Re: Compounded prescriptions and insurance

[Guest guest]

Armour is a brand name and is never on the formulary. My Armour costs less than the $80 90-day mailorder copay, but I still get it from my Caremark drug plan for a retail price that no local drugstore can beat. A lot depends on your copay. I get my compounds from Womens International. They are all less than my $40 one month brand name copay. They would be covered, but there is no longer any reason to file. I would not choose a health plan based on just the drug plan unless you take a bunch of expensive stuff. You can get

better prices on Armour by getting your doc to write quantities of 100 or more and shopping for the best prices. (Costco usually wins that one.) More important considerations might include whether or not your docs are in-network. Do you have to have referrals from a primary care doc to see a specialist? Do you have an out-of-network benefit? Amy wrote: Hello, Y'all:Well, I finally got hired on and have until January 24th to pick an insurance plan. I planned on getting Blue Cross/Blue Shield (now called

Regence Blue Shield), but now I'm not so sure. I have been on the phone with these folks, and it don't look good. Armour is "covered," but it's "Non-formulary," so I'd pay more. (Fortunately, it's CHEAP.) Then I asked about compounded prescriptions. This little chickadee on the phone did NOT like me asking that question. She said that it has to be "pre-approved." I asked, "what are the criteria for approval?" She says, "your doctor or pharmacist has to fax over a copy." I said, "That's not what I asked you." Then I get, "well, if you'll just be patient, I'll explain it to you." Seems that it has to be "approved by the FDA," and it has to be covered by Medco, the administrator of the prescription plan. I called Medco. I don't like this. They couldn't tell me ANYTHING. So. . .I've seen comments from some folks who have had their compounded thyroid and other hormones paid for by insurance. Am I wrong?

I've got a list from Women's International Pharmacy to start calling, and have looked at the database here. Any advice would be greatly appreciated, this is becoming so not worth my time!Gracias. Amy __________________________________________________

[Guest guest]

We have Blue Cross/Blue Shield. I submitted receipts for my HC for Women's

International. They have not reimbursed me. They did send me some sort of

explanation but I could not make heads or tails of it. I have not had time

to call them back to see whether it is a covered benefit or not.

Kim in Aubrey

Compounded prescriptions and insurance

Hello, Y'all:

Well, I finally got hired on and have until January 24th to pick an

insurance plan. I planned on getting Blue Cross/Blue Shield (now called

Regence Blue Shield), but now I'm not so sure. I have been on the phone

with these folks, and it don't look good. Armour is " covered, " but it's

" Non-formulary, " so I'd pay more.

(Fortunately, it's CHEAP.)

Then I asked about compounded prescriptions. This little chickadee on the

phone did NOT like me asking that question. She said that it has to be

" pre-approved. " I asked, " what are the criteria for approval? " She says,

" your doctor or pharmacist has to fax over a copy. " I said, " That's not

what I asked you. " Then I get, " well, if you'll just be patient, I'll

explain it to you. " Seems that it has to be " approved by the FDA, " and it

has to be covered by Medco, the administrator of the prescription plan.

I called Medco. I don't like this. They couldn't tell me ANYTHING.

So. . .I've seen comments from some folks who have had their compounded

thyroid and other hormones paid for by insurance. Am I wrong?

I've got a list from Women's International Pharmacy to start calling, and

have looked at the database here. Any advice would be greatly appreciated,

this is becoming so not worth my time!

Gracias.

Amy

[Guest guest]

Amy, I didn't bother sending my prescrips for reimbursement to BCBS. And the

drug reimbursement for us is a different company.?? I think to make it

confusing. They have a different deductable. Don't pay much. But, if like Jan

said your doctor copays and testing are paid for, the meds are a small amount of

this. Don't let the medicine stop you. BCBS has been good for me for EVERYTHING

in network and out of network, except Breast MRIs... that is another current

story and off topic. Just my 2 cents.

-Ruth

Compounded prescriptions and insurance

Hello, Y'all:

Well, I finally got hired on and have until January 24th to pick an

insurance plan. I planned on getting Blue Cross/Blue Shield (now

called Regence Blue Shield), but now I'm not so sure. I have been on

the phone with these folks, and it don't look good. Armour

is " covered, " but it's " Non-formulary, " so I'd pay more.

(Fortunately, it's CHEAP.)

Then I asked about compounded prescriptions. This little chickadee

on the phone did NOT like me asking that question. She said that it

has to be " pre-approved. " I asked, " what are the criteria for

approval? " She says, " your doctor or pharmacist has to fax over a

copy. " I said, " That's not what I asked you. " Then I get, " well, if

you'll just be patient, I'll explain it to you. " Seems that it has

to be " approved by the FDA, " and it has to be covered by Medco, the

administrator of the prescription plan.

I called Medco. I don't like this. They couldn't tell me ANYTHING.

So. . .I've seen comments from some folks who have had their

compounded thyroid and other hormones paid for by insurance. Am I

wrong?

I've got a list from Women's International Pharmacy to start calling,

and have looked at the database here. Any advice would be greatly

appreciated, this is becoming so not worth my time!

Gracias.

Amy

[Guest guest]

I would check with the Pharmacy as to which plans pay them. They would

know. My insurance, which is the TRS Care through Aetna, pays me back

about 40% of the cost of compounded drugs and they are expensive. Our

pharmacy is Caremark.

Marti

<snip>

> So. . .I've seen comments from some folks who have had their

> compounded thyroid and other hormones paid for by insurance. Am I

> wrong?

>

> I've got a list from Women's International Pharmacy to start calling,

> and have looked at the database here. Any advice would be greatly

> appreciated, this is becoming so not worth my time!

Marti Lovejoy

Proud Owner of SING which raised $9595 for YSF Scholarships in 2006

PayPal donations: http: //martilovejoy. 50webs. com/index.html

Score Collector for SING (and the site below)

Life Member, Reg 10, TX, USA - 34 years so far

http: //groups.yahoo . com/group/SweetAdelinesScores

marti59 @ isp.com  <--remove spaces from links and edress

[Guest guest]

Thanks, y'all. No, I don't take any expensive prescriptions, and not knowing how much the rest of it is, I'm clueless. I've got a list from Women's International, and I need to start calling them this week. One doc around here, Dorothy Merritt, is on that list and does do Armour and BioID--question is how much. One of the ladies in another thyroid group who lives in Galveston told me not to go see her for hormones but I can't seem to get in touch with her to ask more questions and for suggestions. (She's also a PhD.) I may call one or two compounding pharmacies here in Clear Lake and ask for a few names, too.

One of my managers had BCBS and went back to one of the HMO's because the paperwork was too much to handle. But from what I understand you can go to any doctor, it's just a matter of in and out of network and all that.

WHEW. . .

I'll let you know what happens. Gracias.

Amy

[Guest guest]

Hi, Marti

Retired educator, eh? I am too; do you take compounded HC and DHEA? If so,

do you send the prescription to Caremark and they pay 40%? I didn't think

they would pay, so I haven't asked for any reimbursement. But even 40%

would help a lot over time.

Helen

Re: Compounded prescriptions and insurance

I would check with the Pharmacy as to which plans pay them. They would

know. My insurance, which is the TRS Care through Aetna, pays me back about

40% of the cost of compounded drugs and they are expensive. Our pharmacy is

Caremark.

Marti

<snip>

> So. . .I've seen comments from some folks who have had their

> compounded thyroid and other hormones paid for by insurance. Am I

> wrong?

>

> I've got a list from Women's International Pharmacy to start calling,

> and have looked at the database here. Any advice would be greatly

> appreciated, this is becoming so not worth my time!

Marti Lovejoy

Proud Owner of SING which raised $9595 for YSF Scholarships in 2006 PayPal

donations: http: //martilovejoy. 50webs. com/index.html Score Collector for

SING (and the site below) Life Member, Reg 10, TX, USA - 34 years so far

http: //groups.yahoo . com/group/SweetAdelinesScores

marti59 @ isp.com  <--remove spaces from links and edress

[Guest guest]

You should not have much paperwork unless you go out of network. The prices for compounds from WI are much lower than those of most local compounders. Amy O'Donnell wrote: Thanks, y'all. No, I don't take any expensive prescriptions, and not knowing how much the rest of it is, I'm clueless. I've got a list from Women's International, and I need to start calling them this week. One doc around here, Dorothy Merritt, is on that list and does do Armour and BioID--question is how much. One of the ladies in another thyroid group who lives in Galveston told me not to go see her

for hormones but I can't seem to get in touch with her to ask more questions and for suggestions. (She's also a PhD.) I may call one or two compounding pharmacies here in Clear Lake and ask for a few names, too. One of my managers had BCBS and went back to one of the HMO's because the paperwork was too much to handle. But from what I understand you can go to any doctor, it's just a matter of in and out of network and all that. WHEW. . . I'll let you know what happens. Gracias. Amy __________________________________________________

[Guest guest]

You bring up a good point. Your drug plan may be different from your insurance. Also, your employer's particular plan may be different from others using the same drug service. Another question worth asking the doc is about billing for labs. If the labs are billed through your doc's office, they may be covered under the copay for the office visit. If they are billed directly by the lab, they may be subject to deductibles and co-insurance. I ran into this with my new primary care doc. I see Dr. Berg for just the copay, but then I end up paying for any labs he runs, because they are billed by Quest. I had to ask myself if it was worth paying several hundred

dollars a year extra to see him. The answer was yes. But in the meantime, I have gotten another one of my docs with better billing policies to order most of my labs. I am just three years away from Medicare. . . . when all of the rules change. . . . . Ruth wrote: Amy, I didn't bother sending my prescrips for reimbursement to BCBS. And the drug reimbursement for us is a different company.?? I think to make it confusing. They have a different deductable. Don't pay much. But, if like Jan said your doctor copays and testing are paid for, the meds are a small amount of this. Don't let the medicine stop you. BCBS has been good for me for EVERYTHING in network and out of network, except Breast MRIs... that is another current story and off topic. Just my 2

cents.-Ruth Compounded prescriptions and insuranceHello, Y'all:Well, I finally got hired on and have until January 24th to pick an insurance plan. I planned on getting Blue Cross/Blue Shield (now called Regence Blue Shield), but now I'm not so sure. I have been on the phone with these folks, and it don't look good. Armour is "covered," but it's "Non-formulary," so I'd pay more. (Fortunately, it's CHEAP.) Then I asked about compounded prescriptions. This little chickadee on the phone did NOT like me asking that question. She said that it has to be "pre-approved." I asked, "what are the criteria for approval?" She says, "your doctor or pharmacist has to fax over a copy." I said, "That's not what I asked you." Then I

get, "well, if you'll just be patient, I'll explain it to you." Seems that it has to be "approved by the FDA," and it has to be covered by Medco, the administrator of the prescription plan. I called Medco. I don't like this. They couldn't tell me ANYTHING. So. . .I've seen comments from some folks who have had their compounded thyroid and other hormones paid for by insurance. Am I wrong? I've got a list from Women's International Pharmacy to start calling, and have looked at the database here. Any advice would be greatly appreciated, this is becoming so not worth my time!Gracias. Amy __________________________________________________

[Guest guest]

Amy,

I have only one compounded prescription from WI, DHEA, and it's only around $22.00 a month and that's including shipping. Price would vary according to dosage, of course.

If you can't reach a Doc just to ask questions that would not be a good sign to me.

Carol

>> Hello, Y'all:> > Well, I finally got hired on and have until January 24th to pick an > insurance plan. I planned on getting Blue Cross/Blue Shield (now > called Regence Blue Shield), but now I'm not so sure. I have been on > the phone with these folks, and it don't look good. Armour > is "covered," but it's "Non-formulary," so I'd pay more. > (Fortunately, it's CHEAP.) > > Then I asked about compounded prescriptions. This little chickadee > on the phone did NOT like me asking that question. She said that it > has to be "pre-approved." I asked, "what are the criteria for > approval?" She says, "your doctor or pharmacist has to fax over a > copy." I said, "That's not what I asked you." Then I get, "well, if > you'll just be patient, I'll explain it to you." Seems that it has > to be "approved by the FDA," and it has to be covered by Medco, the > administrator of the prescription plan. > > I called Medco. I don't like this. They couldn't tell me ANYTHING. > > So. . .I've seen comments from some folks who have had their > compounded thyroid and other hormones paid for by insurance. Am I > wrong? > > I've got a list from Women's International Pharmacy to start calling, > and have looked at the database here. Any advice would be greatly > appreciated, this is becoming so not worth my time!> > Gracias. > > Amy>

[Guest guest]

I have never had any paperwork with BCBS until very recently when Dr R. stopped billing my insurance for me. All that is involved now is mailing in the bill to BCBS.

I do receive EOBs (how much they are paying) from BCBS but that has been it. One questionnaire regarding my daughter's accident...they were just trying to find out if there was any other insurance involved.

Maybe others have had other experience with more paperwork?

Kim

From: Texas_Thyroid_Groups [mailto:Texas_Thyroid_Groups ] On Behalf Of Amy O'DonnellSent: Wednesday, January 03, 2007 8:35 AMTo: Texas_Thyroid_Groups Subject: Re: Compounded prescriptions and insurance

Thanks, y'all. No, I don't take any expensive prescriptions, and not knowing how much the rest of it is, I'm clueless. I've got a list from Women's International, and I need to start calling them this week. One doc around here, Dorothy Merritt, is on that list and does do Armour and BioID--question is how much. One of the ladies in another thyroid group who lives in Galveston told me not to go see her for hormones but I can't seem to get in touch with her to ask more questions and for suggestions. (She's also a PhD.) I may call one or two compounding pharmacies here in Clear Lake and ask for a few names, too.

One of my managers had BCBS and went back to one of the HMO's because the paperwork was too much to handle. But from what I understand you can go to any doctor, it's just a matter of in and out of network and all that.

WHEW. . .

I'll let you know what happens. Gracias.

Amy

[Guest guest]

Carol:

I haven't called any docs yet, but I'm trying to get one in Texas City

and ask a few questions. A friend of mine recommended her, but someone

else said she wasn't that great. I'll call them this week and next.

I don't want to wait too long, or they'll give me the HMO where they

give you X amount of health care and anything else is on your own.

If you know of anything I should ask. . .speak now, please!

I take it y'all like WInP? I got my friend in Mesa to request a

packet from them, so she will be going to one soon. I've been telling

her this for a year.

You'd be surprised how many people think we have naturopaths in Texas.

Amy

>

>

> Amy,

>

> I have only one compounded prescription from WI, DHEA, and it's only

> around $22.00 a month and that's including shipping. Price would

vary according to dosage, of course.

>

> If you can't reach a Doc just to ask questions that would not be a

good sign to me.

>

> Carol

>

[Guest guest]

Amy,

The very word, HMO, makes me nervous.

I couldn't even think straight, form questions, etc., that's

why I went to The Doc.

Yes, I do like WI. I was a little worried at first, far

away and we are procrastinators about getting refills. They

have an auto-refill option, one less thing to worry about.

I don't even know what a 'naturopath' is...sounds like a

nature trail.

Carol

Re: Compounded prescriptions

and insurance

> Carol:

>

> I haven't called any docs yet, but I'm trying to get one

in Texas City

> and ask a few questions. A friend of mine recommended her,

but someone

> else said she wasn't that great. I'll call them this week

and next.

> I don't want to wait too long, or they'll give me the HMO

where they

> give you X amount of health care and anything else is on

your own.

>

> If you know of anything I should ask. . .speak now,

please!

>

> I take it y'all like WInP? I got my friend in Mesa to

request a

> packet from them, so she will be going to one soon. I've

been telling

> her this for a year.

>

> You'd be surprised how many people think we have

naturopaths in Texas.

>

> Amy

>

>

> >

> >

> > Amy,

> >

> > I have only one compounded prescription from WI, DHEA,

and it's only

> > around $22.00 a month and that's including shipping.

Price would

> vary according to dosage, of course.

> >

> > If you can't reach a Doc just to ask questions that

would not be a

> good sign to me.

> >

> > Carol

> >

>

>

>

>

>

[Guest guest]

Oh well guess what, they're going to change it all when you're on Medicare too because they just changed my Mom's plan starting January 1st! They do what they WANT to do to make their nest flufflier. She was on Cierra Rx, but now the government has decided that she's now going to be on Cigna, lol. They change it the way they want to change to suit their own nest. Who even knows whether this is a better plan or not. It all is making me dizzy, and frankly, I think that IS the intention, so that you won't know which is up or down.

Re: Compounded prescriptions and insurance

You bring up a good point. Your drug plan may be different from your insurance. Also, your employer's particular plan may be different from others using the same drug service.

Another question worth asking the doc is about billing for labs. If the labs are billed through your doc's office, they may be covered under the copay for the office visit. If they are billed directly by the lab, they may be subject to deductibles and co-insurance.

I ran into this with my new primary care doc. I see Dr. Berg for just the copay, but then I end up paying for any labs he runs, because they are billed by Quest. I had to ask myself if it was worth paying several hundred dollars a year extra to see him. The answer was yes. But in the meantime, I have gotten another one of my docs with better billing policies to order most of my labs. I am just three years away from Medicare. . . . when all of the rules change. . . . .

[Guest guest]

My husband is the retiree in Texas. I taught in Missouri way back in

the late 60's/early 70's.

I'm on Cortef, not compounded HC. I get my DHEA from iHerb.com, but

the compounded Rx's I was mentioning are for the sex hormones -

estrogen, testosterone, progesterone.

Marti

> Hi, Marti

>

> Retired educator, eh? I am too; do you take compounded HC and DHEA?

> If so,

> do you send the prescription to Caremark and they pay 40%? I didn't

> think

> they would pay, so I haven't asked for any reimbursement. But even 40%

> would help a lot over time.

>

> Helen

>

> Re: Compounded prescriptions and

> insurance

>

> I would check with the Pharmacy as to which plans pay them. They would

> know. My insurance, which is the TRS Care through Aetna, pays me back

> about

> 40% of the cost of compounded drugs and they are expensive. Our

> pharmacy is

> Caremark.

>

> Marti

>

>

> <snip>

>> So. . .I've seen comments from some folks who have had their

>> compounded thyroid and other hormones paid for by insurance. Am I

>> wrong?

>>

>> I've got a list from Women's International Pharmacy to start calling,

>> and have looked at the database here. Any advice would be greatly

>> appreciated, this is becoming so not worth my time!

>

>

> Marti Lovejoy

> Proud Owner of SING which raised $9595 for YSF Scholarships in 2006

> PayPal

> donations: http: //martilovejoy. 50webs. com/index.html Score

> Collector for

> SING (and the site below) Life Member, Reg 10, TX, USA - 34 years so

> far

> http: //groups.yahoo . com/group/SweetAdelinesScores

> marti59 @ isp.com  <--remove spaces from links and edress

>

>

>

>

>