I received a letter from my insurance company that they need authorization from my doctor as to why I'm taking metformin.
Has anyone had to do this before? I'm worried that they might not cover it since I'm not diagnosed with diabetes (which is what it's FDA approved for). Or that they'll deem that I'm taking it for fertility reasons, and I have zero fertility coverage.
Just wondering if anyone has had to do this!
hostess / wonderful apple seed / 16729 posts
No, I didn't have to do that. I took it to my local pharmacy and they filled it. I assumed it was because metformin is used for diabetes.
I know I was diagnosed with insulin resistan PCOS and because of it, I have a risk of developing diabetes in the future. If I got that letter, I would ask my RE to mention that to the insurance. Can you ask your RE if you are at risk? Maybe that might help.
pomelo / 5129 posts
@bluestriped bee: that's not a bad idea. I know they put me on it after taking a blood test, so there must be a record of me needing it based on some sort of level.
pomelo / 5129 posts
And it's weird because I've been on it for at least two years with no problem.
We also are being forced to enroll in mail order for maintenance meds or have to pay out of pocket after the third refill.
nectarine / 2132 posts
@MaryM: no i didn't have to do that. have you been diagnosed with pcos? if so, i think it can be argued that pcos is more than just a fertility issue and therefore the metformin should be covered.
our ins company made us enroll in mail order maintenance meds and it was a huge pain in the butt! at least it is cheaper, though...
pomelo / 5129 posts
@jmarionsmith: I used mail order years ago when you could mail in a prescription and I didn't mind it so much. But I tried switching over recently, and of course my doctor's aren't responding to the requests from the pharmacy so I have to follow up on that too. It's all so annoying.
nectarine / 2631 posts
I had no problem getting it through my insurance but I had full IF coverage (and had PCOS). I bet my new crappy insurance wouldn't cover it though!!!
pomegranate / 3895 posts
Do you have Publix where you live? They do medicine for diabetes (Metformin included) for free!
http://www.publix.com/pharmacy-wellness/pharmacy/diabetes-management#meds
No insurance cards needed. I know it's more of a pain to get your medicine from the grocery store, but it could be an easy work around.
pomelo / 5093 posts
It looks like Walmart has it on their 4$ prescription list, so if you're denied coverage, you can get it there cheaply.
grapefruit / 4862 posts
I get it free from publix. No insurance involvement. Meijer does too I believe up in the Midwest.
pomelo / 5129 posts
I'm in the DC area. I'm not sure that meijer or publix have sister companies here?
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