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Medical Forum / General / Pharmacy / December 2005Paying cash when I have insurance...
Hello all- I have a question. I have recently run into an issue which troubles me. I attempted to fill my refill for Ambien at a chain-drugstore. My insurance (which is Medicaid) declined it, because according to my insurance, they will only pay for 14 pills every 25 days. So, logically, that means there will be periods when I won't have that particular medication. So, I told the Pharmacist that I would just pay cash. She said "No." I explained to her that I am a cancer patient, and I need my sleep. She still refused to let me pay cash ($51.00) for the script... saying- "People on Medicaid can't pay cash for their scripts- it's [STORE NAME]'s policy and State Law." I was pretty upset. However, I drove 7 minutes away to another store (but in the same chain) and the Pharmacist there filled my script, and I paid cash. Does any have a clue why this happened? Same company. Same script. Different policy. Who's right? Here's a few facts- I live in Connecticut, I have Medicaid, it was for 14 pills of 10mg Ambien, and I was at a large chain. Thanks! > Hello all- I have a question. > [quoted text clipped - 23 lines] > > Thanks! One of the pharmacists was wrong about the law or the one that filled your Rx just ignored the law. The State board of pharmacy for Connecticut should be able to tell you the law. A pharmacist buddy of mine said that in Alabama you must have your controlled drug Rxs filled by Medicaid, if you have Medicaid. You can not pay cash for them. This is so the State of AL can try to prevent drug diversions. They assume if people get a control drug for free (close to it - co-pay with Medicaid) that they will be more likely to sell it to someone. Its more fall out from the failed War On Drugs policy that is eating away our rights in the United States. >One of the pharmacists was wrong about the law or the one that filled your >Rx just ignored the law. The State board of pharmacy for Connecticut should >be able to tell you the law. The State board of Pharmacy BETTER be able to tell the original poster the "regulation" law or whatever ... Personally I do not have a problem wqith the States limiting the use of Ambien to "only" 14 tablets per month... nor do I have a problem with the State refusing to pay for any more then that quanity...what I do have a problem with is that I do not see how the State could prohibit the original poster to pay for his medication...as long as the Rx was being filled correctly and not every 2-3 "nights" etc... I am semi retired with almost 40 years behind Rx counters and this situation is new to me..and I though I had seen and heard everything... I have been wrong about Laws before....and to be honest I have ignored plenty of laws in situations where "my" customers "needs" required me to ignore them... I do what is right for the patient IF I possibily can...and normally that sure does not involve bending or breaking any laws.. Just my opinion.. Bob G.. Thank-you for your response. I talked to another Pharmacist, (same chain, different location) and she said that technically, the Phamacist who wouldn't let me pay cash was correct- HOWEVER, she said that she would let me pay cash anytime, because she understands that because my insurance only pays for 14 pills every 25 days, I could pay cash for the remainder if I so wanted. Thanks again! > Thank-you for your response. > I talked to another Pharmacist, (same chain, different location) and [quoted text clipped - 3 lines] > pills every 25 days, I could pay cash for the remainder if I so wanted. > Thanks again! Ask your doctor if switching to Lunesta would be appropriate for you. It's in the same class as Ambien but has no short term use limitations in it's literature. While it recommends that long term use of sleep medications should only be undertaken with a doctor's supervision, it contains an indication for long term use. Insurance companies have latched onto this "short term use" disclaimer in all other sleep aids to reduce cost thereby dictating a patient's drug therapy. Rich there is absolutly no reason that the pharmacist should refuse to sell the medication to you I would report this to the manager and the state board. My response is assuming your prescription is for 30 pills? or a month supply if the rx was written for 14 pills than he or she can only give 14 every fill. |
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