i got blue cross and they wont give me welllbutrin?

Question

i have medical blue cross in california and my psychiatrist perchribed wellbutrin xl but the pharmacy i went to said its not covered but a few montsha go i was able to buy the non generic paxil cr should i try a different pharmacy?

Answer 1

Your insurance did that because there is a generic form of Wellbutrin. The generic name is bupropion. Get a prescription written for that, and you'll probably be fine.

Answer 2

You may also ask your pharmacy to contact the Dr. and get what is known as a "prior authorization." This means that the Dr will send over a copy of your chart and will tell Blue Cross why he thinks you should be on Wellbutrin instead of something else. Many times, insurance companies reject claims if they think the medication is too expensive. Further, since Wellbutrin can be used for smoking cessation (which is usually not covered by insurance-go figure) they may want verification from your Dr that you are taking it for depression etc instead of for smoking. Ask your pharmacy to try for the Prior Authorization-they'll know what to do from there.

Answer 3

It's because paxil is cheaper in general. Welbutrin is a newer drug compared to paxil. Paxil is an SSRI (Serotonin Re-uptake inhibitor.) There are many choices of this type of medicine (ie prozac, zoloft, lexapro, celexa etc.) since there is competition in the SSRI market , prices go down. Welbutrin has a little bit different action it works on improving the transmission of Norepinephrine and Dopamine to the post synaptic cell. There aren't as many "good" drugs similar to this drug so there is less competition. Therefore the drug companies can sell at a high price without too much fear of competition.

You can still get welbutrin if this is what your provider thinks is best. Ask them to get a prior authorization for the insurance company. This will allow you to get the drug if you have tried other less expensive medications first and they were not helpful to you. They (your prescriber) may say no if they feel it is best that you try something else. There is no hurt in asking.

Hope that helps
DZ, Psych RN, NP, CNS

Answer 4

No. You'd get the same results at any other pharmacy.
ins Co's are continually evaluating drugs and refusing to pay if there is a generic around.
Best bet, call BC and see if this is the case and see if they'd give you the Wellbutrin if your Dr ordered no substitutes.The, make a call to your Dr and let him know what's happening. .He will either call BC and argue your case, or prescribe a generic. Dr's deal with this all the time.
Good luck

Answer 5

You should contact your insurer to confirm whether or not its a formulary drug on your policy. ("Formulary" = preferred brand name drugs, generally the ones that the insurer/pharmacy benefit administrator is able to negotiate a good deal on/ "Nonformulary" = non-preferred brand name drugs, which you might have a higher out of pocket cost on or may not be covered at all.)

If it is a nonformulary drug, you have 2 options - 1) see if there is a drug on your formulary that works just as well for you and have your physician prescribe that. 2) If there is no alternate drug which would work for you, your physician may be able to assist you with a request for an exception. (Your insurer should be able to tell you where that request would go.) There's no guarantee that you would be granted the exception - it would depend upon the terms of your policy and also the medical documentation for your request. But, if no other drug would treat your symptoms, its at least worth trying.

Answer 6

You can have your doctor get prior authorization, but blue cross can still refuse to pay for it.