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Medicaid new procedure for filling pain medication

Aug 29, 2017 12:16 PM

I had a gynecologist appt today for pre-op for a procedure that's getting done Friday. Also we had to go over my blood work which was that my thyroid level was a little high and my prolactin levels were high. Which he ordered an MRI on my head to see why it's high. I'm freaking out cause I looked up some info about it and it said I could have a tumor on my pituitary gland. Also he called in 5 prescriptions for Friday procedure. Well I went to get them filled and now Medicaid has a new procedure that any pain meds over 14days worth needs prior approval. So I had to get 14 days worth filled and then when 14 days is up I get the other 14 days and have to forfeit 2 days worth. Now Medicaid is making hard to get the pain meds filled at the pharmacy. Because they take their time to do prior approval. It's just stupid.

Aug 29, 2017 12:27 PM

Good Luck at your appointment. I had my thyroid a little high a few times. All they did was do the cam thing . They never did an MRI on my head. 🤔 It turned out to be nothing I guess . Anyways Good Luck. Please keep us updated 🤗🤗

Aug 29, 2017 12:36 PM

@Westrengirl, no the MRI on my head that I have to get done is because my prolactin levels are high which is a hormone that makes your breast leak milk which I'm not having. But in order to see why it is high that's why I have to have the MRI. I looked up some info on it and it said I could have a tumor on my pituitary gland. Which I'm staying positive and rebuking that diagnose away from me.

Aug 29, 2017 2:34 PM

I hope your scan is normal. Sending positive energy.

Not sure what state you are in but it’s been like that with Medicaid for a while here anyway. Everything needs prior auth. I also found out the hard way Medicaid will not fill or pay for prescriptions from a non Medicaid doctor. Are you in an HMO or straight Medicaid?

Aug 29, 2017 8:29 PM

@LAT I'm in North Carolina and they just started this new pre-authorization this past Sunday. It's if you are prescribed more than 14days worth of a narcotic med then you need pre-authorization. So the pharmacy told me they can give me the 14 days worth and I can come back for the other 14 days after 14 days has passed. But then I forfeit 2 days worth. But they will still do my preauthorization. It's crazy. Oh and I'm straight Medicaid. We don't have certain doctors that we can go to. As long as a doctor accept Medicaid then you can go anywhere you want to.

Aug 30, 2017 8:02 AM

I’m glad you’re not stuck in hmo. In WI, I’m required to be in hmo. HMO doesn’t cover much. I just found out I can get an exemption when I need to see non hmo covered dentist and non covered occipital nerve blocks. I’m very grateful for the exemption I was never told I could receive. That just means more phone calls and paperwork for me. But at least I can get things covered without worrying now. I’m sorry you have to go through all that. All of these regulations can be stressful. I hope you can get by with the meds you have. 🤗

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