About a month ago, my friend gave me one of his to try and it worked very well for me-I felt so good the next day and it was wonderful to experience a full good night's sleep. So I went to my doctor on Feb 27 and he wrote me a prescription which I took to get filled that night. I was told that they needed some sort of authorization from my insurance and doctor and to check back in 72 hours. I called on Friday (the 2nd) and was told that they were waiting for a a fax from my doctor's office so I called them and they had just sent it to the pharmacy and said that I should be able to get it by Monday (the 5th). Well, life got busy and I didn't get a chance to call the pharmacy until today to check on it but I figured that by now I'd be able to get them (plus I have been sleeping horribly and could really use them). I called today and was told that it still was not approved. So I called my doctor's office and was told that the insurance company told them that they had not yet made a decision and to try back in a few days-which the nurse told me she would do. But what the heck?? What sort of big decision is it to decide to let me get sleeping pills or not? I was tempted to just get them w/o insurance but they are $140 Has anyone else had issues with this?
2007-03-13 04:04:20 · 3 answers · asked by chocolatemartinigal 2 in Science & Mathematics ➔ Medicine
your insurance company has a formulary which is a list of drugs that they will cover. since lunesta is fairly new it is probably not on their formulary. sometimes they will cover it but the doctor has to apply for a non-formulary approval first. this is a kind of long process where they review your history and see what drugs that are on the formulary you have taken for that condition and why they have failed to work for you. if you haven't taken other drugs that are on their formulary to treat the same condition that lunesta treats, they will most likely get the doc to write a new rx for one of those drugs that is on the formulary and you will have to try that first. go to the website for your insurance company's formulary and find out if lunesta is on, if not find out what is and speak to your doc about prescribing that instead. if lunesta is on there it will most likely be in the higest tier and you will have to pay the highest copay.
2007-03-13 04:59:40 · answer #1 · answered by saveit 4 · 0⤊ 0⤋
I would call the insurance company yourself. I've had to get approvals on medications before from the insurance company and they came through in 24 hours. There's no reason this should take weeks. Raise some hell.
2007-03-13 04:08:23 · answer #2 · answered by leaptad 6 · 0⤊ 0⤋
The insurance companies are trying to get people to choose generic ambien. If you continue to have problems with the insurance, ask for a prescription for ambien.
2007-03-13 05:33:57 · answer #3 · answered by Lea 7 · 0⤊ 0⤋