We live in one of the freak towns that doesn't have fluoride in the water.
My kids have both already had cavities, so I want to make sure to follow our pediatrician/dentist recommendation to get them fluoride pills, but it hasn't been so easy. So we don't have to wait in line at the pharmacy every month, we had been getting our pills from Express Scripts, but we changed insurance, so now we can only use Walgreens online pharmacy. This has proved to be quite the challenge.
Walgreens would not allow me to add the kids to my pharmacy account until I placed an order with physical pharmacy, so I did this first.
The local pharmacy would not fill the medication because they covered only drops but not pills unless they got "extra info" from our pediatrician. After a week, this was not received. Our giant peds practice did not know somehow that this info was being requested. Finally, we just paid $11 each out of pocket for the month's worth of pills.
I was still unable to add the kids online to the pharmacy and had to call to do it.
I then asked the pediatrician to call in the pills to Walgreens online. They assumed that was the same as Express Scripts and called it in there. I assure you, they are not the same.
I called the pediatrician's office again and convinced them that Walgreens and Express Scripts were not the same. I gave them the fax number for Walmart, and they said they had to look it up themselves. I suggested calling the adult branch of their practice, which I know uses Walmart online. They said they weren't allowed to do this.
A week later, I got a letter from Walgreens saying that our prescription plan would not cover the 1 mg fluoride pills. So they would not fill it.
I called my health insurance. They said the reason they wouldn't cover it was because they only covered 0.5 mg pills but not 1 mg pills. So I needed to call the pediatrician to ask them to write for 0.5 mg pills and they would cover that. And the cost would be $25 for a month, and $60 for a 90-day supply from Walgreens online.
I was like, "WTF? It was $11 to pay out of pocket for the pills! How could it be more expensive if the insurance is paying for it???"
It took me a while to wrap my head around this one. The copay for any med is $25, so I have to pay that no matter what, even if the drug is cheaper than that. Insurance is quite a racket.
Finally, I called Walgreens and asked how much it would be if I paid out of pocket for the 90 day supply. It would be $13 apparently. So I said I'd just pay for the fluoride myself.
To date, I still don't have the fluoride. I don't know what other hurdles I will have to go through to get fluoride. I can't even imagine the hurdles people who are on like ten meds have to go through.
Thank God it's only fluoride. If it were a real med, they'd be dead by now.
Me: "Fluoride pills should just be over the counter."
Mr. McFizz; "No! It's not safe to sell over the counter! It's only safe to dump in the drinking water."
Bureaucracy is alive and well. Kafka would be proud.ReplyDelete
check the cash price at Walmart or grocery store it is cheaper for me to pay cash there than using my insurance and mail order (maintenance meds all generic)ReplyDelete
Have you considered asking your children's dentist to apply sealants to your children's teeth? Meanwhile, is it safe enough for your kids to use a fluoridated toothpaste or mouthwash instead of the oral fluoride?ReplyDelete
We have done the sealant, but they say the kids also need fluoride.Delete
You are way more tenacious than me I'm impressed! Will you be me medical proxy if I ever need one?😊ReplyDelete
And health insurance is supposed to make things easy and affordable. I suppose it benefits the companies that continue to send our collective blood pressures through the roof.ReplyDelete
This is filling me with a certain amount of foreboding. We currently live someplace with fluoride in the water, but we're moving to a house that's on well water. I've been told that we're going to need to give our daughter fluoride pills once we're in that house. It hadn't occurred to me that it would be a complex prescription to get filled.ReplyDelete
We have a well so we buy fluoride water at the grocery store.ReplyDelete
The pediatric dentist was horrified when I refused the fluoride treatment for my daughter. She's had the sealants done, and uses fluoridated toothpaste and bottled water so I saw no need for it (of course it's not covered thru our insurance anyways). Can order a bottle of the fluoride mouthwash thru McKesson easier.ReplyDelete
Pharm. Tech. RDC'06
It's not a complex prescription, it's a series of blockheads at the peds office and the pharmacy. Get one of your colleagues to just write a scrip and pay cash. Less money and less heartburn all aroundReplyDelete
You'll all be happy to know our fluoride finally arrived in the mail yesterday.ReplyDelete
You should see how difficult it is to get any biologic drugs covered. I wait around in agony with my autoimmune issues. The prior auth process is worse than it ever has been before. Even my cheap generic ambien got denied. Despite my doctor trying to do a prior auth (as sonata doesn't work for me and it's all on my formulary) they still deny it. I don't understand because it is also cheap now. It's frustrating as hell not getting the meds your doctor prescribed and takes a whole lot of following up and patience.ReplyDelete