Hi, I have a question. Is it considered routine, or at the least acceptable to expect your primary care doctor to file an exception for a medication if Part D denies coverage for it? (It is a quantity limit exception.)

Don't get me wrong. I think it's terrible that doctors have to spend valuable time doing this, as they are overworked and underpaid to begin with. (At least the GP's are.)

But this year my *new* part D insurance company is refusing to pay for my medicine without my doctor filing an exception due to quantity limits. The nurse told me "There is nothing we can do". I do not know what the insurance company said to her. The D company will not tell me anything.

The weird thing is that my doctor filed an exception for this same med., recently and it was approved. Now the Part D company wants another exception for the second dosage of the same medicine.

My doctor has prescribed this medicine that I have been stable on for over 7 years, and I have seen this doctor for over 3 years. We have a really good patient/doctor relationship. I know he has no qualms with my taking this medicine.

I do not recommend Caremark/ CVS/ Silverscript to anyone. They are highly trained to give you the run around, deny meds, not give answers, etc.

I have used Part D since it's inception and this company is the absolute worst I have ever dealt with. I say this because I hope others will not have to go through the same BS that I am.

I'm not sure where to post this so please advise or move if needed.

Thanks in advance for your experiences with doctors asking Part D insurance for exceptions/prior autorization, etc.

Mine won't do it either. Although for a psyche med I was able to get my pdoc to write a letter to help me get my abilify covered. My GP refuses to do prior authorizations, I run into this alot even with my son's pediatrician, they just would rather rx something else then diddle around with the paperwork. That is why insurance companies do it to begin with if you ask me, because they know the majority of GP's won't do it because if they do it for ONE patient, they have to do it for ALL their patients or it's not fair.

Hey Pam, Thanks for your reply. Geesh! I'm really surprised and sorry your doctors are not willing to help. Maybe I am too much of an idealist.

And upon reflection I guess this just doesn't sound like my doctor. He helped me file paperwork with drug companies when I hit the donut hole last year. He said when I asked if he would, " I will do anything I can to help." And he did.

So I'm now thinking it's a problem with the nurse or a miscommunication between her and the D company. Hopefully I will find out during my next appointment.

I would still love to get replies from anyone else who has had a problem, or *not*!
Is this the right place to ask about it?

Thanks again,
Sunrise

I think this is as good a place as any to ask about it Sunrise, glad to offer my experiences with this and hope that you get the situation worked out soon. Hopefully some others will see this and add their thoughts too.

it does suck.

silverscript makes my docs do the runaround too.