Friday, August 08, 2008

Over a week ago we received a phone call from our pharmacy asking if DH would like his Prevacid prescription refilled and he said yes because he was running low. I was also waiting for my doctor's office to call in a reauthorization of my 75mg of Effexor which I take daily along with an additional 150mg. Well, I've heard nothing and on Wednesday, DH and I went to the pharmacy to see if the scripts were ready and DH was told there was a problem with the insurance. In the meantime his prescription is dwindling and he's going on vacation soon and I'm having to double up on the 150mg pills because if I take less than my prescribed dose it'll make me sick.

On Thursday morning I called the pharmacy to ask what was up and they told me that the doctor hadn't yet called in the prescription for the 75mg dose for me and there was a "prior authorization" hold on Dh's prescription. Nobody could explain what "prior authorization" meant so I called the doctor's office and they told me that they had done everything that needed to be done. I called AvMed that afternoon and asked about this "prior authorization" and they said that they were trying to get people who had been on PPI's (Proton Pump Inhibitors which includes Prevacid) to take the generics first then if they don't work go back to the original PPI. And so for DH not to have to go to a generic they needed a "prior authorization" from the doc saying he should stay on Prevacid. What nobody told me was that it takes 14 days to approve.

I called the doctor's office back about my Effexor and they said they faxed over a prescription for 75 mg but I talked to the pharmacy afterwards and they said they only received a 150mg prescription fax which was incorrect. I called the doctor's office again and they swore it was 75 while the pharmacy swore it was 150. So who was I going to believe? I gave up that evening.

Friday morning I called AvMed directly and asked "what's the deal?" and a nice lady explained first that there is absolutely NO reason my Effexor should be on hold. Then when they checked DH's Prevacid she said they had faxed our doc the form on August 3rd and it was completed and returned on August 6th so my doc did her job, to her credit. But she said that it still takes up to fourteen days to approve. Then she told me that the doc could simply call in a prescription for generic Protonix which is Pantoprozole or the generic for Prilosec which is Omeprazole (or is it vice versa?) Anyway, I called the doc's office and relayed the information hoping that sometime today they will call in a prescription for one of those for DH. I hope it will go through because DH would get sick to his stomach if he doesn't have his acid reflux med.

Next comes the good part. When I talked to the nice young lady at my doc's office about the fact that there are no insurance holds on my Effexor, she noticed something new on my record. She noticed that underneath a recent note where it says the prescription for 75mg was to be faxed, there's another note that says "no refills allowed till patient comes in for visit" so basically I have to take time off work , drive across town, and wait 20 minutes (there's always a wait) to see the doc so she can send me on my way after I pay my $25 copay of course. They don't need to see me, they just want my money, I think it's such bullshit. WTF? Why do I have to see the doc if there's nothing wrong with me? This also costs the insurance company because they pay the remainder of the unnecessary office visit. Such crap.

But because there was nothing I could do, I made an Monday afternoon appt with my favorite nurse practitioner because she's always taken care of DH and me and I trust her, she cares.

An hour and a half on the phone today to clear this up, you better believe something better get cleared up today or I'm going to raise holy hell. I'm sure there will be more to this saga so stay tuned...


  1. What a waste of time! I'm so sorry that happened to you!

    Now, back to a post you did a while ago where some jerk drove you off the side of the road or something like that and DH said he wished he had a gun... well, something along those lines happened to us recently and I asked John if he felt better knowing that he was carrying a gun... and he said "no, cause I can't use it!" Just thought I'd pass that along in case DH is still considering one...

  2. Anonymous8/08/2008

    I can't believe they told you to get a perscription for prilosec. That is available over the counter. I'm not sure if it will be as effective as prevacid. It didn't work for Robert. Neither did protonix. He has to use nexium.

    Unfortunately, docs are required to see patients on a regular basis to prescribe medications. Generally it is at least once a year. However, it may be more frequent with certain meds. Their files are audited on a regular basis to make sure they are in compliance. This still doesn't explain why you were not notified the first time you called.

    Good luck. I know first hand how much fun it can be to navigate the medical/insurance world.

    I just thought of something. Did your doc fax a rx for 150 mg of the effexor with a change in directions to read take one and a half tablets daily rather than prescribing both the 150 mg and 75 mg tablets? Then the note would read no further refills until patient is seen. That would essentially give you a month to make an appointment.--ST

  3. Exactly what happened to me a few months ago with my Lunesta. I got a leter from BCBS saying they wanted me to switch to a generic equivalent for one month, then, if I find that it doesn't work for me, my doctor can authorize another Rx for Lunesta again. As for having to see your doctor just to get a refill....I've spent more than several hours in my doctor's office just waiting for him to see me so I could get a refill. There was nothing wrong, at least nothing that hadn't been wrong before. And he was probably in with me for all of 5 minutes, at a cost of $30. PLUS the cost of the med. I'm not made of money, but apparently the health system must think I am.

  4. how long has it been since you have seen your doctor? state law here in missouri requires that we re-visit the doctor, even if nothing will change, every 12 months. could there be something similiar in florida?

  5. My name is Judith Haven and i would like to show you my personal experience with Effexor.

    I am 37 years old. Have been on Effexor for at least 1 years now. As soon as I was on the beginning dose I could feel releave from my anxiety. My family life is so much better. My kids notice it. They applaud my for taking the side affects for a better live with them. No explosive episode any more.

    I have experienced some of these side effects-
    Nightsweats, I have twitches if I forget a dose.

    I hope this information will be useful to others,
    Judith Haven