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Will be starting medicare in nov---how can I get brand imitrex not generic, drug plan do not cover?

Responses (2)

balbanese 17 Jul 2012

Simply tell the Dr about this and he'll write "Do not substitute" on the prescription and you'll get the brand name, also just specify to the pharmacy when you drop it off. Hope this helps.

DzooBaby 17 Jul 2012

All due respect Balbanese, this suggestion may not work. With Medicare you usually have a formularies and coverage tiers and they will only cover what is on the formulary no matter what the Dr writes. Why dont you want generic Imitrex? Do you have bad side effects or it doesnt work? You may need to go the route of contacting the company covering your Part D plan and ask for an "exception". Your Dr will need to go to bat for you and write a letter explaining why you need the Brand name over the generic formula. You will pay your highest copay for the drug. Generally they will make an exception once your Dr writes an explaination of why you need brand over generic within 72 hours of receiving notification from your Dr. There may be a quantity limit on the drug as well and if this doesnt work for you, you will need to also ask them to waive the limit and your Dr will need to also write the reason why this is needed. Usually they will only make an exception if preferred alternative drugs (in this case the generic) or any restrictions would not be as effective for treating your condition and/or would cause you to have adverse medical effects.

Lisa01 18 Jul 2012

I've been on both sides of this particular fence. The generic version of immitrex doesn't even come close to helping me the way the immitrex does, so I used to have the dr write do not substitute and I would get the immitrex at the highest co-pay. At $40 a script, it wasn't great, but I'd rather pay that than have the generic that didn't work. Then my insurance decided to no longer honor the DNS order. I had too pay the difference between what amount the insurance would cover for the generic and the actual price of the immitrex, unfortunately putting it out of my budget range. Because I have insurance I don't qualify for help from the manufacturer. But that's just me and my insurance. Some companies still honor the DNS orders, so I'd probably check that option out first.
Lisa

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