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MickinMD

Prescription Rejection - new to me

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Have you had long-use medication suddenly rejected lately?

I've had relatives telling me they're suddenly getting prescription renewals rejected due to the type of medication no longer being covered.

That just happened to me with Metformin ER (Extended Release) for type-II diabetes under my near-Cadillac BCBS, CVS/Superscript managed prescription coverage.

When I called CVS/Superscript to ask why, I was told Metformin ER is NOT among the meds covered.  I replied they've been covering it for me for over a decade, what happened?

The short version is that I asked for an exception, they're calling my doctor, and either Metformin ER or a substitute will be ok'd and I should get a call from my CVS Pharmacy within 72 hours telling me what prescription is ready.

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3 minutes ago, MickinMD said:

either Metformin ER or a substitute

Yep - probably looking for a substitute/generic.

As the pharmacy-benefit managers market tightens due to mergers and buyouts, the big guns like CVS will be able to try to control costs through their shear size.  It Metformin's owner doesn't play ball, they will just drop them.

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4 minutes ago, Dirtyhip said:

Is there a generic now.  Sometimes patents wear out and you can get the generic version.  Most insurance wants you to use the cheapest option for care. 

I may be wrong but I think metformin is generic.  My mom took metformin decades ago...

Never had what Micm experiences but I had my insurance company reject a RX my doctor tried to prescribe as they wanted me to try a less expensive med first to see if that worked. 

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11 minutes ago, Dirtyhip said:

Is there a generic now.  Sometimes patents wear out and you can get the generic version.  Most insurance wants you to use the cheapest option for care. 

Metformin is generic, but apparently not a cheap one from the insurance company's end. I'm automatically switched to a generic if there is one, with which I have no problem.

I'm paying my generic copay ($10/90 days) for metformin er now.

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9 minutes ago, Razors Edge said:

Yep - probably looking for a substitute/generic.

As the pharmacy-benefit managers market tightens due to mergers and buyouts, the big guns like CVS will be able to try to control costs through their shear size.  It Metformin's owner doesn't play ball, they will just drop them.

True.

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Good reason to reorder while you still have some of the previous prescription left. I don't like the automatic reorder procedure, but call when I have a weeks worth left in the bottle.  All of my shifts to other brands have been pretty smooth, whether mail order or local.

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5 hours ago, sheep_herder said:

Good reason to reorder while you still have some of the previous prescription left. I don't like the automatic reorder procedure, but call when I have a weeks worth left in the bottle.  All of my shifts to other brands have been pretty smooth, whether mail order or local.

I like the auto refill on my maintenance drugs. I have to keep an eye on their system to make sure it works properly. The recent tornado wreaked havoc on the system. I had to chase prescriptions all over town to reinitialize the procedures.

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