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A new Cigna MA mb called to tell me that her Tramadol is only covered for 7 days. The Cigna formulary lookup says QL 240 in a 30-day period, does not mention a Prior Auth needed. Does anyone else have issues with this type of med?
Tramadol covered only for 7 Days!!
- Thread starter wehotex
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StephanieCJ
Guru
- 671
It is because of the class of medication (pain). Each state is going to treat it somewhat differently, but you should be able to contact your rep for the company and get guidance. In Louisiana, they are only covered for 7 days if "opioid naive" or plan switching, but then the company will cover follow up scripts.
AcemanX007
Expert
- 79
If the client has a history of taking the medication, the pharmacist can call the insurance company for an override code.
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- #4
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The local pharmacy tech told me that it would correct itself and that he would attempt to rebill for the remainder of the month in 5 days.
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- #5
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These particular prospects are just not worth it! They are extremely impatient and scoff when I explain that a federal law authorizes only 7 days for a "new" prescription. The pharmacist of the previous case told me that these cases normally fix themselves and to call at about the 5th or 6th day to verify if the 1-month supply would go through or not? The client's Dtr texted me that her mother had picked up the med at pharmacy, but she didn't mention the retrieved quantity.
The mb ended up being a chargeback who cockroached her way out.
When other agents have this issue, does it typically RESOLVE ITSELF or is the prior Auth required? I really hate these pain med ppl.
The mb ended up being a chargeback who cockroached her way out.
When other agents have this issue, does it typically RESOLVE ITSELF or is the prior Auth required? I really hate these pain med ppl.
Seeing more and more of this, I just tell them hey there are a lot of new changes to the laws due to the opioid crisis, Unfortunately, as usual, the Govt hurts the people in need and does not hurt the illegal drug users, Listen if you have had used this in the past a lot of times your doc can call and override it
Most get it Some really are not happy about it but they get it
InsuranceGuy29
Guru
- 843
It's not their fault. They're being squeezed by big government, due to a small minority of idiots that decided to make that the drug of choice for a while. Tomorrow, it will be another drug of choice. I understand the frustration, but understand they're going through hell with their bodies, and the government is basically saying...."Uhhh...oh well. Put some ice." A lot of people don't truly understand until they or their loved one goes through it.
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Physicians need to get with the new regulations also. My wife had rotator cuff surgery and a written script for 2 weeks of pain meds. The pharmacy would only fill enough for 7 days and the pharmacist only put 7 pills in the bottle. It tok a few phone calls and all was well at the pharmacy the next day to pick up the remainder of the script. Sometimes the physician has to rewrite the script. It is a game that no one is winning.
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