Getting MA to cover meds?

[DancingLight]

Hello all!

I am feeling completely overwhelmed and lost as to where to go to try to get meds covered by PA Medical Assistance.

I am not elligible for Medicare.

Are any of the rest of you on Medicaid and having problems getting your meds covered?

I take several meds and NONE are covered under the new formulary.

They all need pre-approval.

So far, they have approved DDAVP (probably b/c there is no substitute?) and Singulair.

Otherwise I am out of luck on Ambien, Allegra, Detrol, and Corgard.

My mom has made many calls to MA, our local assistance office, etc. and I have been fighting with the doc for weeks about this.

I have already, without success, tried the generic Corgard, the 'substitutes' for Ambien, and the 'substitute' for Allegra. For Detrol, you must FAIL at SIX other drugs FIRST before you can get Detrol.

I don't know what to do...I am terrified.

As many of you know my health is more than precarious at this point. The littlest changes in meds can tip me over the edge. I am overwhelmed at the thought of re-trying all of these meds to 'proove' to MA that I need the ones that I am on.

I can't even count all of the meds I have tried in the past seven and a half years.

I can't get good answers from the doc office, they claim they cannot get through, but when they do they don't seem to have the right documentation for WHY I need the meds I need.

Any tips on navigating the system? And getting the doctor's office to DO THEIR JOB without making them so angry they treat your horrible!?

I am getting ready to start high dose antibiotics for Lyme disease and it is way too much for my body to be changing the maintenance drugs at the same time.

Any tips would be much appreciated...

Thanks,

Emily

P.S. Have any of you ordered drugs from Canada and can you recommend a reputable pharmacy/service to use?????

[Poohbear]

I know you don't want to spend your precious energy this way but honestly one of your best options right now is to CALL your local congressman AND your state senators.

Explain the urgency to them and get as many people as you know to contact their representatives about this.

I know how scary it is....I currently have no coverage either. I don't have any great words of comfort except to say to you and everyone else that we need to stand up in this country and make our leaders do whatever is necessary to fix our health care crisis. It should be illegal to make people choose between their life and their grocery bills!!!!!

[dizzygirl]

Oh em... I can totally relate to what you are saying...I have medicaid and medicare.. and I must say that with all the changes going that I am thuroughly confused!!..

I live in PA to.. so I know the struggles that you are ahving..

inregard to medicaid..did they automatically switch you to a medicaid plan?? I know that they automatically switched me to Amerihealth advantage.. and I am ahving great trouble with them noth covering meds..

and to top it off I am also fighting w/ Mdicare HMO medical plan.. OMG what a night mare!! I have yet ben able to get a real live person on the phone to talk to about meds!! I call the pharmacy line.. and they trnasfer me to another line.. where I am on hold for an hour then get disconnected!! AAAAAAAARRRRRRRRRRRRRRGGGGGGGGGGGGG!!

I'm so sorry em.. I have yet to figure out the manuvering of the new medical coverage system and how to get my med covered yet either.. I am stressing about how I am going to pay for my meds here real soon!

if I figure any pointers I will be sure to let you know..sorry i cant be of more help..just wanted you to know that you arent alone in this battle..

[morgan617]

Emily, I know how frustrating this is, but sometimes the doctor's hands are tied. In order to get pre approval for you for brand only, especially on medicaid, they have to prove you have tried the generics and they don't work.

If you have taken the generics and don't tolerate them, or whatever, then there shouldn't be this much trouble. They just send the documentation that you tried the generic and it was unsuccessful.

I guess in paradise this would be simpler, and I am so sorry you are having to go through this, because I know how sick you've been.

Someone is dropping the ball somewhere. We get a drug for Jacob from Canada, but I believe a law was passed so that now the only time you can do it legally is if the drug is not available here. I'm not positive about this. This is the last thing you need I know and my heart is breaking for you...morgan