Prescription Question for Pharmacists or Doctors

[wendyroo]

My son takes fluoxetine (30 mg a day).  He can either take 3 10mg tablets or 3 10mg capsules each day.  It doesn't matter to him, and it doesn't matter to the prescribing doctor, but it very much matters to our insurance and pharmacy.

 

Each month we are charged somewhere between $3 and $200 for a month's supply of either tablets or capsules.  Some months they are both cheap, some months they are both exorbitant, but most months one is high and one is low.  On those months, we often have to have the prescription re-issued so we can get the cheaper option.

 

The problem is, we don't know the prices until we go to pick up the prescription each month, and getting a busy psychiatrist to re-issue a prescription requires many days of phone calls, voice mails and confused "support staff" who don't understand why we need a "refill" since there are clearly many months left on our current script.

 

My question is, is there a way to work within the system to give the pharmacy permission to issue us either tablets or capsules at my request since they are exactly the same medicine in exactly the same dosage and the doctor doesn't care which we get?  What exactly would the doctor have to write (or not write) on the prescription?  She is completely oblivious to all pharmacy and insurance issues, but is perfectly willing to write whatever I want her to as long as it is medically appropriate.

 

Thanks,

Wendy

[Alice]

I think she can either write it as tablets or capsules like this: 

 

Fluoxetine 10 mg tablet (or capsule)

Take 3 daily. 

 

Or she could write it like this: 

Fluoxetine 10 mg tablet

Take 3 daily

(Substitute of capsule is allowed)

 

I'm not a pharmacist and not sure of what they are allowed to substitute but I think either of those would work. I've written similar prescriptions that seemed to work. You could ask the pharmacy if they would be allowed to choose which form to fill it in if it was written like one of the above. 

 

 

[3 ladybugs]

I would think it could be done if she orders both scripts in the needed amount for the month (or however you normally get it) but have it have refills for the whole year. This would assume that you go to the same pharmacy every time.

 

However I do have to ask, have you looked into mail order pharmacies so you could get 3 months at a time if you child takes it all the time? It may be cheaper for you in the long run, and insurance companies tend to work with a "preferred" mail order pharmacy where the cost would be minimal (relative term there) to you.  

[MercyA]

Do you have to use that particular pharmacy? I've saved quite a bit by comparing prescription prices at goodrx.com.

[Tap]

I work in pharmacy.

 

The doctor can write 'tablets or capsules'. Once the script is written and typed, it will kind of lock it into either capsules OR tablets.Only one script can exist at a time, so they have to deactivate and retype the script, document the issue, and then try to run the new script...each time they switch it.   To switch it back and forth, would require a lot of documentation/time and I can see that a pharmacy wouldn't want to bother with that. 

 

I would suggest a few different solutions. (Honestly, I would do #2 for the 90 days supply if it were me)

 

1.  Have the doctor write 1 script for 20mg capsules and one script for 10mg capsules.  See what your insurance would do with that for price.  20mg capsules are pretty cheap, 20mg tablets are NOT cheap.  You will have 1 copay/copayment for each, but since they are both for #30, it may be cheaper in the long run.

 

2. Use Goodrx app to find a pharmacy that has a decent price on the meds.  Goodrx is a discount card and it bypasses your insurance.  It is not 100% accurate, but fairly close. Right now it says fluoxetine 10 capsules x90=under $10. If you doctor will let you get a 3month supply and writes the script that way, then you can drop that price per month even lower.  #270 (10mgx3x3months) is $15 at many pharmacies. Let them know when you are dropping off the script that you want to use Goodrx. You have to register and the app will give you an ID#.  You have to show that information when you drop off the prescription for them to give you that pricing. Let them know you want to verify the price before you fill the scipt to make sure it is at least in the expected Goodrx ball park.  I have only seen it be really wrong one time, and it was a medication that there was a national shortage of at the moment, so we had to order in a more expensive brand that usual. It is typically accurate within a dollar or two. 

 

3. contact your insurance and ask about the price fluxuations.  The pharmacy cost on fluoxetine 10 capsules shouldn't be that high, so if you insurance is pricing it with $200 copay then there is an err somewhere. Tablets are more expensive, but the capsules should be cheap. The only time we really see tablets used are if someone can't swallow capsules or if they are doing 1/2 tablet doses. 

 

4. Your insurance may do better with using 20mg Tablets and doing 1 1/2 tablets at a time (can't do 1/2s with capsules).  That way you are only buying 45 units for 1 month instead of 90. 

 

 

[Guest]

Yes, use Goodrx and ask your doctor NOT to specify the form of the medication unless they absolutely have to, because then you can call the pharmacist and request the cheapest form equivalent to that dosage. They can call and clear that up anyway but it's more straightforward if they understand what you're asking is for that medication as cheaply as possible. If the doctor has specified a more expensive form then have them call the office and clear up whether a cheaper option can be subbed in.

[wendyroo]

I work in pharmacy.

 

The doctor can write 'tablets or capsules'. Once the script is written and typed, it will kind of lock it into either capsules OR tablets.Only one script can exist at a time, so they have to deactivate and retype the script, document the issue, and then try to run the new script...each time they switch it.   To switch it back and forth, would require a lot of documentation/time and I can see that a pharmacy wouldn't want to bother with that. 

 

I would suggest a few different solutions. (Honestly, I would do #2 for the 90 days supply if it were me)

 

1.  Have the doctor write 1 script for 20mg capsules and one script for 10mg capsules.  See what your insurance would do with that for price.  20mg capsules are pretty cheap, 20mg tablets are NOT cheap.  You will have 1 copay/copayment for each, but since they are both for #30, it may be cheaper in the long run.

 

2. Use Goodrx app to find a pharmacy that has a decent price on the meds.  Goodrx is a discount card and it bypasses your insurance.  It is not 100% accurate, but fairly close. Right now it says fluoxetine 10 capsules x90=under $10. If you doctor will let you get a 3month supply and writes the script that way, then you can drop that price per month even lower.  #270 (10mgx3x3months) is $15 at many pharmacies. Let them know when you are dropping off the script that you want to use Goodrx. You have to register and the app will give you an ID#.  You have to show that information when you drop off the prescription for them to give you that pricing. Let them know you want to verify the price before you fill the scipt to make sure it is at least in the expected Goodrx ball park.  I have only seen it be really wrong one time, and it was a medication that there was a national shortage of at the moment, so we had to order in a more expensive brand that usual. It is typically accurate within a dollar or two. 

 

3. contact your insurance and ask about the price fluxuations.  The pharmacy cost on fluoxetine 10 capsules shouldn't be that high, so if you insurance is pricing it with $200 copay then there is an err somewhere. Tablets are more expensive, but the capsules should be cheap. The only time we really see tablets used are if someone can't swallow capsules or if they are doing 1/2 tablet doses. 

 

4. Your insurance may do better with using 20mg Tablets and doing 1 1/2 tablets at a time (can't do 1/2s with capsules).  That way you are only buying 45 units for 1 month instead of 90. 

 

Thank you for all your ideas.

 

1. This might work.  I will have to look into the pricing.

 

2. & 3. So far we have always been able to get a good price on tablets or capsules through our insurance...the price just fluctuates like crazy.  The past two months we have gotten 90 tablets for $4, which is great.  This month the same 90 tablets rung up at $78 and when I called the insurance to double check the price about an hour later it had gone up to $96.  A $74 increase over less than a month seems crazy, but an $18 increase in an hour?!?!?

 

So far the doctor has not wanted to do a 90 day supply because she thinks we might still need to adjust his dose.

 

4. Another idea worth looking into.

 

Thanks.

[Tap]

Thank you for all your ideas.

 

1. This might work. I will have to look into the pricing.

 

2. & 3. So far we have always been able to get a good price on tablets or capsules through our insurance...the price just fluctuates like crazy. The past two months we have gotten 90 tablets for $4, which is great. This month the same 90 tablets rung up at $78 and when I called the insurance to double check the price about an hour later it had gone up to $96. A $74 increase over less than a month seems crazy, but an $18 increase in an hour?!?!?

 

So far the doctor has not wanted to do a 90 day supply because she thinks we might still need to adjust his dose.

 

4. Another idea worth looking into.

 

Thanks.

Even if the doctor wants to adjust his dose, you will still adjust in increments of 10mg. Having a supply of 10mg on hand will allow you to still adjust the dose. Sonce ur bypassing the insurance you won't end up with a "refill too soon issue".