Why won't medicaid pay for my prescriptions?!


Question: I have been trying to get my lexapro 20mg filled at the Crab Orchard Pharmacy. But it turns out that my medicaid won't pay for my prescription. I don't understand why. On the computers it said that I hadn't gotten Lexapro refilled since May, but I know I have gotten it refilled even after May. The last month I remember getting it filled was in September. And I don't know why their computers are showing that I hadn't gotten it filled since May. Can someone please explain this to me?


Answers: I have been trying to get my lexapro 20mg filled at the Crab Orchard Pharmacy. But it turns out that my medicaid won't pay for my prescription. I don't understand why. On the computers it said that I hadn't gotten Lexapro refilled since May, but I know I have gotten it refilled even after May. The last month I remember getting it filled was in September. And I don't know why their computers are showing that I hadn't gotten it filled since May. Can someone please explain this to me?

Medicaid pays for what is listed on their formulary and this is always changing. When there are several medications in a classification such as an anti-depressant often ones having a generic are covered and sometimes what is called a prior-authorization must be done to get some of the others covered. This means the doctor must submit additional information to medicaid in order for it to be covered. This is time consuming and a hassle for the doctor and often they won't do it. Usually they change it to something covered. Sometimes certain drugs are just not covered. You need to call medicaid to see it Lexapro is covered at all. With the thousands of drugs out there, neither the doctor or the pharmacy will know just what is covered. Each state has a different formulary.

Medicaid wont pay for it because there is no generic brand and they make you buy generic brands because they are cheeper





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