Drugs covered or not covered by insurances are so confusing. We have mostly medicaid patients and even though they're spread out over 5 managed care plans; thankfully, they all have to use the "texas medicaid formulary," which is published on the web. But some drugs are covered for only the brand name, and we have to hand write "brand medically necessary" on the script. Some generic drugs are covered but it's a store generic version, so you can only get it at Walgreens. If we send it to CVS they just fax back asing for PA. (But the formulary doesn't specify the store name of course, just different NDC numbers.)
One time an Rx for a private insurance pt was rejected for not preferred. I had no idea how to look up an equivalent that would be covered. The doctor just picked another one and hoped that one is preferred.
So for those of you that see more insurance patients, how do know which drug is covered? Do the major insurance companies all use the same formulary? Do you accept requests to change drugs because it's not preferred?
We're still on V6.3.3 because of the vaccine coding issue, but I see that in "manage via NewCrops" window from the write scripts window, it seems there is a way to check formulary. Has anyone used this? When I search for a drug in this window, drug may say "preferred 1", "preferred 2", "on formulary" but there is no glossary that explains these terms.
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