ABC 33/40 & Focus@4 – asled this question:
Has your physician ever had to give you a medication other than the one he wanted you to take because your insurance did not cover it? Please share your stories with us.
This is my response:
I went thru this with my blood pressure med. Corgard works great & I have taken it for years with Tricare covering it.
After my open heart surgery they re-evaluated my profile & decided to stop paying for the non-generic form. We went thru this several years ago & already knew the generic forms did not work. We went thru it again.
After having a triple heart bypass, the last thing I needed was to have my blood pressure out of control. I tried four or five different meds for a month or so at a time with each letting my blood pressure fluctuate drastically from high to low. My vision started going, very rapidly. I had to have a new eyeglasses prescription within three months.
The heart doctor was not happy with the results of the generic meds but complied with everything they asked us to do. He finally sent them letters requesting me to go back on Corgard as he prescribed, as a medical necessity. Even they eye doctor was sending letters to Tricare to get me back on Corgard.
I finally started just paying cash for the meds so I could get what the doc wanted me to take & keep my blood pressure under control. Express Scripts is the one denying the non-generic Corgard. The local Tricare representative even approved it & asked them to aprove it & they still would not approve it. So, for about a year & a half, I have been paying almost $200 a month for my meds which should only cost $9.00 a month.
If the doctor tries alternatives & they don’t work, the insurance companies should pay for what does work. Period. This is ridiculous. I have asked them to re-evaluate & they say they will but they still have not approved it.
Then, to top it all off, I got a discount pharmacy card to reduce the cost of this one prescription a little bit. I get about a 10% discount by using it. It is not alternative insurance, just a discount prescription card. Every time I get my prescription filled, the codeing somehow gets messed up & when I go in to order new prescriptions from Tricare, my account is frozen because they have me listed as having other insurance coverage. I have to call them & wait for a live person to get on the line then after explaining the problem, they will take the hold off the account. Only then can I order any refills they have for me so they can get them shipped to me.
Frustrating. Raises my blood pressure on a regular basis.
Good for my heart? I don’t think so!