Prescription Formulary (my Rx wasnt covered)

[hychamaz]

I just came back from the Pharmacy and my Prescription Nasal spray was not covered. I looked on the Kela website just now and saw that this medicine is not covered but similiar ones are. When physicians prescribe medicines here do they know which ones are covered and which ones arent. Should I call the doctor to let them know?? I worked for many years in Pharmacies in the US and always had to call physicians for patients when their Insurance didnt cover something but would for an equivalent type of medication. Do pharmacies do that? Or does the patient have to go back to the doctor every time they write for something that is not covered. Thanks in advance.

[Hank W.]

No, of course the doctors cannot google. The pharmacy can switch the medicine for an "equivalent", theres the information in the medicine database.

[hychamaz]

No, of course the doctors cannot google. The pharmacy can switch the medicine for an "equivalent", theres the information in the medicine database.

Hank, I don't think that you are right or at least it wouldnt make sense or we are using the word equivalent differently. I can see a pharmacist using a cheaper generic that contains the exact same ingredients but I cant imagine that they can say switch for example one broad spectrum antibiotic to another without a doctors ok. That is what I am asking. How the procedure for that goes.

[Hank W.]

Yes, "equivalent" as in "same sh* in a different package". Like my Daewoo is
relabled a Pontiac in California.

So then - how do you think you get your Viagrine switched for Valiumites?

a) call the plumber
b) call 112
c) call your momma
d) call your doctor

It also depends, this KELA coverage also if and how the disease is classified as then some medicines can be in a different compensation category... as ronbladholm said it is quite peculiar.

[hychamaz]

Yes, "equivalent" as in "same sh* in a different package". Like my Daewoo is
relabled a Pontiac in California.

So then - how do you think you get your Viagrine switched for Valiumites?

a) call the plumber
b) call 112
c) call your momma
d) call your doctor

It also depends, this KELA coverage also if and how the disease is classified as then some medicines can be in a different compensation category... as ronbladholm said it is quite peculiar.

Hank, you are so helpful (and very witty) but what in the world are you talking about?? My question is again not about the SAME sh*t in different packages but something in the same chemical family. My question is, if you are written a medication, go to the Pharmacy, and find out that it is not covered, what is the way here in Finalnd to have it changed to something that is covered (different chemical composition, but performs the same action in the body).

a. Do you have to go back to your drs office for a new paper Rx
b. Do you call your Dr and ask them to call the Pharmacy with something else?
c. Do they do it here like we do in the states, the Pharmacist would call your Drs office and reccomend something that is covered and get the MDs approval.
Thanks

[Hank W.]

I don't think we're in the States any more Dorothy.

I don't understand what you are asking.
equivalent vs. similar 1=1 or 1~1

OK, so C is slightly unprobable because of doctor-patient confidentiality, but you can ask if they'd call but they won't initiate. They need a new perscription anyhow unless its strictly a replacement "off the list". So then its B, and if B does not work then you do A and if that doesn't work you change the doctor

And you asked what I'd do? I'd put my perscription on the table and hand over my card and be out of there in 5 minutes because I'm not that a poor prole Then again if I had regular medication I'd be asking about that at the doctor's... rephrase - if I took my medication

[richard berman]

No, of course the doctors cannot google. The pharmacy can switch the medicine for an "equivalent", theres the information in the medicine database.

Hank, I don't think that you are right or at least it wouldnt make sense or we are using the word equivalent differently. I can see a pharmacist using a cheaper generic that contains the exact same ingredients but I cant imagine that they can say switch for example one broad spectrum antibiotic to another without a doctors ok. That is what I am asking. How the procedure for that goes.

I think by law they only have to ask you if you wish to switch brand if the other generic is cheaper.

[Hank W.]

And they've only done that for a couple of years. Before that you only got what your perscription read.

[Hank W.]

Well thats generics - I do ask for the cheapest, but the question was about KELA-covered that weren't "on the list" as being equivalents they can deal with in the pharmacy.

[hychamaz]

Thank you everyone for your answers. I really appreciate that and get the point now. Just to clarify I wasnt asking about generics I was asking about as Hank puts it 1~1. I was a drug rep in the States and the easiest example I can give is say for high blood pressure meds. There are 18 different ones on the market that do just about the same thing but some are covered by some insurances and some are not. Depeneded on the particuliar Insurance companies formulary list.
I just feel like a fish out of water here in Finalnd sometimes so thank you all with your help and patience.
P.S- I try to use the search function as much as I can so I dont seem like an idiot asking a question that has been asked 100 times before.

[Hank W.]

Those who ask shall be answered.

Whether the answer makes any sense is a totally different question...

[milou]

By the way...

When buying painkillers, Burana and Ibusal are exactly the same product, but in different packages. Burana just happens to be much more expensive (brand name product, well advertised...) than Ibusal.