Brand Name–Appeal Process. Anyone successfully go through this?

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This topic contains 3 replies, has 2 voices, and was last updated by  Skypark962 1 month ago.

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  • #122536

    Skypark962
    Participant

    I’ve been on Prasco for the last two months and have really fallen behind on my school. I didn’t make the connection that this manufacturer’s version is garbage until I noticed that classes which usually take me 5-6 days to complete, have now taken me over two months. I had my Dr write brand name & my P.A. request was denied. It says all they need is for you to document w/the Dr. how/why the brand name is more tolerable and if your symptoms have been helped…..I just wonder what the success rate with this, actually is. It’s alot of time & effort. I’m basically out $229 for this med this month bc I only have two weeks to wrap up this class and time is precious.

    Let me know if any of you have had to appeal for brand name before.

  • #122628

    gretagrits
    Participant

    If your physicians office will fill out the form , to include all pertinent, DETAILED info and office notes, there should be no problem. You might also be reimbursed for the money you shelled out for this months Rx. There is a valid reason the insurance company requests the information listed on the form. Ultimately it’s to keep insurance premiums down, what the insurance companies don’t understand is that not all generic meds are chemically made the same as the next generic or even the same as the “brand name.” I can really tell the difference from pharmacy to pharmacy with my Adderall. One is awesome at controlling my symptoms, while another only does the job for the first week and then tapers off, until eventually I feel like I might as well have taken a sugar pill. To be honest, I might even discuss this with my physician at my next appointment and take these steps to get the “name brand.” It’s worth a shot. Good luck!!!

    • #122784

      Skypark962
      Participant

      Awesome, thank you. I will also definitely make copies & get a fax confirmation. I can’t believe this happened today, but I accidently grabbed the generic and all the crappy side effects returned! I thought, I better check which bottle I grabbed and BAM, right there was the damn generic, you know they virutally look the same except for what’s written on them. I NEVER in all my years have had ab/intestinal tightness like I do with this Prasco Generic….it’s WORSE than garbage. You’re right the paperwork says they need documents on WHY I’m better with the brand name—it’s the difference between DAY & NIGHT & now that I have a good medication that works, I can actually read what they’re asking for & follow the instructions. THANK GAD.

    • #122785

      Skypark962
      Participant

      Thank goodness my sister paid me back this month so if I need to grab ONE more bottle before I see the appeal process decision…..see this is why most people don’t bother…who can afford $229/mo and wait 30 days to hear a decision. Thank goodness for goodrx $229 buys almost 700 of the generic, but what good is it when your whole life can’t function correctly.

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