'Nother crappy pharmacy

My husband came home from the pharmacy today and they had the nerve to give him generic drugs just because our insurance company only covers generic drugs. He asked for the name brand and they said he'd have to pay the difference! Can you believe that??!!

I'm going down there tomorrow and pitch a fit. I can't believe all these crappy pharmacies that won't give us name brand drugs for free just because our insurance only covers generic drugs. If his doctor said he has to have the name brand drug they HAVE to give him the name brand drug for free. I know because I read it on the internets!!!!

Damn pharmacies ....they're just like all those crappy DMEs!

Do not feed the troll.

Depending on the drug and the formulary, generic formulations can differ enough from the original that Doctors can prescribe the brand name as 'Medically Necessary'. It generally means you have to get special dispensation from your insurance company with proof that some ingredient from the generic is either messing with your health or your other prescriptions or the generic is missing a secondary ingredient that is imperative to your treatment. Insurance company formularies are increasingly byzantine, and each insurance company's accepted formulary is different. If anything, I would blast the insurance company before blasting the pharmacist.

You can call me a troll all you want, but I'm not going to put up with this crappy pharmacy just because my insurance has rules. I don't care what the pharmacy says, I know I'm entitled to whatever I want. And it's the pharmacy's job to give it to me at no extra charge.

I was expecting more support here on this. I'm a CPAP patient and if I hadn't found this place I would have never known DMEs had to give me free stuff my insurance doesn't pay for. Are you saying the same rule doesn't apply to pharmacies? That's crap. I don't believe you! Stop lying!!!!

If you really stopped and thought about this MANY of the generic drugs are made on the same production line as the brand name. The generic saves YOU and your insurance company money. So why would you want to give away money for no reason?

There are a few drugs that require specific brand names to be used. And of course new drugs on the market that do not have generics.

Quite frankly I'd prefer to have a only tried and tested generic that has been around for years than some new brand drug that we are going to read about all the bad stuff it has done to people after few years of complaints.

Good luck with your insurance company on the brand name...sure you can have them..you just need to pay for them. Also you have to blame your doctor who wrote the script and checked the box "generic substitution allowed"

But its your money...so if you want to waste it go ahead. Since you love lining the pockets of the drug companies...Now I need to go walk away...cause I have laughing too hard at your post and don't want to spew my soda on my keyboard.

DreamDiver wrote:Depending on the drug and the formulary, generic formulations can differ enough from the original that Doctors can prescribe the brand name as 'Medically Necessary'. It generally means you have to get special dispensation from your insurance company with proof that some ingredient from the generic is either messing with your health or your other prescriptions or the generic is missing a secondary ingredient that is imperative to your treatment. Insurance company formularies are increasingly byzantine, and each insurance company's accepted formulary is different. If anything, I would blast the insurance company before blasting the pharmacist.

I called my insurance company and they said they won't pay extra for the name brand drug. They don't think the difference between the generic and the name brand drug is medically neccessary, but the name brand drug has a gel coating and my husband has a sensitive stomach, so I know he needs the name brand drug.

So in that case I think my pharmacy should have to give my husband the name brand drug for no extra charge. Yes, yes, I KNOW the name brand drug costs the pharmacy more, but it's not MY problem if the pharmacy makes enough to pay the pharmacists, and their rent and keep their license and make a profit. If my insurance company will only pay for generic drugs it's my pharmacy's issue. Let them deal with my insurance company. I am entitled to whatever I want.

archangle wrote:Do not feed the troll.

Sorry, archangle, I should have paid closer attention.

gotta love that entitlement attitude!! ROFL

If your husband needs a drug specifically because of stomach upset then you have a few choices. Get the doctor to write the script for brand only...and the reason why. Your doctor will most likely have to submit special paperwork to your insurance company to get them to approve it...and then the insurance will most likely ask the doctor to change the med to something else just as effective that is generic. In the mean time...you hubby will have to wait without the medication until insurance approves or denies the request. Because they are ONLY going to pay for the medication ONE time in a given time frame.

The other option is to add one of the stomach protector-ant type drugs aka Protonix, Nexium or the like...keep in mind that many of these are now over the counter...so you would have to pay for them yourself as most insurance companies stop covering a prescription medication as soon as it goes over the counter and no longer requires a prescription.

The next option is to have your husband speak with the pharmacist about the medication and what can be done to eliminate stomach upset.

Either way...good luck...on this one...you will get a lot of eye rolls and laughter behind your back..and most likely your doctor is going to tell you suck it up and drive on it he feels its not medically necessary...then I guess you'll be back complaining about the doctor and the rest of the medical system that is not kissing your entitled butt! lol

msradar65 wrote:If you really stopped and thought about this MANY of the generic drugs are made on the same production line as the brand name. The generic saves YOU and your insurance company money. So why would you want to give away money for no reason?

@msradar65, I have to agree - in most cases, generic is cheaper and just as effective. However, if there are extenuating circumstances, it is still important for doctors to be able to prescribe the brand name, especially if the generic formulation is different enough that it could cause complications. Likewise, it's possible the generic formulation could be more appropriate than the brand name for a specific patient, and the doctor could prescribe that specific generic as 'Medically Necessary'.

The 'entitlement thing' is, as archangle suggested, just someone being a troll. Some people, like our sociopathic original poster, get their rocks off by twisting up other people emotionally.

We now use almost exclusively generics.
I even had two brand names changed from non-formulary to formulary--doc is good with them.
I also keep track of all my drug patent expiration dates.
I buy our Metformin at a local pharmacy to make sure we get the small pills instead of the GIGANTIC ones.
Just getting ready for Medicare.

A DME is just like any pharmacy. That's a valid analogy any way you come at it. Any pharmacy can choose to give you 7 year old medications because the doctor did not specify "recent" on the prescription. That is all the insurance company's fault. Because it is the insurance company's fault, I am going to sit on my hands and do nothing about this 7 year old medication. In fact, I am going to praise the pharmacy for being so altruistic as to make a bigger profit off me than it would have if it had given me fresh medication.

I am also going to post under an unregistered name.

Oh, wait, that was all full of shit.

(Sorry, couldn't resist.)

PS: I am only going to acknowledge people who forward my agenda.

This is a good example of the moocher group that feeds of the rest of us. The I want and I'm entitled class that we have in America today.

msradar65 wrote:gotta love that entitlement attitude!! ROFL
Either way...good luck...on this one...you will get a lot of eye rolls and laughter behind your back..and most likely your doctor is going to tell you suck it up and drive on it he feels its not medically necessary...then I guess you'll be back complaining about the doctor and the rest of the medical system that is not kissing your entitled butt! lol

You know what? I actually agree with you completely. And it's exactly the same thing when comparing "fully data capable" PAP devices and basic PAP devices as far as insurance providers are concerned. The only difference is that even if your physician writes a letter about this the insurance company will still not pay the additional fee for the "fully data capable" device.

I find it very illuminating that in my example the advice from other posters is to complain to the insurance company instead of the pharmacy, AND claim that I have an entitlement attitude. All I can say to that is you are EXACTLY right. Thank you for helping me make my point. Patients should be petitioning their insurance companies rather than blaming DMEs for insurance company policies.

squid13 wrote:This is a good example of the moocher group that feeds of the rest of us. The I want and I'm entitled class that we have in America today.

You don't understand, squid. CPAPDiva is a troll making fun of those who insist on having a data capable CPAP machine, not someone who's actually talking about name brand prescription drug coverage by insurance.