Champva Recipienets

[Berta]

About 2 years ago my pharmacist told me CHAMPVA would not pay for a DAW prescription for Toprol XL and I had to get the generic.(metoprolol)

I have suffered from side affects ever since and they got worse when my doctor recently upped my dosage a little.After doing hours of research on the generic metoprolol I demanded the pharmacy give me the real Toprol.They charged me 66 bucks and said CHAMPVA will not pay for it.

Then I called my doctor to find that the prescription was DAW all of this time and NY state law prohibits changes to a DAW prescription.

I am considering how I will handle that part of my problem.

But my point here is this- I called CHAMPVA and they are always as helpful as they can be and they referred me directly to the SXC Health Solutions department which has the formulary as to what CHAMPVA will and wont pay for.

SXC called my pharmacist right away.

Long story- The Pharmacy has my refund waiting-My cost has been reduced to the regular co pay- for the med (Toprol)I should have been given all along.

I am really ticked off by this because how many CHAMPVAers are given generic when the real med will not cost them that much more.

The SXC number is 1-888-546-5502 and they can tell you right away if your prescription is on their formulary list. Most brand names are.

I am angry at myself knowing prescribed meds were part of my wrongful death FTCA award regarding my husband.

I should have questioned the pharmicist 2 years ago but I bought what he was selling:

He said

CHAMPVA wont pay -WRONG and

the generic is the same -REALLY WRONG!

I guess all of us have to be very proactive in any medical issues as well as our claims.

I have had serious side affects from the metoprolol and reported them to my doctor and am writing complaint to the FDA.

My doctor thought I was getting Toprol as prescribed but I wasnt.

The pharmacist didn't realize that CHAMPVA is not like the other forms of Insurance so we CHAMPVAs have to make sure they know the benefits we get and dont try to pull this on anyone else.

[Pete53]

My wife requires a compounded prescription and the pharmacy has been unable to do it so I had to pay full price 92 bucks. Been doing it for over 10 years and I would get copay back when I would submit to ChampVA using proper forms.

Last month I called up and talked to a nice man who got me a proper code to use next time and supposedly I will only have to make my copay like all the other meds.

I was also under the impression that ChanpVA would not exclude any prescription either brand or generic?

Berta thanks for your post.

[Chuck75]

If the prescriptions were written DAW, the pharmacist is required to obtain the physician's approval before issuing a substitute.

Failure to do so can cause a pharmacist to loose his or her license, assuming they are not working for the VA.

[Berta]

You bet Chuck-I have the pharmaceutical laws on that right here for NYS. Some states might be different.

I filed a complaint with the District Manager of TOPs Markets where I got this script filled.

The pharmacists have lied to me.

I had no way to even appeal a CHAMPVA denial (because I didnt get a denial-the pharmacy never even tried to run the Toprol prescription through.so I took the generic instead thinking I had no choice.

Come to find out there would have been no problem at all with the actual real medication and CHAMPVA.

Instead of 4.42 for generic I would have paid about 9 bucks for the real stuff. No problem there.

I asked the District Manager to send me copies of my prescriptions that they have and I going to see why they switched me when my doctor said they were written as DAW.

The real toprol is affecting me differently and I think I was allergic to the binders or something in the other med.

If I dont get a straight answer from TOPs on this I am seeing my lawyer.

[deltaj]

About 2 years ago my pharmacist told me CHAMPVA would not pay for a DAW prescription for Toprol XL and I had to get the generic.(metoprolol)

I have suffered from side affects ever since and they got worse when my doctor recently upped my dosage a little.After doing hours of research on the generic metoprolol I demanded the pharmacy give me the real Toprol.They charged me 66 bucks and said CHAMPVA will not pay for it.

Then I called my doctor to find that the prescription was DAW all of this time and NY state law prohibits changes to a DAW prescription.

I am considering how I will handle that part of my problem.

But my point here is this- I called CHAMPVA and they are always as helpful as they can be and they referred me directly to the SXC Health Solutions department which has the formulary as to what CHAMPVA will and wont pay for.

SXC called my pharmacist right away.

Long story- The Pharmacy has my refund waiting-My cost has been reduced to the regular co pay- for the med (Toprol)I should have been given all along.

I am really ticked off by this because how many CHAMPVAers are given generic when the real med will not cost them that much more.

The SXC number is 1-888-546-5502 and they can tell you right away if your prescription is on their formulary list. Most brand names are.

I am angry at myself knowing prescribed meds were part of my wrongful death FTCA award regarding my husband.

I should have questioned the pharmicist 2 years ago but I bought what he was selling:

He said

CHAMPVA wont pay -WRONG and

the generic is the same -REALLY WRONG!

I guess all of us have to be very proactive in any medical issues as well as our claims.

I have had serious side affects from the metoprolol and reported them to my doctor and am writing complaint to the FDA.

My doctor thought I was getting Toprol as prescribed but I wasnt.

The pharmacist didn't realize that CHAMPVA is not like the other forms of Insurance so we CHAMPVAs have to make sure they know the benefits we get and dont try to pull this on anyone else.

Berta, You do have the option to file a complaint with the state pharmacy board about this pharmacist's handling of your prescription since the pharmacist filled the prescription with a generic when it had DAW written on it.

[GuaymasJim]

bobbyq, My wife uses CHAMPVA at the Tucson VAMC. They have a really nice old (dirt is younger) fellow who sets up each new enrollee. He has the process down to a science and gets it all done right the first time. The care that VAMC offers to CHAMPVA recipients is very limited, but they make great referrals to other local providers who don't hang you out to dry with co-pays and such. The only service not offered that concerned me was the weight reduction and maintenance program which as a proactive approach to better health would ultimately save many $$$ by avoiding costly treatments later. I pointed this out--but got nowhere. Oh well!

[broncovet]

I may humbly suggest you try this:

I call it "the kids method". When one person in the VA says no, you talk to another, because we understand well the right hand does not know what the left hand is doing at the VA. This includes, of course, Champva. You can call at a different time, go to a different part of the hospital, go to a different hospital, etc. Just do something different and you will get a different result if you dont like the result the first time. You might try a different pharmacy.

Teenagers figured this out first..if Mom says no then ask Dad. It makes me proud of the younger generation.

Its one way we can take advantage of the lack of quality managment at the VA. If management was very good, then there would be good training and you would get the same result from each person you spoke to. We all know that does not happen.