Medicare, Medicaid, Life and Health Insurance/Medicaid supplimental insurance
QUESTION: I have Medicaid but they will not cover the medication that I am taking. Is there any way to get some kind of prescription only plan through insurance that is affordable? The medication that I am taking is Opana ER 20mg.2x a day and Opana IR 10mg. 3x per day. They want me to try 5 or six other medications in a row before they will approve this medication. I have already tried all the medications they have recommended but it was awhile ago. What can I do? Please help me???????????????????
ANSWER: You may have to get yourself a Part D plan. Have you tried going to medicare.gov ? You can enter your drugs and dosage and preferred pharmacies and they will give you a list of plans. I went there myself and typed in the closest drugs I could find to yours (the site doesn't list Opana IR, so I put it in as Opana ER) I put in my zip code here in Oregon (you will have to use your own) and the plans range from $45-$125 per month. As for your doctor wanting you to take drugs you don't feel will work, that is something you have to discuss with them. Make sure you tell them what the drugs did or didn't do that they were supposed to do or not do. If that doesn't work, contact your Medicaid representative and ask if they can put you in contact with a doctor who will listen to your concerns.
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QUESTION: It's Medicaid that wants me to try all those other drugs that I have already tried. They want me to go through it all over again. it's not the doctor it is Medicaid wanting me to do all this crap again. And the Opana is oxymorphone.They approved me once for oxycontin and I was taking oxycodone 15mg along with it, but the oxy 15's are hard to come by down here in Florida.So they switched me to Opana. And that works awesome!!!!
It sounds like you're going to have to contact Medicaid and explain to them the situation and get a doctor's approval for skipping the medication steps they want you to go through again. Be persistent as sometimes the rules are unclear to doctors and Medicaid reps alike. In the meantime, check out some Medicare Part D plans just so you're covered.