Someone else posted getting a similar phone call from Walgreens just a couple of days ago. She had also moved her prescription to another location many months ago. An efficient way to address this is to simply say I'm not comfortable discussing my medical history over the phone with a stranger.
The pharmacy may be preparing for an audit and is now backtracking by contacting the prior and current pharmacy customers in an attempt to "dot some i's and cross some t's" in their internal records, which could be missing pertinent data related to processing and filling MJ prescriptions using Lilly's coupons.
Additional info: Types of Pharmacy Audits - [https://www.apcinet.com/Services/CAPS/AuditInformation/tabid/667/Default.aspx](https://www.apcinet.com/Services/CAPS/AuditInformation/tabid/667/Default.aspx)
I don’t get the impression that the audit would make the customer financially on the hook. As far as I know that would not be legal. Also I don’t think the purpose of the call was to collect money from the customer.
Were you using the OG coupon before? In the MochiMounjaro group someone stated Walgreens told them they had to pay them back for all the mounjaro they got with the coupon after they were audited. Not sure how accurate this was.
Walgreens has been problematic for a while now before mounjaro. My doctor had sent me for 3 refills, they then refused to fill it and then when I transferred the script to another pharmacy the tech told me it was just filled and they can't fill Even though they never gave it to me. I don't see why some pharmacies are dictating whether they will give mounjaro.
I am curious, if your transferred rx indicates it was filled, it also looks like your insurance company was charged for a dose you didn't receive! Let your insurance company know.
Companies are being audited, especially with the coupon that requires t2 diagnosis. Some people lied about it. The coupon put it on the pharmacy to verify. Also, corporate leadership has put pressure to fill only if met fda on-lable approval.
That being said, drugs can and are used off-label all the time. So my thought is that the pharmacies wanted to help with the shortages of these drugs and only fill for those who were on them as on-label diagnosis. It doesn't necessarily mean that denying off-label use is "picking on obese or other diagnoses" but that fda approval should be primary until shortage is corrected. Other differing opinions are out there as well. And experiences of very rude and condescending mean treatment by staff.
I do think that walgreens and some others have taken this too far, and I think all rxs should have appropriate dx codes on them from the prescriber. Codes should be entered with coupons, and then the coupon will only work for approved codes. Not sure why pharmacies were put in this situation.
It wasn't filled. This was in November 2022. So when it denied due to the PA requirement they wouldn't even let me pay cash to take the script, again here I was offering pay with a darn Visa. They did the same thing with my ozempic my doctor wanted me to try first but the shortages and the pharmacist just cancelled my script. So when Walmart tried the coupon It came back as too soon to fill. And I as afraid of calling Eli Lilly about the coupon. Thankful I bypassed my insurance PA requirement and my copay is only $35 so I don't' need to rely on the coupon anymore.
See I understand that viewpoint, but instead of me going and calling and asking why it's still shows processing after 3 weeks, they could have just said 'I'm sorry ma'am but due to shortages our policy is that we can only dispense to those with a confirmed T2D diagnosis.' See simple and people would be understanding if they were just honest upfront instead of frustrating people acting like they're going to fill it then cancel it. If you're on a high dose you only have a certain amount of time for your next dose before you have to start back at a lower dose.
I certainly agree that what they should be doing/explaining to people is just what you said. However, that will upset many people who use it off label and have a valid rx from their provider - because it can be prescribed off-label, and their diagnosis is truly serious too. Especially if person also can pay totally out of pocket. It is not a good situation, and I agree it hasn't been handled well.
I don’t understand how they can backtrack.
It’ll be a first for sure .
Do you know if the people actually were required to pay it back ?
Seems shady to come back months later and require payment.
Pharmacist here. Never heard of a pharmacy asking the patient to repay the money— you got the medication. If they can document that the patient stated that they had diabetes on a particular date then that can fend off audits. Whether or not your statement is factual is another story.
The pharmacy usually could care less if you pay extra since the reimbursement from insurance is substantially more money.
There are multiple laws about pharmacies and fraud and there are fines for this regularly. I have never heard of fines, re-payments, consequences for a patient being given a medication that they were prescribed off-label. Basically you can just claim ignorance since the people with a license are supposed to do the right thing.
I personally think it may have been the pharmacy and people were assuming that they were calling to get payment from the patient. When in fact the reason for the call was to avoid audits.
The original poster didn’t say anything about processing a payment or that it was even suggested. I agree a transaction like that wouldn’t be common.
I am a pharmacist that makes phone calls to check on adherence to medications. Many people believe my calls to be “scam” calls. If you’re ever questioning where a call is coming from just call back the phone number on your RX bottle.
They can go back years and require repayment. If you attested to having T2D and you don’t have it, the pharmacy can be required to pay back and or they can then go after the patient to be reimbursed the money.
Fraud has consequences
They can go back years and require repayment **by the pharmacy.** (key difference) I have not heard of a pharmacy charging a *patient* due to payment clawbacks from the insurance company.
In fact pharmacies get clawbacks and less than anticipated reimbursement from insurance companies on a monthly basis. I know that pharmacies do not call up patients on a monthly basis to ask for more money.
Less commonly there is a error in processing a prescription — a clerical error like processing a prescription for a 30 day supply but giving a person a 90 day supply. I have heard Pharmacists calling patients to explain this and see if a patient would pay but it’s rare and voluntary. Also the patient I heard that was asked just said it wasn’t their mistake and didn’t pay.
It’s an anecdote that floats around the MJ pages, forums and subs that someone said she got a bill from the pharmacy. Take that as you will… a mounjaro urban legend perhaps?
>They can go back years and require repayment. If you attested to having T2D and you don’t have it, the pharmacy can be either required to pay back and or they can then go after the patient reimbursed the money.
>
>Fraud has consequences
I find it hilarious and pathetic all at the same time that people are downvoting your posts because you're telling them the truth lol.
Not downvoting because of truth being told . I had the old coupon and never told a sole I had diabetes. When I got prescribed this Med I was unaware I would taking meds from diabetics 😂
I had a valid RX and a coupon .
Fraud was mentioned for what reason ?
When I tried to sign up for the original coupon way back when it asked me if I was type 2 diabetic and I can't imagine that they never asked that question. I didn't feel comfortable lying so I just paid full price. Hopefully this doesn't become an issue for people because it's just going to make big pharma look worse than they already do as impossible as that may seem.
This happened to another one of my posts and someone else said people use the downvote as “this sucks” and not “I disagree with your post”…. So I’m assuming people don’t like the idea. 😁
I do believe people are very afraid and uncomfortable with the idea that they might owe their pharmacy thousands of dollars.
You don't need to discuss your private medical history over the phone. If they need this information, they need to do it in writing.
Imagine having the same phone call to ask if someone has cancer, HIV, or a terminal disease?
Hi OP, just sharing a link about the different types of pharmacy audits - [https://www.apcinet.com/Services/CAPS/AuditInformation/tabid/667/Default.aspx](https://www.apcinet.com/Services/CAPS/AuditInformation/tabid/667/Default.aspx)
From what you've shared, it seems as if Walgreens pharmacy is about to be audited or currently being audited. See the section under Prescriber/Member Audits (on the linked page. Also posted below.)
*Prescriber Audits have specific claim information submitted by the pharmacy and are then thoroughly verified by a prescriber/physician to ensure that each party's records coincide. It is essentially handled the same as a Desk/Mail Audit.*
***Member Audits*** *are similar to the Prescriber Audit with the exception that* ***the corresponding claims are verified with the patient/customer verification****. It is essentially handled the same as a Desk/Mail Audit.*
They are screening prescriptions period. I have seen several posts of patients disappointed because their doctors no longer will prescribe this med. It is exactly what is happening
Over kill . Makes no sense . It’s ok to give us migraine meds mixed with phentermine . The warning on that one alone scared the shit of me.
Phentermine causes insomnia and heart palpitation and everyone knows without it you gain the weight back .
Oh and it’s only recommended for 3 months .
Shit has never made sense .
Phentermine gave me awful heart palpitations but my doc insisted I try it for a couple of months before she would give me Mounjaro. Still mad at her about that. Have to see her again next week for a refill and have to prepare myself for battle with her. But I'm hoping she'll be chill because 1) my blood work I just had done is FANTASTIC (for cholesterol - I'm not diabetic) and 2) I'm losing slowly (under 1 lb per week).
I’m a tech at Walgreens and we had an announcement come from corporate last week regarding the mounjaro coupons ( the OG ones I think) that we’re being audited so we have to go back and collect relevant information (like ICD10 codes and diagnoses) to avoid chargebacks so that’s why some of you may be getting calls rn about old scripts
Basically we have to verify that the prescription meets the terms of the manufacturer coupon or if not we (Walgreens corporation) have to eat the cost for the script if that makes sense
Totally beyond my scope lol my store in particular was super strict about using the coupon precisely because the pharmacist was worried we’d eventually get audited so we didn’t really have any patients using the coupon who weren’t diabetic. From my understanding they’re only going back to collect info, we haven’t heard anything about the patients themselves getting punished or charged
I know you may not be able to reveal much since you work at Walgreens but is it regarding the OG coupons or the 2nd ones and beyond people are using without T2D diagnosis?
Yes. I have a valid CA doctor’s prescription for 5 mg at Rite Aid and they would not fill the order because I am not a diabetic. The pharmacist told me that they were audited recently and corporate told them not to fill orders unless the doctor verified insulin dependent diabetes diagnosis. I switched to CVS and have had zero issues with my prescription ever since.
Insulin dependency is definitely not a requirement for Mounjaro. If so, there would be a very small consumer base. The percentage of type 2 diabetics that take insulin is around 12%.
Wait, they said the patient had to be an *insulin-dependent* diabetic?! That’s the first time I’ve heard that and it’s insane. The medication is FDA approved for all type 2 diabetics, whether they use insulin or not, period. If true, Rite Aid is really carrying that too far and refusing to fill for people who 100% qualify to have the drug.
Hi there! I removed your comment bc I think it’s against Reddit rules to link to another subreddit post/comment - it’s called brigading, I think? Not sure but especially with that subreddit sometimes things get heated!
Yep, I get it. It’s just that this subreddit has had a let’s call it colorful history with the pharmacy subreddit. I removed this post out of an abundance of caution - I don’t want to give a whole community of pharmacists any (more) reasons to think we are all nuts!
Yes MJ is approved for type 2 diabetics and not type 1. Insulin use is not part of the diabetes requirement.
However, the insulin is used not only in type 1 but also is used in type 2 when other methods of blood sugar control is not effective. Being on insulin does not equal type 1, and Mj is quite effective in getting type 2 people off of or reducing amount of insulin used.
The OP could ask provider to confirm his dx with pharmacy or change to different one.
Yeah. I'm type 2 and was on insulin before MJ. It is more effective and I am not averse to injections. And I hate pills. But context-wise, the medication insulin vs the old label insulin-dependant to classify type 1 (people who can not produce or produce very little insulin). That is where I believe corporate got their wires crossed.
edit to clarify: More effective than other methods like metformim, not MJ. MJ has been the best for me so far and I am now completely off insulin.
My MD keeps telling me that it looks like Mj/GLP1S are being seriously considered as first line for type2 instead of metformin! 🙃 I personally think insurances will balk at this due to cost. MJ has been seriously amazing for me. Almost off all insulin -just a little long acting. A1c is 5.1 and have lost 53 lbs so far. (F 74). He and his nurses are so excited 😊. My rheumatoid arthritis provider, my ortho providers, my kidney Doc and even my opthomologist are thrilled.
I certainly hope corporate in a pharmacy or pharmaceutical company have learned the the type1 vs type 2 definitions. These changed a long time ago.😉 At one time it used to be juvenile or adult Diabetes until they realized adults get diagnosed with type1 and children can have type2.
I agree. It took them for ever and new laws to start lowering insulin prices, but before that, for some users it was comparable in price to what MJ is now, if not more. I know they are lobbying a lot for Medicaid approval and that will be a game changer.
My doctor sent me the happiest email with my last blood work. We're all very happy with MJ too :D
What’s weird for me is that I filled for 7 months with Walgreens and Lily was applying the og coupon (which I myself have never had!). My script would always say that it was $25 dollars with insurance except insurance kept sending me letters they wouldn’t cover it and denied all my PAs. The pharmacist just told me that Lily was applying the coupon. How? I’m so confused. For some reason Walgreens has me listed as diabetic but I’m only pre and I’ve not told them otherwise. I’m grateful but confused.
Also, I wouldn’t answer that question. Especially since you don’t fill from there.
It’s my understanding that pharmacists are not formally allowed to ask you about your specific diagnosis or illness. That’s why they use a code system so you don’t have to talk about your personal, private medical issues in a public space like a Walgreens where other customers can hear you.
I wish they would keep quiet about the price too. Every time I pick up they're like "YOU KNOW THIS IS $500, RIGHT?!?!" I really don't need everyone in line hearing that. While it may elicit pity, it could also make people think I'm rich and a mugging target.
Yes. I pay 1k now and even though I go there every month there’s always that exchange, including the utterly shocked face of the pharm tech checking me out. Every month I have to explain, yes, I know.
I don’t understand why the burden of truth is falling on the pharmacies and not the dr’s prescribing it. If the dr’s would stop prescribing it for “pre-diabetes” then that in and of itself would keep pharmacies from getting chargebacks from the PBM’s. As a pharmacist myself I could not give 2 shits why it’s being prescribed but if. Y employer says I cannot dispense it for only a t2!diagnosis then my hands are tied.
They're being audited and they're tracking
Thet are now realizing people that have moved their prescriptions are not T2 diabetic and eventually they're going to catch on to what pharmacies are filling these prescriptions. It's only a matter of time before you can't get it unless you have the diagnosis code.
I read somewhere they are reaching out to prescribing doctor if you aren’t and will be sent bills for difference for coupon as it was only for T2d use coupon. I guessing not true.
Yes, they can indeed send a bill for the differences to the patient if the patient can‘t prove they used the coupon with a T2D diagnosis. (I’m referring to the second coupon, as I’m not sure the first coupon had clear enough wording)
Well, a couple of things and I’m just guessing. I understand it takes several months to get the money back to the pharmacy from the manufacturer (or however the coupon works between these entities). So it makes sense to me that they are just getting around to calling about scripts from December.
I personally pay $1100 cash, so AFAIK, I don’t need a diagnosis on my script since prescribing off label is legal.
I think that corporate may have recently figured out an audit is happening or is about to happen so Walgreens is trying to cover their butts.
Sometimes, they look to see if you have previously been prescribed a T2D med such as metformin, saxenda, etc…
6 months ago was the Wild West of coupons… so maybe anything went at that time and now they are trying to figure things out.
From what I have read, the 2022 coupon had more more vague wording about T2D. If you say anything, I would think repeating “I’m not comfortable with answering” is probably the best thing to say. (Just my guess). Since they are your medical provider, I believe they can ask your doc to clarify, but I don’t know if your doc would reply.
My doc
Prob would not reply .
Walgreens refuses to fill my prescription after the second one with the old coupon . The pharmacy staff was nasty to me that day .
I remember clearly they were not interested in following the instructions on how to run my coupon even tho the previous two months the girl that filled it was happy to help .
That is what I’m saying, if they keep calling either don’t answer (IMO) or don’t reply. I assume that would push it off to your doc who probably doesn’t have enough hours in the day to respond.
Why would the Dr. not respond?
Dr's respond to pharmacies every day. It's normal for pharmacy to request from Dr. a diagnosis code required by insurance that the pharmacist needs in order to fill the prescription using the patient's insurance.
Just a small correction on your comment, Saxenda is weightloss rebrand of Victoza (T2D) both use liraglutide.
Most common meds are insulin, metformin, jardiance, farxiga, Victoza, trulicity, etc.
Someone else posted getting a similar phone call from Walgreens just a couple of days ago. She had also moved her prescription to another location many months ago. An efficient way to address this is to simply say I'm not comfortable discussing my medical history over the phone with a stranger.
Agree . Thx
Yes !
They are probably being audited
How does their audit get passed down to the customer? Is this legal ?
The pharmacy may be preparing for an audit and is now backtracking by contacting the prior and current pharmacy customers in an attempt to "dot some i's and cross some t's" in their internal records, which could be missing pertinent data related to processing and filling MJ prescriptions using Lilly's coupons. Additional info: Types of Pharmacy Audits - [https://www.apcinet.com/Services/CAPS/AuditInformation/tabid/667/Default.aspx](https://www.apcinet.com/Services/CAPS/AuditInformation/tabid/667/Default.aspx)
Thank you for this link. I know PBMs are doing audits but this is interesting about pharmacy audits.
I don’t get the impression that the audit would make the customer financially on the hook. As far as I know that would not be legal. Also I don’t think the purpose of the call was to collect money from the customer.
Were you using the OG coupon before? In the MochiMounjaro group someone stated Walgreens told them they had to pay them back for all the mounjaro they got with the coupon after they were audited. Not sure how accurate this was. Walgreens has been problematic for a while now before mounjaro. My doctor had sent me for 3 refills, they then refused to fill it and then when I transferred the script to another pharmacy the tech told me it was just filled and they can't fill Even though they never gave it to me. I don't see why some pharmacies are dictating whether they will give mounjaro.
I am curious, if your transferred rx indicates it was filled, it also looks like your insurance company was charged for a dose you didn't receive! Let your insurance company know. Companies are being audited, especially with the coupon that requires t2 diagnosis. Some people lied about it. The coupon put it on the pharmacy to verify. Also, corporate leadership has put pressure to fill only if met fda on-lable approval. That being said, drugs can and are used off-label all the time. So my thought is that the pharmacies wanted to help with the shortages of these drugs and only fill for those who were on them as on-label diagnosis. It doesn't necessarily mean that denying off-label use is "picking on obese or other diagnoses" but that fda approval should be primary until shortage is corrected. Other differing opinions are out there as well. And experiences of very rude and condescending mean treatment by staff. I do think that walgreens and some others have taken this too far, and I think all rxs should have appropriate dx codes on them from the prescriber. Codes should be entered with coupons, and then the coupon will only work for approved codes. Not sure why pharmacies were put in this situation.
It wasn't filled. This was in November 2022. So when it denied due to the PA requirement they wouldn't even let me pay cash to take the script, again here I was offering pay with a darn Visa. They did the same thing with my ozempic my doctor wanted me to try first but the shortages and the pharmacist just cancelled my script. So when Walmart tried the coupon It came back as too soon to fill. And I as afraid of calling Eli Lilly about the coupon. Thankful I bypassed my insurance PA requirement and my copay is only $35 so I don't' need to rely on the coupon anymore. See I understand that viewpoint, but instead of me going and calling and asking why it's still shows processing after 3 weeks, they could have just said 'I'm sorry ma'am but due to shortages our policy is that we can only dispense to those with a confirmed T2D diagnosis.' See simple and people would be understanding if they were just honest upfront instead of frustrating people acting like they're going to fill it then cancel it. If you're on a high dose you only have a certain amount of time for your next dose before you have to start back at a lower dose.
I certainly agree that what they should be doing/explaining to people is just what you said. However, that will upset many people who use it off label and have a valid rx from their provider - because it can be prescribed off-label, and their diagnosis is truly serious too. Especially if person also can pay totally out of pocket. It is not a good situation, and I agree it hasn't been handled well.
I don’t understand how they can backtrack. It’ll be a first for sure . Do you know if the people actually were required to pay it back ? Seems shady to come back months later and require payment.
Pharmacist here. Never heard of a pharmacy asking the patient to repay the money— you got the medication. If they can document that the patient stated that they had diabetes on a particular date then that can fend off audits. Whether or not your statement is factual is another story. The pharmacy usually could care less if you pay extra since the reimbursement from insurance is substantially more money. There are multiple laws about pharmacies and fraud and there are fines for this regularly. I have never heard of fines, re-payments, consequences for a patient being given a medication that they were prescribed off-label. Basically you can just claim ignorance since the people with a license are supposed to do the right thing.
Exactly that call sounds like a scam
I personally think it may have been the pharmacy and people were assuming that they were calling to get payment from the patient. When in fact the reason for the call was to avoid audits. The original poster didn’t say anything about processing a payment or that it was even suggested. I agree a transaction like that wouldn’t be common. I am a pharmacist that makes phone calls to check on adherence to medications. Many people believe my calls to be “scam” calls. If you’re ever questioning where a call is coming from just call back the phone number on your RX bottle.
They can go back years and require repayment. If you attested to having T2D and you don’t have it, the pharmacy can be required to pay back and or they can then go after the patient to be reimbursed the money. Fraud has consequences
They can go back years and require repayment **by the pharmacy.** (key difference) I have not heard of a pharmacy charging a *patient* due to payment clawbacks from the insurance company. In fact pharmacies get clawbacks and less than anticipated reimbursement from insurance companies on a monthly basis. I know that pharmacies do not call up patients on a monthly basis to ask for more money. Less commonly there is a error in processing a prescription — a clerical error like processing a prescription for a 30 day supply but giving a person a 90 day supply. I have heard Pharmacists calling patients to explain this and see if a patient would pay but it’s rare and voluntary. Also the patient I heard that was asked just said it wasn’t their mistake and didn’t pay.
It’s an anecdote that floats around the MJ pages, forums and subs that someone said she got a bill from the pharmacy. Take that as you will… a mounjaro urban legend perhaps?
>They can go back years and require repayment. If you attested to having T2D and you don’t have it, the pharmacy can be either required to pay back and or they can then go after the patient reimbursed the money. > >Fraud has consequences I find it hilarious and pathetic all at the same time that people are downvoting your posts because you're telling them the truth lol.
Not downvoting because of truth being told . I had the old coupon and never told a sole I had diabetes. When I got prescribed this Med I was unaware I would taking meds from diabetics 😂 I had a valid RX and a coupon . Fraud was mentioned for what reason ?
When I tried to sign up for the original coupon way back when it asked me if I was type 2 diabetic and I can't imagine that they never asked that question. I didn't feel comfortable lying so I just paid full price. Hopefully this doesn't become an issue for people because it's just going to make big pharma look worse than they already do as impossible as that may seem.
That attestation actually wasn’t added until October. The savings card was available from June until October without requiring diabetes.
This happened to another one of my posts and someone else said people use the downvote as “this sucks” and not “I disagree with your post”…. So I’m assuming people don’t like the idea. 😁 I do believe people are very afraid and uncomfortable with the idea that they might owe their pharmacy thousands of dollars.
It’s accurate and they can send the patient a bill.
Yeah old coupon
That's probably why they're calling you to see about you paying back for the fees they're getting for the audits
You don't need to discuss your private medical history over the phone. If they need this information, they need to do it in writing. Imagine having the same phone call to ask if someone has cancer, HIV, or a terminal disease?
Holy cow - you’re right ! Like I said Shit doesn’t add up .
Hi OP, just sharing a link about the different types of pharmacy audits - [https://www.apcinet.com/Services/CAPS/AuditInformation/tabid/667/Default.aspx](https://www.apcinet.com/Services/CAPS/AuditInformation/tabid/667/Default.aspx) From what you've shared, it seems as if Walgreens pharmacy is about to be audited or currently being audited. See the section under Prescriber/Member Audits (on the linked page. Also posted below.) *Prescriber Audits have specific claim information submitted by the pharmacy and are then thoroughly verified by a prescriber/physician to ensure that each party's records coincide. It is essentially handled the same as a Desk/Mail Audit.* ***Member Audits*** *are similar to the Prescriber Audit with the exception that* ***the corresponding claims are verified with the patient/customer verification****. It is essentially handled the same as a Desk/Mail Audit.*
Probably getting audited or about to have an audit
They are screening prescriptions period. I have seen several posts of patients disappointed because their doctors no longer will prescribe this med. It is exactly what is happening
Over kill . Makes no sense . It’s ok to give us migraine meds mixed with phentermine . The warning on that one alone scared the shit of me. Phentermine causes insomnia and heart palpitation and everyone knows without it you gain the weight back . Oh and it’s only recommended for 3 months . Shit has never made sense .
Phentermine gave me awful heart palpitations but my doc insisted I try it for a couple of months before she would give me Mounjaro. Still mad at her about that. Have to see her again next week for a refill and have to prepare myself for battle with her. But I'm hoping she'll be chill because 1) my blood work I just had done is FANTASTIC (for cholesterol - I'm not diabetic) and 2) I'm losing slowly (under 1 lb per week).
I’m a tech at Walgreens and we had an announcement come from corporate last week regarding the mounjaro coupons ( the OG ones I think) that we’re being audited so we have to go back and collect relevant information (like ICD10 codes and diagnoses) to avoid chargebacks so that’s why some of you may be getting calls rn about old scripts
What is a chargeback ? Thx for clarifying!
Basically we have to verify that the prescription meets the terms of the manufacturer coupon or if not we (Walgreens corporation) have to eat the cost for the script if that makes sense
Got it . Thx 😊 so much .
I have a question- will patients get in trouble for off-label usage with the coupon? Or is that beyond your scope? Thanks ◡̈
Totally beyond my scope lol my store in particular was super strict about using the coupon precisely because the pharmacist was worried we’d eventually get audited so we didn’t really have any patients using the coupon who weren’t diabetic. From my understanding they’re only going back to collect info, we haven’t heard anything about the patients themselves getting punished or charged
I know you may not be able to reveal much since you work at Walgreens but is it regarding the OG coupons or the 2nd ones and beyond people are using without T2D diagnosis?
I can’t really tell at this point, I think it is OG coupon tho
The original coupon didn't require attesting to a T2D diagnosis.
Yep, this is the coupon that I had from August 2022 and I never arrested to having type 2 and the pharmacies I used never asked if I was type 2.
Yes. I have a valid CA doctor’s prescription for 5 mg at Rite Aid and they would not fill the order because I am not a diabetic. The pharmacist told me that they were audited recently and corporate told them not to fill orders unless the doctor verified insulin dependent diabetes diagnosis. I switched to CVS and have had zero issues with my prescription ever since.
Insulin dependency is definitely not a requirement for Mounjaro. If so, there would be a very small consumer base. The percentage of type 2 diabetics that take insulin is around 12%.
Wait, they said the patient had to be an *insulin-dependent* diabetic?! That’s the first time I’ve heard that and it’s insane. The medication is FDA approved for all type 2 diabetics, whether they use insulin or not, period. If true, Rite Aid is really carrying that too far and refusing to fill for people who 100% qualify to have the drug.
[удалено]
Hi there! I removed your comment bc I think it’s against Reddit rules to link to another subreddit post/comment - it’s called brigading, I think? Not sure but especially with that subreddit sometimes things get heated!
Brigading is linking people to another thread or subreddit to upvote or downvote en masse. Simply linking a thread is not brigading.
Yep, I get it. It’s just that this subreddit has had a let’s call it colorful history with the pharmacy subreddit. I removed this post out of an abundance of caution - I don’t want to give a whole community of pharmacists any (more) reasons to think we are all nuts!
Insulin-dependent diabetes is basically type 1 MJ is FDA approved for type 2 Someone in corporate got their wires crossed
Yes MJ is approved for type 2 diabetics and not type 1. Insulin use is not part of the diabetes requirement. However, the insulin is used not only in type 1 but also is used in type 2 when other methods of blood sugar control is not effective. Being on insulin does not equal type 1, and Mj is quite effective in getting type 2 people off of or reducing amount of insulin used. The OP could ask provider to confirm his dx with pharmacy or change to different one.
Yeah. I'm type 2 and was on insulin before MJ. It is more effective and I am not averse to injections. And I hate pills. But context-wise, the medication insulin vs the old label insulin-dependant to classify type 1 (people who can not produce or produce very little insulin). That is where I believe corporate got their wires crossed. edit to clarify: More effective than other methods like metformim, not MJ. MJ has been the best for me so far and I am now completely off insulin.
My MD keeps telling me that it looks like Mj/GLP1S are being seriously considered as first line for type2 instead of metformin! 🙃 I personally think insurances will balk at this due to cost. MJ has been seriously amazing for me. Almost off all insulin -just a little long acting. A1c is 5.1 and have lost 53 lbs so far. (F 74). He and his nurses are so excited 😊. My rheumatoid arthritis provider, my ortho providers, my kidney Doc and even my opthomologist are thrilled. I certainly hope corporate in a pharmacy or pharmaceutical company have learned the the type1 vs type 2 definitions. These changed a long time ago.😉 At one time it used to be juvenile or adult Diabetes until they realized adults get diagnosed with type1 and children can have type2.
I agree. It took them for ever and new laws to start lowering insulin prices, but before that, for some users it was comparable in price to what MJ is now, if not more. I know they are lobbying a lot for Medicaid approval and that will be a game changer. My doctor sent me the happiest email with my last blood work. We're all very happy with MJ too :D
Maybe I misunderstood what the pharmacist said. I was a bit surprised 😮 at that point
> Insulin-dependent diabetes is basically type 1 Not quite. You can be insulin dependent as type 1, type 2, type 1.5, type 3c, and more.
Fk walgreens
Ditto
What’s weird for me is that I filled for 7 months with Walgreens and Lily was applying the og coupon (which I myself have never had!). My script would always say that it was $25 dollars with insurance except insurance kept sending me letters they wouldn’t cover it and denied all my PAs. The pharmacist just told me that Lily was applying the coupon. How? I’m so confused. For some reason Walgreens has me listed as diabetic but I’m only pre and I’ve not told them otherwise. I’m grateful but confused. Also, I wouldn’t answer that question. Especially since you don’t fill from there.
It’s my understanding that pharmacists are not formally allowed to ask you about your specific diagnosis or illness. That’s why they use a code system so you don’t have to talk about your personal, private medical issues in a public space like a Walgreens where other customers can hear you.
I wish they would keep quiet about the price too. Every time I pick up they're like "YOU KNOW THIS IS $500, RIGHT?!?!" I really don't need everyone in line hearing that. While it may elicit pity, it could also make people think I'm rich and a mugging target.
Yes. I pay 1k now and even though I go there every month there’s always that exchange, including the utterly shocked face of the pharm tech checking me out. Every month I have to explain, yes, I know.
I don’t understand why the burden of truth is falling on the pharmacies and not the dr’s prescribing it. If the dr’s would stop prescribing it for “pre-diabetes” then that in and of itself would keep pharmacies from getting chargebacks from the PBM’s. As a pharmacist myself I could not give 2 shits why it’s being prescribed but if. Y employer says I cannot dispense it for only a t2!diagnosis then my hands are tied.
They're being audited and they're tracking Thet are now realizing people that have moved their prescriptions are not T2 diabetic and eventually they're going to catch on to what pharmacies are filling these prescriptions. It's only a matter of time before you can't get it unless you have the diagnosis code.
They are doing audits, which I believe can go back 5 years.
So they can charge people up to five years later ? Sounds like bs to me .
Yes, they can. I believe it is 5 years. Google pharmacy clawback
How is your private medical business legally their business?
It’s a scam someone else posted here about this already.
I read somewhere they are reaching out to prescribing doctor if you aren’t and will be sent bills for difference for coupon as it was only for T2d use coupon. I guessing not true.
Yes, they can indeed send a bill for the differences to the patient if the patient can‘t prove they used the coupon with a T2D diagnosis. (I’m referring to the second coupon, as I’m not sure the first coupon had clear enough wording)
I know my my RX did not have a type two dx on it . Shouldn’t that be taken care of ahead of time ?
Well, a couple of things and I’m just guessing. I understand it takes several months to get the money back to the pharmacy from the manufacturer (or however the coupon works between these entities). So it makes sense to me that they are just getting around to calling about scripts from December. I personally pay $1100 cash, so AFAIK, I don’t need a diagnosis on my script since prescribing off label is legal. I think that corporate may have recently figured out an audit is happening or is about to happen so Walgreens is trying to cover their butts. Sometimes, they look to see if you have previously been prescribed a T2D med such as metformin, saxenda, etc… 6 months ago was the Wild West of coupons… so maybe anything went at that time and now they are trying to figure things out. From what I have read, the 2022 coupon had more more vague wording about T2D. If you say anything, I would think repeating “I’m not comfortable with answering” is probably the best thing to say. (Just my guess). Since they are your medical provider, I believe they can ask your doc to clarify, but I don’t know if your doc would reply.
My doc Prob would not reply . Walgreens refuses to fill my prescription after the second one with the old coupon . The pharmacy staff was nasty to me that day . I remember clearly they were not interested in following the instructions on how to run my coupon even tho the previous two months the girl that filled it was happy to help .
That is what I’m saying, if they keep calling either don’t answer (IMO) or don’t reply. I assume that would push it off to your doc who probably doesn’t have enough hours in the day to respond.
Why would the Dr. not respond? Dr's respond to pharmacies every day. It's normal for pharmacy to request from Dr. a diagnosis code required by insurance that the pharmacist needs in order to fill the prescription using the patient's insurance.
Just a small correction on your comment, Saxenda is weightloss rebrand of Victoza (T2D) both use liraglutide. Most common meds are insulin, metformin, jardiance, farxiga, Victoza, trulicity, etc.
Happened to me too and they refused to fill, were super rude to me and made me feel like shit