Prescription Refills and Renewals
The process of prescription refills and renewals has become an overwhelming burden to IntimMedicine Specialists and your other practitioners. The problem is not of your making or ours. Your insurance company, the middlemen, pharmacy benefit managers (PBMs), and the retail pharmacies have made it difficult and complicated for us to get you, our patients, the prescriptions you need.
Generic Substitution—The “One Size Fits All” Solution
To save money, the entire prescription business is focused on using generic products. Generics cost significantly less than their brand name alternatives, particularly when multiple generic manufacturing sources are available, typically 6 months or more after the brand first becomes generic. Paradoxically, pharmacies usually make more money on a generic prescription than a branded one. This situation provides a strong incentive for both your insurance company and your pharmacy to dispense generics.
Not everyone can use generics, and some medications don’t have a generic equivalent. Some people have sensitivities to ingredients in generic products which are not in the brand name product. These can be inactive ingredients or additives, or there may be a different adhesive on a patch, even though the active ingredients are identical. The “one size fits all” of everyone can use generics creates a problem.
Many medications are being used “off-label.” Off-label prescribing is when a licensed health professional (i.e., physician, nurse practitioner, physician’s assistant) gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat one condition that is different than your condition. Off-label use is common and legal. There are many examples. Here are a few that are common in our practice.
Bupropion (brand name Wellbutrin) is FDA approved for treatment of depression, and as a smoking cessation drug sold under the brand name, Zyban. It is prescribed off-label for adult attention-deficit hyperactivity disorder (ADHD), and to counter other antidepressant’s negative effects on sexual function. We use it to increase sexual desire, improve arousal, and facilitate orgasm.
Gabapentin, (brand name Neurontin), is FDA approved for treatment of seizures and post-herpetic pain syndrome in adults. It is used off-label for a variety of conditions including menopausal hot flashes, migraine headaches, other nerve pain syndromes.
Clomiphene citrate (brand names Clomid, or Serophene) is used for male infertility, and men with low testosterone, but is only FDA approved for female infertility due to ovulatory dysfunction.
Many antidepressants of the SSRI class, like sertraline (brand name Zoloft) are FDA-approved treatments for depression but are commonly prescribed off-label to help men suffering from premature ejaculation.
Many products are FDA approved for use either in women or in men but are used in both sexes. For example, many of our female patients are prescribed testosterone. It’s a good example of an entire product class that is widely available, extensively studied, and FDA-approved for men, but not for women, so it is nearly impossible to get one’s insurance company to pay for its use in women.
An Additional Impediment
Increasingly, insurance companies, the PBM’s, and pharmacies are requiring prior authorizations for prescriptions which they have filled and refilled, often for years, without additional paperwork. Now it’s a paperchase as often as every 3 months. This year (2021), CVS pharmacies, the second largest chain in the US behind Walgreens, dissolved their longstanding relationship with Pfizer and all of Pfizer’s women’s hormonal health products. Pfizer is the world’s largest seller of many such products for sexual pain, vaginal dryness, hot flashes, and night sweats. This, too, has created a complicated mess requiring new prescriptions, alternative prescriptions, and/or different pharmacies or payment mechanisms.
As We Scramble to Help You Get Your Prescriptions Refilled, We Need Your Help.
We ask you to be an active, sharp-penciled, hard-nosed pharmaceutical consumer and bargain hunter. This may take the form of paying for your prescriptions without using your insurance card. While this approach is counterintuitive, it may save you money. Here are some ways you can shop smarter.
- Check for discount coupons on that product’s website.
- Check for a third-party coupon online or on your phone. This may require that you download the GoodRx, SingleCare, and/or RxSaver apps. These apps are available for both iPhone and Android.
- Check out the price at Walmart and other discount outlets (i.e., Costco). Many pharmaceutical products, but particularly generics, have extremely low prices at these outlets, according to the AARP bulletin, March 2021.
- When you are in the office, ask if we have samples to either tide you over or stretch your prescription. Sometimes we do, and not infrequently the brand name manufacturers want our samples used in that way.
- Before you leave the office, ask if the manufacturer has provided us with any co-pay or discount cards. Even if we have them, it does not guarantee they are the lowest cost option or that the pharmacy knows how to properly process them.
Prescription Refill Timeline and Approach
Please check your bottles, boxes, etc., for prescription refills. If you need refills, and your prescription has not expired, please contact your pharmacy. This information may be listed directly on the bottle or box (i.e.,”3 refills before January 2022”). In this case, you do not need to contact our office.
It is your responsibility to notify the office in a timely manner when prescription renewals are necessary. Approval of your renewal may take up to three (3) business days, so please call as soon as possible. If you use a mail order pharmacy, please contact us at least 14 days before your medication is due to run out. The US Post Office has been extremely slow for all types of mail. If you need a new prescription and have a scheduled appointment, please make this request at the time of your visit.
Some medications, seemingly more and more each day, require prior authorization. Depending on your insurance plan this process may involve several steps by both your pharmacy and your healthcare professional. Neither the pharmacy nor the provider can guarantee that your insurance company will approve the medication. Sometimes it requires a personalized letter, a peer-to-peer discussion with a representative of your insurance company, the pharmacy benefit manager (PBM) or both. It sometimes requires all these steps, and that takes time.
Required Follow Up Appointments for Rx Refills and Renewals
It is important to keep your scheduled appointment to ensure that you receive timely refills and renewals. All prescriptions require a follow-up appointment every three (3), six (6) or twelve (12) months depending upon the prescription type. If you are overdue for your appointment, your prescriptions will not be authorized for refill or renewal. Please keep on top of this challenging situation.
Should you have any questions, please contact our office.
James A. Simon, MD, CCD, NCMP, IF, FACOG
Lucy D. Treene, MSHS,
Carol Mack, MPH, MSHS, PA-C