Hello here is what happen my doctor recently changed my script for inject-able  estradiol.  OK no problem there I try to fill at Walgreens Ok back ordered I expected  that so I called around a few  smaller pharmacies bingo they have some available I do have insurance through my job with Anthem so I give  them my info they call me back  about a hour later, "we can't fill  your script due to reimbursement your insurance is going to pay  out too low for the drug" and suggested I pay like 270 dollars for this stuff.  I know what they did is not legal and they agreed to whatever reimbursement rates and that  really is not my problem.  I am wondering who I should complain to for this.  There ain't  no way I am paying for 270 dollars for a medicine when I have insurance.  I another pharmacy in my area after  this Sams Club they said they have availability for the medication so for now I am not going to trip, unless they start trying to cheat me  to....If they deny me for that reason I may contact someone....

Never had that issue, and that sounds like a load bs!!!! I hope I don't encounter this.

You need to check the Drug formulary for your plan. It's possible what they have in stock isn't covered by you plan and if so, it's their decision if they will make a substitution for what the doctor prescribed. Nobody does it but if you have your formulary in hand when the doctor writes the prescription, the doctor would be able to write the prescription for a drug that is covered.

The drug is covered it is generic estradiol valerate injection...they just said what the insurance is paying is "too low"....on one hand I am like  "at  least they were honest"...but like I said that ain't my problem you agreed to those rates behind the scenes. So why make that my problem...

Walgreens is one of the more expensive places to deal with so if Sam's Club doesn't work, go to Good RX and price shop there. My estradiol tablets were about a quarter the price at Walmart and they are so cheap I don't bother with insurance.

Also try CVS. They were half the price for me of good RX. $10 for a 5ml bottle of 20mg/ml estradiol valerate. I have Caremark insurance.

Funny thing about drug prices and insurance. My doctor prescribed me Viagra, but said she would have the pharmacy call me. They did, if I got the Viagra through my insurance  it wouldn't be covered and would cost $190 for five tablets....or I could just buy them out of pocket at $60 for five tablets.

Some people have good insurance, some want to pay towards their deductible.

Hugs, Devlyn

I am a Pharmacist and I have refused to fill prescriptions. If the prescription is NOT for a legitimate medical purpose, I have an ethical obligation to NOT fill that prescription. This is mainly used for people who misuse certain controlled drugs such as Oxycontin and Xanax.

What you have run into is one of the numerous quirks of health insurance in the US. Every insurance company has contracts with drug store chains such as CVS or Walgreens. Small independent drug stores are at a disadvantage in negotiating favorable contracts. The end result is that prices vary from store to store and whether your prescription is generic or brand name.

I know that my insurance covers pills, but won't cover me for injections for some reason.

You must ask your pharmacist if your medication is cheaper if you pay cash than use your insurance. It often is. This is part of the deal with the devil that Insurance Companies make with big pharma and you're their patsy. They aaren't required to tell you unless you ask. So do yourself a favor and always ask your pharmacist. They want to tell you! This also applies to tests that your Dr. issues for Estrogen and Testosterone and CBC. Always ask! My testing is three times as expensive as a deductible than if I simply pay cash for the same tests. Our medical system is broken. Make no mistake. It's your job to take control. Caveat Emptor applies here more than you can imagine. Contentious relationships abound with your medical professionals.

I wasn't denied but I had a really odd experience at my first fill of my HRT.  I was in male mode, so I expected some confusion.  When I came to pick up the prescription, the pharmacist had me go over to the consultation window.  I expect to hear something about sterility or breast growth or something - you know side effects someone conceivably might be concerned about.  But when I went over there, and this pharmacist just said, "You know this is estrogen, right?"

I said, "yep"

She repeated her self, "You know this is estrogen?"

I said "yep" again.

She then said it a third time.  I told her "yep" again, she went "ok" and then rung up the pills and gave them to me.

She didn't say anything else.  It's by far the weirdest experience I've ever had at a pharmacy, and my first taste that sometimes as uncomfortable as I am, the other person is even more awkwardly uncomfortable!

But I did get my pills!

Yes the pharmacy a few blocks down from me basically lied and told me that I didn't have spiro on my medication list. Even after I protested by mentioning my other pharmacy does have it the woman told me "we see all the medications you have and it's not on here for you". You know when you hear dishonesty in a person's voice? That's how I felt she was talking to me and also it felt belittling.

I called my original pharmacy and thankfully they do have my refill. It was a relief. I have to commute 30 mins each way to get there but it's worth it.

Sent from my SM-G930T using Tapatalk