Originally Posted by NOPD
You probably need a prior authorization from the insurance company because they don't usually cover the medication since it's not in their formulary; due to the fact that there are over the counter allergy medications comparable to the zyrtec. The pharmacy usually calls the dr. and the dr. has to call the insurance company to give the insurance company a reason why you have to take it. And that doesn't mean that it will be covered. The process normally takes a few hours or days. I say try out the claritin over the counter or the generic first to see if it works.
The other option is to call the insurance co. and see what is covered under the insurance and tell the dr. to call that particular medication in.
What he said.
Also, on occasion, I dunno if it's still true...the insurance will get rebates from one manufacturer in return for covering their product. Basically, they want to pay as little as they possibly can. As far as they're concerned, Claritin should be just fine...and if it's not, they want your doctor to tell them so. Your word just won't cut it.
For NOPD: We have this guy whose MD DAW'd his Prilosec. Not Prilosec OTC, but the original stuff. ...and his f'n insurance pays for it! No wonder insurance premiums are so damned high.
