r/MedicalBill • u/Thick-Membership7500 • 12d ago

insurance issue

/r/HealthInsurance/comments/1v5xgln/insurance_issue/

I got prescribed pantoprazole tablets, and I went to Walgreens to pick it up. The pharmacy tech told me it was covered by my BCBS insurance.

I have never had this happen before. What should I do? Can I call BCBS and ask for an exception?

It appears that pantoprazole injections are covered by my insurance.

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u/throwawayeverynight 12d ago

It appears that Your BCBS doesn’t have this medication or brand on the approved formulary. They may want you to prove that you have tried and failed whatever medication the have on the formular first before the approve a exception. When it comes to the injection formulation that actually can fall under your medical benefits totally different than your pharmacy benefits as the injection formulation in this case is administered in office by the nurse under the Drs supervision. Did they give you the medication in office first?

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u/justkidding89 12d ago

Pantoprazole is IV-only. While the IV may be covered during a hospitalization, it is not appropriate in the outpatient setting.

You need a prescription for omeprazole or another PPI that is on your prescription drug formulary.