How can they deny paying CASH for pain patches?

Discussion in 'Fibromyalgia Main Forum' started by misskoji, May 22, 2009.

  1. misskoji

    misskoji Member

    Hello friends,
    Please if anyone has ideas, let me know where to go from here.

    I called Walgreens today to see if my Rx's were ready. They were for Valcyte, Duragesic, and Valtrex. My insurance company denied both Valcyte and Duragesic.

    Valcyte because "my insurance company feels I have had enough Valcyte to benefit me". HA! A month's worth? I don't think so!!!!!!!!!! But I cannot afford to pay over $2700 cash for that right now.

    Duragesic (pain patch) they denied because it needs a prior authorization with a stipulation that I must be on Morphine or Methadone for a period of time and have that fail. Dr. Lerner does not rx either of those drugs, so he could not do that for me. Fine, last month I paid cash for them at a Walgreens in Wisconsin when I was visiting there last month.

    This time, I brought this Rx to my local Walgreens where I have been a loyal customer for about two years. The pharmasicst REFUSES to fill it if I pay by cash. If she would get a prior auth from Dr. Lerner, it would start the whole battle of insurance company/Dr. Lerner's policy....which last time lasted days.

    Well I told them I would be taking my business elsewhere, thanks for nothing. But now what? What if I start going through withdrawal? I've suffered in pain for many years, just like many of you. I am so sick of this crap we have to go through!

    Frustrated and Crying,
    Thanks my friends
    [This Message was Edited on 05/22/2009]
  2. Shananegans

    Shananegans New Member

    They can't do that. I would ask for your original prescription back, take it to a different pharmacy, tell that pharmacy that you will be paying via cash and have them fill it. Walgreens does not get to decide whether or not you can have this prescription since it was prescribed by a doctor. You need to get the prescription back, they have no right.

  3. tig519

    tig519 Member

    I had this issue with Ambien of all things. It was the 28th day of the existing prescription and I requested a refill, they told me that insurance wouldn't refill until the next day. (I was going out of town so this was an issue). I then said, well I'll pay cash and they said they wouldn't sell it to me and actually insinuated that I was abusing the medication. WHAT? Their logic was that I was refilling it too early. Of course the month we're talking about also had 31 again, I was at day 28. Generally, it's been my experience that you're allowed to refill within 7 days of the last prescription except on more controlled medications. The ironic thing is that Lyrica is a more controlled refill, and the timing was exactly the same as the Ambien, and they refilled that one.

    I told them I was never coming back, went to Dominicks which is a little more $$s (about 1-2%) than Walgreens, but I never had issues with them. I moved all my scripts over. Very easy process, just gave them my old pill bottles and they did all the work!

    I have not had an issue since.

    I don't trust Walgreens and believe that somehow they are getting a kickback from the insurance companies... some sort of incentive. The other thing I noticed is that when I was with Walgreens, I constantly got things in the mail about "did I know that there were alternatives to Aciphex?" and my doctor was getting called about this script as well every other month (My doc told them this is the med that works!). Since moving my scripts to Dominicks I have not received the mail anymore and my doctor hasn't been called. Just is too coincidental.
  4. Pippi1313

    Pippi1313 New Member

    I use Walgreen's just cuz they're convenient & close by. But from now on, I'll be aware of what y'all said about them!

    I should consider switching pharms, just on principle.
    Does anybody know if CVS (also conveniently located nearby to me) is any more reputable than Wag's?

  5. daylight

    daylight New Member

    CVS is good . I used to use them when I lived by one. I just switched to Walgreens a months ago . I have no cvs pharmacies near me. We used to go to Rite Aid until they gave one of my prescriptions to a stranger. Had to file a complaint several people about that one. But to my knowledge nothing was done about it.
    So now I'm at walgreens because there local. But if given the choice I would go to CVS . For the most part I loved them.
  6. Pansygirl

    Pansygirl New Member

    I've used CVS pharmacy for over 8 yrs and I've been happy with the service.

  7. Janalynn

    Janalynn New Member

    Yep, get your prescription back (if they have it) and go elsewhere. Not all pharmacies will do what they did.
    If they have a problem with it, have them call the Dr. - I mean for crying out loud it's on his rx pad.

    These darn ins companies too, who decide what you should and should not take. They're not even medical people.
    Dont' panic, just go to a different pharmacy - tell them you're paying cash cause your ins. won't cover.
  8. GranmaBB

    GranmaBB New Member

    They called my Dr and sent her a list of all my prescriptions, and it went on and on...
    I switched all my rx's to Target pharmacy 2 years ago & I just love them.
    They're so much friendlier and even know my voice on the phone.
    I had some issues when someone tried to refill my Vicodin rx and they spent tons of time on it and were so helpful.
    I even emailed their corporate office about how I love this pharmacy, and they called me to thank me.

    I don't know what the deal is with walgreens, but I've never met anyone who likes them.
  9. AuntTammie

    AuntTammie New Member

    I've used Walmart, Dominick's, and Jewel/Osco for scripts and had no problems from any of them....have also heard good things (and good prices) from Costco (and you don't have to be a member to use their pharmacy - just tell anyone who asks for a membership card that you are there for the pharmacy)....have heard a ton of bad stuff about walgreens - won't go there

    Osco is most convenient (close by and 24 hrs) for me, but I would still go there even if it weren't bc they have always been super nice and very helpful to me (& though I don't use many meds anymore, I have certainly used a lot of them over the yrs and had nothing but good experiences with them)
  10. pacotaco

    pacotaco New Member

    I think they are mistaken unless you have something like mine(insurance), I have Kaiser so therefore i have to use their pharmacy because they are my ins. carriers. If you are able to pay cash, they do not have the right to say no! get the presc. back and try walmart or rite aid. I have heard that if you switch to rite aid for your meds, they will give you a 50$ gft certificate. good luck and i wish you well. fyi...let you dr. know whats going on and how your afraid of withdrawals, and he should give you something so they dont feel responsible for what may happen to you.(maybe).......miss pacotaco
  11. misskoji

    misskoji Member

    Well honestly, I felt defeated by this whole situation. I let myself be weak and did not try to get this Rx filled elsewhere, I did not have the energy to fight I guess. I did indeed get the actual Rx's back from the pharmacy and they are sitting in my drawer. I intend to bring my Valcyte Rx in today and hopefully Dr. Lerner will be fast to respond to a pre-auth for it.

    The pain patches, well, I think I'm just going to hand that Rx right back to Dr. Lerner and tell him what happened. Honestly I cannot afford them anyway, it's like chosing between my phone and food bill for pain relief. I guess I can endure pain for a little while longer while I battle my ins. company to pay for the patches.

    I didn't think this was legal at all for them to deny me my pain medicine...I mean couldn't I hold them liable if I went through wds? IDK...I should not let myself be this easily defeated, but I just let it go at the time, I couldn't deal I guess. I am hoping to write a letter to Walgreens...the manager, the district manager, regional, and headquarters. If it will accomplish anything I have no clue.

    Thank you again for your support and ideas.

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