CVS Caremark denies (TRT) prescription

[Splash]

Splash - I would also be inclined to contact the administrator of benefits that manages your state health care plan to let them know that the pharmacy is not following the direction of the physician's orders.

It’s funny you mentioned that because my wife deals with medical billing and were in the process of appeal. We will definitely be contacting the human resource department to file a complaint as our next step.
We pay top premium for our (PPO) insurance just to prevent all the referral headaches and being told what we can do and who treats us. Now, they’re getting away with forbidding medications that keep us all healthy… unbelievable!!!

 

[Splash]

Every year my doc has to submit info to the insurance company for renewal, even with the same insurance. Have your doc resubmit the info.

Unfortunately they did without succes.

 

[xqfq]

Can you clarify that this is due to the insurance company not wanting to cover the medication at the pharmacy and not the pharmacist denying a fill of the prescription?

I have never heard of a pharmacist making a decision that someone's testosterone levels were not low enough for a prescription and then refusing to fill a prescription on that basis. I suppose anything is possible - pharmacists have autonomy, etc.

 

[fof99]

I just paid $55 for a 90 day supply of Test Cyp from APS Pharmacy (mail order). Forget your insurance!

Do you know of any tele-health providers that can write a script?

 

[fof99]

Could you share where you obtained prescription?

Would also like to know where you can get a script?

 

[jobshopper]

Do you know of any tele-health providers that can write a script?

I don't think that a telemedicine provider can write you a script out of state. I asked a provider out of Florida about that and they said they could not. They said I would have to buy it from their pharmacy and have it mailed to me. I can get it here through GoodRx for about 40 bucks for a 10 week supply.

 

[fof99]

I don't think that a telemedicine provider can write you a script out of state. I asked a provider out of Florida about that and they said they could not. They said I would have to buy it from their pharmacy and have it mailed to me. I can get it here through GoodRx for about 40 bucks for a 10 week supply.

That's a great deal. You got the script through your primary?

 

[jobshopper]

That's a great deal. You got the script through your primary?

Yes. It took awhile to find a doctor to take over the management of my TRT after my other PCP retired but they are out there. My new PCP is a D.O. but there are a number of naturopaths who will write scripts for TRT from my understanding.

 

[Nelson Vergel]

Your options are:

1. Private clinic funded by yourself

2. Get your own testosterone from the black market

3. Game the system to your advantage. Stop all treatment. At some point all exogenous testosterone will be out of your system, and your HPTA would not yet be restarted. Around 4 weeks after your last injection. You should get a very low reading at this point. Do another test a few days later, and submit these. I have heard pulling an all nighter before the test will lower levels even more, as will be doing the test in the late afternoon.

4th option: Have your doctor fax the script to EmpowerPharmacy.com and pay cash (injectable T is very affordable)

 

[Deleted member 43589]

Good Evening,

I have been a (TRT) patient stemming from low testosterone since 2016. After bloodwork confirmed my levels, I was referred to and treated successfully by a urologist ever since.

For the last year, I have had my mail order prescriptions of testosterone cypionate filled through CVS Caremark without issue. I recently submitted a refill prescription and was personally contacted by my urologist informing me that CVC Caremark is now requesting my (2) lowest testosterone levels since treatment began in 2016. Due to my lowest levels only coming in at (400-430), CVS Caremark is now denying my prescription because the levels never fell below the “New“ standard of (264-916). When I began (TRT) testosterone standards were (348-1197).

It makes me furious that for the last (5) year’s I’ve followed all protocols, stabilized my testosterone level, and have never felt better ultimately to be destroyed over insurance/government “BS”. If anyone on this forum is personally dealing with these denials, please let me know how I should proceed forward with appealing the denial.

What amazes me is how a pharmacy review board can over ride a doctor's medical opinion. Seems they believe we don't even need to have a doctor involved, just let Caremark make all of our decisions.

Anyway, in January my doctor wrote me a script. My t levels were at at 321 (long story). Caremark refused the prescription but I had already paid cash using Good RX. Still slightly cheaper than I can get it blackmarket so I had no issue with that. Two weeks letter I got a call from Caremark saying they has reviewed my case and decided to honor my prescription. I got a follow up letter from them showing this agreement was good for a year. OK, so next time I pay $14!

For 42 years I have paid cash for testosterone and never had a problem with it. I have paid up to $100 for a 10ml vial and in the last few years $45. I don't really care what they agree to pay for because I am going to get it one way or another. Same with other medication, either pay for it or I will get is cheaper from either China or India. I am not for this socialized managed medicine at all and I prefer the doctor of my choice to make these decisions not some bunch of idiots sitting on a review board of CVS. Going to the pharmacy which is a 1/2 mile from my house is convenient but I am not going to let CVS tell me or my doctor what I really need or don't need. That is my decision, not theirs.

Splash, I am a retired State employee too and understand your issues.

 

[Seth]

Since when does a pharmacy decide if you need something. There job is to fill the script. Tell them to go fk them selves and take your business elsewhere.Also test is not that expensive. Just cash pay if your have issues. Three years and my hospital pharmacy has never questioned my dose or asked for labs

My thoughts exactly. The pharmacies role is to fill the prescription, not second guess the physician prescribing it. Saw the same thing with prescriptions for Ivermectin over the last couple of years. I would change pharmacies.

 

[barry1]

It’s funny you mentioned that because my wife deals with medical billing and were in the process of appeal. We will definitely be contacting the human resource department to file a complaint as our next step.
We pay top premium for our (PPO) insurance just to prevent all the referral headaches and being told what we can do and who treats us. Now, they’re getting away with forbidding medications that keep us all healthy… unbelievable!!!

Skip insurance. Use goodrx. Even cheaper sometimes.

 

[VacationMan]

I don't think that a telemedicine provider can write you a script out of state. I asked a provider out of Florida about that and they said they could not. They said I would have to buy it from their pharmacy and have it mailed to me. I can get it here through GoodRx for about 40 bucks for a 10 week supply.

I can tell you first hand that my physician at Defy has written prescriptions for me while I was in Texas. Then again, it wasn't for a controlled substance...so the rules may be different for controlled substances.

 

[Deleted member 43589]

Skip insurance. Use goodrx. Even cheaper sometimes.

right now 10ml vial of testosterone cypionate is on sale for $39.69 at Costco and Walgreen with a Good RX coupon.

 

[VacationMan]

Something to be said about GoodRx. My PCP prescribed me 5 mg daily Cialis. I take 4 of them when "needed", not every day. Get more that way. I go to fill the prescription with my insurance. Insurance says they need "authorization" and the co-pay is in excess of $90 even for the generic. I pull out a GoodRx coupon. $14.50 for a 90-day supply right then and right there - no "authorization" or insurance required.

Go figure...

 

[jobshopper]

I can tell you first hand that my physician at Defy has written prescriptions for me while I was in Texas. Then again, it wasn't for a controlled substance...so the rules may be different for controlled substances.

They are... of course.

 

[Splash]

What amazes me is how a pharmacy review board can over ride a doctor's medical opinion. Seems they believe we don't even need to have a doctor involved, just let Caremark make all of our decisions.

Anyway, in January my doctor wrote me a script. My t levels were at at 321 (long story). Caremark refused the prescription but I had already paid cash using Good RX. Still slightly cheaper than I can get it blackmarket so I had no issue with that. Two weeks letter I got a call from Caremark saying they has reviewed my case and decided to honor my prescription. I got a follow up letter from them showing this agreement was good for a year. OK, so next time I pay $14!

For 42 years I have paid cash for testosterone and never had a problem with it. I have paid up to $100 for a 10ml vial and in the last few years $45. I don't really care what they agree to pay for because I am going to get it one way or another. Same with other medication, either pay for it or I will get is cheaper from either China or India. I am not for this socialized managed medicine at all and I prefer the doctor of my choice to make these decisions not some bunch of idiots sitting on a review board of CVS. Going to the pharmacy which is a 1/2 mile from my house is convenient but I am not going to let CVS tell me or my doctor what I really need or don't need. That is my decision, not theirs.

Splash, I am a retired State employee too and understand your issues.

Ya gotta love it!
All those years we’ve paid top premiums for our medical coverage and now when we need to use it, they deny us. They make me sick!!!

 

[Splash]

My thoughts exactly. The pharmacies role is to fill the prescription, not second guess the physician prescribing it. Saw the same thing with prescriptions for Ivermectin over the last couple of years. I would change pharmacies.

I actually changed over to Walgreens and now use GoodRX without issue.

 

[Seth]

Something to be said about GoodRx. My PCP prescribed me 5 mg daily Cialis. I take 4 of them when "needed", not every day. Get more that way. I go to fill the prescription with my insurance. Insurance says they need "authorization" and the co-pay is in excess of $90 even for the generic. I pull out a GoodRx coupon. $14.50 for a 90-day supply right then and right there - no "authorization" or insurance required.

Go figure...

I have done the same thing. Even though I have insurance, Good RX is often cheaper than my co pay and no need for authorization.

 

[Deleted member 43589]

Just to let you know I got my 10ml vial of test cypionate from CVS Caremark today with no issue. Insurance (Medicare Advantage) covered it and I had a $5 co-pay. I had a huge smile on my face leaving. I did show my doctor the vial I had previous from CVS .....SUN PHARMA, India. He laughed and said "don't we make anything in this country any more."