No medication without insurance...

[hrforme]

Yeah, this is very legal. Most states now have investigative branches which try to bust (if you will) doctors who over prescribe listed narcotics. Whether fair, right or wrong it is what it is. Some pharmacy's will not even fill certain listed medications regardless of who wrote them.

hate to admit it but i have a relative in the medical field who WAS busted for exactly this...overprescribing ...

 

[welkin]

I walk into a pharmacy with a legal script from a doctor, hand it to the pharmacist and he asks if I have insurance. I say "no", I will pay cash.

It doesn't matter what insurance coverage (contract) I have unless I seek reimbursement from my prescription insurance company.

So, OP could have gone to another pharmacy as TC suggests and received his meds.

 

[cbg]

I walk into a pharmacy with a legal script from a doctor, hand it to the pharmacist and he asks if I have insurance. I say "no", I will pay cash.

It doesn't matter what insurance coverage (contract) I have unless I seek reimbursement from my prescription insurance company.

So, OP could have gone to another pharmacy as TC suggests and received his meds.

As long as the pharmacy is willing to fill it. They are not obligated to do so.

 

[Tax Counsel]

As long as the pharmacy is willing to fill it. They are not obligated to do so.

While true, my bet is that pretty much every pharmacy will do it if you pay the pharmacy for it in advance. No risk the pharmacy won't get paid, no hassle or time taken to file claims with insurers, and less paperwork the pharmacy will have to keep. That means taking a risk the pharmacy won't then fill the prescription, but assuming it's a pharmacy that's been around for awhile the risk is likely quite low.

 

[cbg]

While true, my bet is that pretty much every pharmacy will do it if you pay the pharmacy for it in advance. No risk the pharmacy won't get paid, no hassle or time taken to file claims with insurers, and less paperwork the pharmacy will have to keep. That means taking a risk the pharmacy won't then fill the prescription, but assuming it's a pharmacy that's been around for awhile the risk is likely quite low.

Isn't a pharmacy refusing a cash payment where this whole thread started?

 

[Tax Counsel]

Isn't a pharmacy refusing a cash payment where this whole thread started?

No, but we have had a thread on that topic awhile back.

 

[welkin]

As long as the pharmacy is willing to fill it. They are not obligated to do so.

Well that really depends on the state and what reason the pharmacy/pharmacist has for refusing.

In Arizona, Georgia, Arkansas, Missouri, South Dakota, and Idaho, a pharmacist can refuse to provide certain meds on moral or religious grounds (when the customer is a female or transgender) and does not have to refer the customer to another pharmacy.

Texas, Oregon, Alabama, North Carolina, Pennsylvania, and New York, on the other hand, a pharmacist can refuse to fill the script on moral or religious ground but must refer the customer to another pharmacy that will fill the script.

Washington, California, Nevada, Illinois, Wisconsin, Main, Massachusetts, and specifically New Jersey (OP's state), The pharmacist is required to provide the medication and can only refuse for specific reasons. Company policy is not one of them.

The Attorney General of NJ states (in 2019) that the reasons are as follows:

4. The pharmacist has the right to refuse to fill a prescription if, in his or her professional judgment, the prescription is outside the scope of the practice of the practitioner; or if the pharmacist has sufficient reason to question the validity of the prescription; or to protect the health and welfare of the patient.

The last reason being such things as:

if doing so would harm the patient, such as when the patient is allergic to the medication, the medication would adversely interact with other medications that the patient is taking, or the prescribed dose is above the recommended dosage.

 

[Tax Counsel]

I'd add another reason that is generally legal for not filling it: uncertainty that the pharmacist will get paid for it. That, I think, is the heart of the issue with the OP's pharmacy. Without insurance, the drug cost may be high and the pharmacy wants to be sure it will be paid. A pharmacy may require payment up front, at least in every state I've lived in, if the drug is not covered by insurance. In that case, the refusal is not because the pharmacist objects to filling that particular prescription but just a desire to be sure the pharmacist will get paid. I see nothing illegal or unreasonable about that.

There are pharmacy discount programs patients can use that are free and just require that you have one of their cards (often found on pharmacy counters in my state). Depending on the drug, that can save a lot of money. When I needed a prescription that for some reason wasn't in my insurance company's list of approved drugs, the initial cost quoted to me for it as self pay was around $800-900 /month. Using one of those discount cards brought it down to $150/month.

 

[cbg]

My husband takes a medication that cost $600 for three months on our old insurance where it was not on the formulary and we had to self-pay. And at that we had to use the mail order program or it wasn't available at all. Today on our current insurance? $10 a month at our local mom-and-pop pharmacy.

 

[Tax Counsel]

That's another thing. The prices pharmacies charge may be signficantly different from one to the other. If you are self-pay or you pay a percentage of the pharmacy price through your insurance plan, it is worthwhile to check out what different pharmacies in your area will charge. I've found several useful websites that compile that kind of information and makes it very easy to determine what you'll end up paying at a particular pharmacy.

 

[sealey300]

I'm not sure if this is the right place to ask this question, but I'm not sure where else to ask it.

I tried filling a prescription at CVS for HYDROCODONE a few weeks ago. CVS told me that it required prior authorization from my prescription insurance company, which happens to be CVS Caremark. I said that rather than wait, since it would likely take many days and I needed the medication asap, I would pay out of pocket. They said that they would not fill it without prior authorization from insurance.

Is this legal? What if I didn't have insurance? Would I not be able to fill this medication? When I called CVS Caremark, they said it's done to combat the opioid epidemic. But why is it their responsibility to do this? Can CVS and CVS Caremark prevent me from getting medication that my doctor prescribed me because it doesn't have insurance approval? FYI, it took approximately 5 days to get prior authorization approved, then CVS said they had to order the medication. So I didn't get it filled for 8/9 days from when the prescription was ordered by my doctor.

I know this is a year old but know you can pay out of pocket if you don't have approval from the insurance I been paying out of pocket for the last 2 1/2 years out of pocket because I don't want to deal with the pre-authorization from my insurance and CVS has been letting me pay for my pain medication ever since

 

[Zigner]

I know this is a year old but know you can pay out of pocket if you don't have approval from the insurance I been paying out of pocket for the last 2 1/2 years out of pocket because I don't want to deal with the pre-authorization from my insurance and CVS has been letting me pay for my pain medication ever since

The problem was solved long ago for the OP. In fact, it was solved before the original question was even posed.
Furthermore, your post is incorrect. The OP obviously wasn't allowed to pay out of pocket. That's why the OP was here.

Please don't post to long-dead threads.

 

[adjusterjack]

Thread locked.