How to appeal for medication

Discussion in 'UPS Discussions' started by Jlemansk, Jun 18, 2016.

  1. Jlemansk

    Jlemansk Active Member

    I was wondering if anyone has had to appeal our insurance for a medication. I take nexium 40 mg every day, and now there is a generic out, so they will not pay for the brand name anymore. 99% of the time I am fine with generic, but this time it does not work for me, something is different. Nothing worse than getting heartburn every time you eat. I have tried all of the other meds on the market, and nothing works as well for me than Nexium. When I went to CVS last week for my refill they said "that will be $334.00 please." Anyway, if anyone has had success with being able to make an appeal for a medication, I would like to know how to go about it.
     
  2. UpstateNYUPSer

    UpstateNYUPSer Very proud grandfather.

    Would they cover the meds if your doctor specified on the script that you must take Nexium 40 mg and then checked the box DAW-----dispense as written?
     
  3. cosmo1

    cosmo1 Just another internet hooligan.

    Ask your doctor to call your carrier and explain the situation. My wife just went through that for her BP meds.
     
  4. Jlemansk

    Jlemansk Active Member

    I will look into that. I know there has to be a way to get them to cover this. I have been taking Nexium for a good 15 years.
     
  5. Indecisi0n

    Indecisi0n Well-Known Member

    If the doctor specifically writes on the script that you need name brand they will cover it.
     
  6. UpstateNYUPSer

    UpstateNYUPSer Very proud grandfather.

     
  7. Vote for Bernie Sanders, issue solved
     
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  8. Jlemansk

    Jlemansk Active Member

    Then the government would tell me why I was not eligible for the medication.
     
  9. UpstateNYUPSer

    UpstateNYUPSer Very proud grandfather.

    No, they would have you pay for your medicine and then give it to someone less fortunate.
     
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  10. toonertoo

    toonertoo Most Awesome Dog Staff Member

    Carry baking soda. Mix it with water. Biggest belch you will ever experience, no side effects. Good for your digestion and stomache lining. 99 cents. Heartburn gone
     
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  11. Jlemansk

    Jlemansk Active Member

    That's sounds funny, but I wouldn't try it. I had an ulcer in my 20's, and my gut hasn't been the same since. I have tried many different ways to get off that medicine, and nothing ever works.
     
  12. Dr.Brown

    Dr.Brown Swollen Member

    ask your Dr. about Pantoprazole... wonders I tell ya
     
  13. Dr.Brown

    Dr.Brown Swollen Member

    too much sodium for hi Bper's out there
     
  14. Indecisi0n

    Indecisi0n Well-Known Member

    Have you had your prostate checked recently ?
     
  15. 1BROWNWRENCH

    1BROWNWRENCH Amatuer Malthusian

    called "Liver Sauce" in the UK I believe. Loud farting too.
     
  16. toonertoo

    toonertoo Most Awesome Dog Staff Member

    Did not know
     
  17. Jlemansk

    Jlemansk Active Member

    I know you are probably joking, but I get that done every year. Anyone that doesn't take that serious, will feel real stupid when they wind up terminal cancer, that could have been prevented by an annual check up.
     
  18. Indecisi0n

    Indecisi0n Well-Known Member

    I am a little over protective. I get it check every Saturday night.
     
  19. toonertoo

    toonertoo Most Awesome Dog Staff Member

    I had acid reflux. Couldnt eat corn flakes, and go unload trailers at 3am. Doc said, no coffee, chocolate, or alcohol. I bought soda.
     
  20. barnyard

    barnyard KTM rider Staff Member

    Back on topic....

    You have to have your Doctor write a letter to your insurance company that states why he is prescribing the name brand over the generic.

    My wife was successful on getting a couple of things covered for your daughter. Both took 3ish months to wind their way through the system.