General Discussion

TheKentuckian

(26,314 posts)

92. I checked the formulary and your Lyrica is non-preferred and yes, has a specialty pharmacy only

Tue May 21, 2013, 07:26 PM

May 2013

so I think you are stuck and sadly, have to count yourself fortunate that they didn't put a step therapy requirement on your medication like the rest of the tier.

My suggestion is to go ahead and set up the mail order. Many policies have a one time emergency fill at the local pharmacy if you need it right away but if prior authorization is in place then it is possible that Optum can get your medications overnighted.

I just don't see how it is worth the effort trying to appeal or to get an exception because it will probably go nowhere unless your doctor is bulldog that knows the criteria better than they do for this but sure understand your frustrations. I also think they have enough legal language to make it near impossible to have an insurance commission do anything to rein them any.

Health care is just not a rational market and it is pretty much crazy to treat it as such so folks end up like you, a captured consumer that is fully dictated to by the seller.

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I'm PISSED!!..need a little help from the smart folks here... [View all] one_voice May 2013 OP

Perhaps a call to your state's insurance board ---- hedgehog May 2013 #1

I thought about my state's insurance board... one_voice May 2013 #2

You sign up for a year and can't change anything, but they can change any services at any time. SharonAnn May 2013 #65

It's because the insurance company's think "single payer" is on the horizon. xtraxritical May 2013 #72

No answer, but thanks to Obamacare you have no choice but to remain their customer Demo_Chris May 2013 #3

I was wondering how long it would take... one_voice May 2013 #5

Well said, once_voice. Bravo! Aristus May 2013 #24

AMEN. calimary May 2013 #50

GREAT COMEBACK! chillfactor May 2013 #29

Few to tide you over evilhime May 2013 #45

Here! Here! solara May 2013 #46

Thank you. Ms. Toad May 2013 #55

THANK YOU! VOX May 2013 #81

Thank you, one_voice. Only suggestion I have at the moment is... Hekate May 2013 #85

thank you, one_voice.. you did say you wanted to hear from "the smart people"! Cha May 2013 #106

((hugs)) one_voice after all that -- that you need to respond to this bullpuckey... Raine1967 May 2013 #112

This is not the case, Slick, in fact it's a blatant lie Warpy May 2013 #56

Are you seriously suggesting there is no mandate in Obamacare? nt Demo_Chris May 2013 #59

Not the way you think it is. Warpy May 2013 #62

Sweet, a mindreader! That's one seriously awesome gift! Use your powers for good. Demo_Chris May 2013 #68

so DO TELL US Skittles May 2013 #91

Single payer. Period. Demo_Chris May 2013 #94

I'm afraid I don't understand how the health care reform either initiated this particular problem... LanternWaste May 2013 #82

I was targeted by a push-poll on Sunday that was more subtle than your post Hekate May 2013 #83

I am concerned about the trend... dixiegrrrrl May 2013 #4

My lyrica was a little... one_voice May 2013 #6

the other trend I am hearing is that insurance payouts dixiegrrrrl May 2013 #10

Life insurance is unrelated to health insurance - Ms. Toad May 2013 #57

They're trying to discourage the use of brand name, on patent drugs Warpy May 2013 #58

Usually it is cheaper, and you often save on copays. Hoyt May 2013 #61

Not all generics are created equal. One made me really, really sick. Now, every year... Hekate May 2013 #86

Different buffers... one_voice May 2013 #95

Also, the extended release formula stays on patent while the rest of the med goes generic Hekate May 2013 #96

U.H. are scumbags. DCKit May 2013 #7

AARP is like the Hotel California..you can never leave. dixiegrrrrl May 2013 #12

I am not even a member of AARP and solara May 2013 #47

Kinda scary, but they have a way of knowing when your turn 50. dixiegrrrrl May 2013 #48

It's pretty scary actually solara May 2013 #52

There's an alternative, I don't remember the organization's name though. cui bono May 2013 #70

Nice to know there is an alternative solara May 2013 #87

UHC should be facing RICO charges for this, which is one of thousdands of examples. Scuba May 2013 #8

What difference does it make to them if you get it locally or via mail order? cui bono May 2013 #9

Honsetly I don't know... one_voice May 2013 #14

Price. jeff47 May 2013 #19

And often the insurance company farms out Ms. Toad May 2013 #63

Because it's company sponsored sharp_stick May 2013 #11

I will go back and look over the paper work... one_voice May 2013 #13

Check with your doc about this sharp_stick May 2013 #21

No, UHC does this all the time, and not just at re-enrollment. jeff47 May 2013 #20

Well that's interesting... one_voice May 2013 #22

Wow sharp_stick May 2013 #23

United Healthcare flat-out sucks. Fuddnik May 2013 #44

I think they're trying to drive local pharmacies out of business starroute May 2013 #15

United pays their CEO $50 million a year. pa28 May 2013 #16

United/Optum had our state Behavioral Health Admin contract duhneece May 2013 #49

That salary is obscene. n/t cui bono May 2013 #60

United has the worst ratio of ceo to employee pay in the country. 1737:1 pa28 May 2013 #67

That is excellent advice BrotherIvan May 2013 #100

GEHA does the same thing with Medscripts...why must things be so difficult?nt FLyellowdog May 2013 #17

Sharp Stick's post seems to have the most practical information. CBHagman May 2013 #18

Was this for Walgreen's? Didn't they drop a number of health insurance prescription plans recently? randome May 2013 #25

Good God I hope not! chillfactor May 2013 #33

It isn't the pharmacy in this case, it is the insurance company formulary MiniMe May 2013 #36

Express Scripts dropped Walgreens for a while but has now allowed them csziggy May 2013 #54

It won't help much, but all I can say is... Behind the Aegis May 2013 #26

I go through this with Nexium liberal N proud May 2013 #27

I don't know how smart I am, but this is kind of my field, so I'll try to help. Aristus May 2013 #28

I didn't know there was a generic for Lyrica... one_voice May 2013 #38

They usually notify the provider first. Aristus May 2013 #41

You need to talk to your HR rep about that. haele May 2013 #30

Ask your insurance company if you can use Express Script. They are pretty good. They southernyankeebelle May 2013 #31

In my experience, they stink. n/t Ms. Toad May 2013 #69

Really? I have never had a problem with them. I have been using them over a year now. southernyankeebelle May 2013 #79

I use Express Script as well, and have never had a problem. n/t tammywammy May 2013 #77

me neither. southernyankeebelle May 2013 #78

I've used Express Scripts/Medco for years now and have nothing but praise for their service. Nay May 2013 #97

I haven't heard of Medco. Do they handle everyone? I know Tricare handles retired military families southernyankeebelle May 2013 #99

I started out with Medco, but ExpressScripts bought Medco and now they are the same. nt Nay May 2013 #102

Oh I see. I just never heard of them before. southernyankeebelle May 2013 #103

The same, but not. Ms. Toad May 2013 #108

This certainly may be true -- it does seem that they have kept all the same Medco processes, Nay May 2013 #109

They already have. Ms. Toad May 2013 #110

Talk to your husbands benefits representative, ASAP. M0rpheus May 2013 #32

I'd write the same letter as your OP dickthegrouch May 2013 #34

Oh, crap. We now have United Healthcare. LiberalEsto May 2013 #35

Oh, God. UHC is a nightmare. Butterbean May 2013 #37

I'm on the Pfizer Connection-to-Care program to receive free Lyrica to treat neuropathy. TexasTowelie May 2013 #39

it costs money to notify you, money that would be better spent by rich people. you've made HiPointDem May 2013 #40

This is a very simplistic answer but I had trouble once and had to switch to a different snappyturtle May 2013 #42

Message auto-removed Name removed May 2013 #43

This message was self-deleted by its author Tuesday Afternoon May 2013 #74

UHC = Satan's jockstrap. They are the Monsanto of "health." n/t TygrBright May 2013 #51

I use Optumrx, too (United Health Care) lillypaddle May 2013 #53

l'd start by creaming them with the truth on FB, LI, TWITTER williesgirl May 2013 #64

Wow. LiberalAndProud May 2013 #66

They were hoping you'd die. Turbineguy May 2013 #71

First - I'd follow up with the person from UHC who posted here. Ms. Toad May 2013 #73

^^^^THIS ^^^^^ Hekate May 2013 #105

Thanks. Ms. Toad May 2013 #107

Good Grief!! 2naSalit May 2013 #75

United (Senior's Choice) is doing that to me, too. Jane Austin May 2013 #76

When I had United they were always pushing me to use mail order leftyladyfrommo May 2013 #101

I think the thing that is so wrong about these problems Jane Austin May 2013 #80

If you are that sensitive to any particular drug you should check before you go to the pharmacy. dkf May 2013 #84

I was just switched to United Healthcare in January Ruby the Liberal May 2013 #88

This is only the latest issues with them... one_voice May 2013 #90

I went through similar aggravations with my insurance a few years ago when I had a lot medical issues Glimmer of Hope May 2013 #89

I checked the formulary and your Lyrica is non-preferred and yes, has a specialty pharmacy only TheKentuckian May 2013 #92

I don't mind the mail order... one_voice May 2013 #93

Many policies have a mandatory mail order vanlassie May 2013 #98

I hate fucking insurance companies gopiscrap May 2013 #104

Something like that happened to us recently MountainLaurel May 2013 #111