Sunday, March 15, 2009

Subscription does not equal Prescription

I went to Walgreens today to pick up Keith's prescription for Medroxyprogesterone. This Rx is used as a mild, direct stimulant of the respiratory center, thereby improving Keith's breathing. His doctor has directed Keith to take 4 pills 3x/day for a total of 12 pills/day. Keith has been taking this medication for about 10 years and it works well in concert with the other meds he has been prescribed. After all, he's still

Okay, back to the story. The pharmacy tech told me that the system was not allowing her to fill the prescription for any more than 60 pills...a 5-day supply based on the prescribing doctor's dosage. She got the pharmacist who also tried to override the system to no avail. She called Humana to find out why a standard medication refill was not being honored. She was told that Humana had determined that they would only pay for 2 pills a day, not the prescribed 12 pills/day per the doctor's orders. I was aghast. How does a insurance company with no medical knowledge of the patient arbitrarily change the prescription? I was told they said it was fine for Keith to take the 12 pills/day, but that he'd have to pay for them himself.

The pharmacist at Walgreens said this happens all day, every day. She has sent a fax to Keith's doctor to see if we can get this changed. Next step is contacting Humana Cares...we'll see if they do.

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