Is there anything that can be done to get part D drug company to cover a pain medication they just dropped from their list?

Part D AARP Rx drug plan just discontinued covering my sister's pain med which is critical in keeping her out of pain. No notification but found out when she tried to refill it. Cost is $800-$1800 which they cannot pay. She has been working with a pain management dr. for over a year who closely monitors her. This is the only drug that covers her pain. Can the pain management dr. provide something to get them to cover it? Going to see if another plan will cover it but wondering if anything can be done with the current drug company.

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The doctor needs to call the pharmacist at the plan to appeal the denial.

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Drug companies usually only provide their formularies once a year. But changes can be made at any time. I have not had much luck in having my doctor appeal denials, but it's worth a try. You never know when it will work.

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5 OPTIONS FOR DRUGS NOT COVERED BY MEDICARE

https://dailycaring.com/5-steps-to-take-when-medications-are-not-covered-by-medicare/

Here is another link that was embedded in the above article.

Seniors can get help paying for prescription drugs

https://dailycaring.com/seniors-can-get-help-paying-for-prescription-drugs/

Lastly, maybe look at GoodRX.

https://www.goodrx.com/medicare?utm_campaign=11601593411&utm_content=114733543362&utm_source=google&utm_medium=cpc&utm_term=kwd-364991598140&gclid=Cj0KCQjwr4eYBhDrARIsANPywCjYKT7CRj9gePAMyahyMThEenkxaxMoILhPs6wksD69-hQ-T60B62caAnw3EALw_wcB&gclsrc=aw.ds

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Yes, get the doctor involved.

My nephew is on Medicaid. He too had a Med that the prescription company Medicaid used said was not covered anymore. This is the only med that worked for him. In talking to Office of Aging we were told that medication is on a tier. The tier he was receiving no longer allowed that med. At the time to go up a tier it was an extra $5 a month. He eventually weened off the meds but by the time he did, it was $16 a month xtra for that tier.

Ask the company if they dropped the med altogether or are there tiers. The xtra cost to go up a tier would still be cheaper than the cost of the med.

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In the meantime--perhaps the dr has samples in his office with which he can tide sister over. It's a long shot, most docs don't keep the 'good stuff' in the office-too much chance for pilferage and abuse by staff (sad, I know, but it happens).

The dr will have to appeal this. It may take some time, but you can be sister's advocate and help her out.

Good Luck. Chronic pain can just wear you out.

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Looks like in my State doctors are not allowed to give out samples.
"Physicians and staff may not accept pharmaceutical samples for their own personal use or for distribution to patients or family members. Distributing sample drugs would place physicians in a drug dispensing role, subject to applicable laws and regulations.”"

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I saw long shots reply. I have always been under the impression that Medicare does not pay for drugs that's why we have a part D that we pay for. My part D is provided by my husbands employer. My Moms drug plan was PADD which was a State plan for low income.

The only plans I know who handle Medicare and prescriptions is a Medicare Advantage plan.

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That sucks. She nay have to order online at inhousepharmacy.ca if they have it. When my cat had asthma we had to buy the flovent there because in the USA it was over $200 and online it was like $30.

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Is there anything that can be done to get part D drug company to cover a pain medication they just dropped from their list?

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