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JOE, Absolutely do NOT PUT UP WITH IT!! I suggest you take the following course of action: #1 Contact your neurologist. Tell him about your problem ask him if you can have some samples to hold you. If you can't get them buy a small quantity to keep you going. Ask him to call Blue Cross and to put in writing that it his medical judgment that Requip has properties which make it unique from the other agonists and it is his medical opinion that nothing else will substitute for it. Ask him to send a copy of the letter to you and to if possible FEDEX the original addressed to the Medical Director of your Blue Cross program, #2 iN THE MEANTIME call them again and ask to speak to someone in the office of the medical director or someone in pharmacy services and ask them and give them a chance to reverse who you talked to.(Since it may be approved but hasn't reached the level where the customer service people have knowledge of it) If denied put in writing what they had told you. Get the name of who you are talking to and try to get down in writing their response verbatim or as close to it as possible. Tell them that you need the information because you think that their decision is arbitrary and not based on current medical thinking and you are thinking of filing suit. #3 PLAY HARDBALL!! If you have an attorney contact him and as important copy all letters you write to him. Also send copies to AARP, your MD and the State Insurance Commissioner (and to me if you'd like) Send a letter FEDEX to Blue Cross telling them that they are contractually obligated to provide medically necessary treatment and if they fail to provide the Requip that you will treat it as a breach of contract. #4 Remember YOU ARE IN THE RIGHT. Don't let them intimidate you. You can call me if you want at 608-833-9336. And if you have an attorney get advice from one. I speak from experience in dealing with insurance companies both as a patient and as a physician. In one case after months of run-around I got my local Blue Cross to deliver me (as a patient) a check for over $1000 they owed me by special messenger rather than run the risk of passing a deadline that I had given them. #5 Continue your Requip and if possible pay out of your own pocket and save the receipts. Otherwise get samples from your doctor. Managed care has its positive points, but this is clearly either a bureaucratic error or flagrant insurance malpractice in my opinion. GO GET'M JOE CHARLIE Joe Young wrote: > > When I arrived home last night, I found a message from my friendly, > neighborhood, pharmacy. Blue Cross/Blue Shield of W. Pa., would no longer pay > for Requip. > Bright and early this morning, I called to straighten them out. Well, it's not > in their new 'formulary', their Bible, which tells them which prescriptions are > covered. > Called my local Blue Cross. She checked, not on the list, not covered. I > should go back to Neuro and have him prescribe a similar drug that was on their > list. Explained that it was newly FDA approved and that if there were a similar > drug, they wouldn't have had to invent a new one. Then go file a grievance. > Called Jim Cordy (who has been a great help to me in the past). Jim hadn't > heard about Blue Cross not paying for Requip. Suggested I call Smithkline > Beecham to see if they were aware their product was not being covered by at > least one major insurer. Couldn't find their number. > And here I sit, two months into the program(I'm at 4mg per day), experiencing > some pluses, (more alert, sleeping better), enough Requip for one more day, next > Neuro appointment Feb 25th and boiling mad. Another case of business > administrators second guessing the doctor. Sure. I can (and will) go lay out > the dough ($90.00 for 110 pills I think), but what really scalds me is that for > the past 45 years I have paid into their coffers. Now, when I could use there > help, my needs are not in their'formulary'. Any suggestions? > > Joe Young (66/6) > [log in to unmask] -- CHARLES T. MEYER, M.D. Middleton, WI [log in to unmask]