discovered the five prescriptions I take on a daily basis are actually cheaper if I pay cash outside my insurance,   than if I paid the co-pay through my insurance !   Talk about a rip off !    my insurance company was basically making money off of my prescriptions !



If I recall correctly, there was a pharmacist on this forum in a similar thread in the past.  He was saying the insurance companies had "coordinators" auditing their prescription claims and they supposedly had some type of contractual hooks that prevented the pharmacist from revealing a lower price than what the insurance co-payment is going to be.  I suppose the pharmacist has to already know what insurance you have up front in order to be held to that??

All I know is the few times I have asked directly "How much if I don't use my insurance?",  I was quoted a price way higher than the co-pay.


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## Milkman (Mar 13, 2019)

Cigna owns their home delivery pharmacy


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## transfixer (Mar 13, 2019)

Oldstick said:


> If I recall correctly, there was a pharmacist on this forum in a similar thread in the past.  He was saying the insurance companies had "coordinators" auditing their prescription claims and they supposedly had some type of contractual hooks that prevented the pharmacist from revealing a lower price than what the insurance co-payment is going to be.  I suppose the pharmacist has to already know what insurance you have up front in order to be held to that??
> 
> All I know is the few times I have asked directly "How much if I don't use my insurance?",  I was quoted a price way higher than the co-pay.


 
    I called a couple different ones,  one the same as I used already,  didn't give my name,  just told them I had been prescribed  blah blah,, and would be paying cash,  how much ?    and they told me,


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