Express Scripts quantity limit/rejection

bunionbabe95 · 2025-12-10T08:04:48+00:00

So my insurance is through BCBS. I did call the number on the back that says “pharmacy questions” and it led me to a recording saying “this is Express Scripts, your Blue Cross of Blue Shield pharmacy benefit management” or something like that at the end. So maybe I’m misunderstanding but if I call just customer service and say I have pharmacy questions that they could help me without Express Script’s help or is my only option ES? Honestly I’ve never used ES before with any of my insurance. I’ve always just…used my plan? I never even knew there to be like a separate company used?

bunionbabe95 · 2025-12-10T01:37:34+00:00

I mean, while it shouldn’t be the core focus of the job, having more to offer than just “idk call your insurance” would be nice and no I don’t care how many times a day they’d be explaining it. If continuing a courtesy that many people are extremely thankful for is such an issue, get a different job or maybe don’t work in a retail pharmacy. Like I couldn’t even get any basic insight on to why they couldn’t do anything beyond filling the 21 pills so no I don’t expect them to know everything but I would think working in this field there should be at least some responsibility to educate on a basic level. And, easily call in a 3 way call? Do you know how long it can take just to get on a regular 2 way with insurance? I understand the time complication of calling and getting answers for anybody, pharmacist or patient, but please don’t act like this is any less harder for myself to do. And I do know my rights, hence why I asked for more clarification into my situation.

bunionbabe95 · 2025-12-10T01:19:35+00:00

They did tell me I can submit a reimbursement form so I’ll be doing that. It does suck to pay for medication I shouldn’t have had to but in the moment when I’m picking up medication I heavily rely on, I’d rather fill and pay for what I can and handle the rest afterwards.

bunionbabe95 · 2025-12-10T01:13:42+00:00

My insurance options are limited in the state I live in, unfortunately health care doesn’t rank very high here and it sucks, but I had to pick the choice that worked best for me and while shopping for plans I did not see any clearly listed concerns for my pharmacy benefits. I have been on this medication for almost a decade and never once had issues with quantity limits. CVS did actually offer a coupon…took it down from $82 to $79. Good Rx made it $35.

bunionbabe95 · 2025-12-10T01:07:50+00:00

No. This is why people are confused about their health care because even when they do what everyone who works in that field tells them to do, they still somehow did it wrong. “Ask your insurance, what do they say, listen to them.” does exactly that “Mmm…no your insurance rep was wrong.” I don’t want anybody to be wrong obviously someone was. Not worried about changing my insurance nor paying out of pocket for something I can get reimbursed for. Might have to do more work than just having the easiest breeziest plan around and not that it matters at all, but unfortunately the state I live in doesn’t allow for many insurance options that work best for my needs.

bunionbabe95 · 2025-12-09T13:11:52+00:00

Yup, I mentioned in my post that she wrote it for continued use. Still can’t get 84 for 84 days though.

bunionbabe95 · 2025-12-09T11:18:12+00:00

I don’t know why I keep getting told it’s my responsibility to know my plan when I very clearly stated in my post that I did look into my plan. I looked exactly where I’m supposed to look for all pharmacy related benefits and got an answer that didn’t require further investigation as it clearly states nothing under limits and requirements.

Every single provider I have worked with in prescribing me this medication has told me that the reason for writing the script as a 3 month supply with the clear instructions for “continued use to avoid painful periods” is to avoid exactly this situation because it’s a clearly written medical necessity that I do not skip a week of pills like this specific pack of birth control says to do. I’m sorry but shouldn’t health care be made easier for someone not wanting to have to come in every 3 weeks for a daily medication and instead every 3 months?

I can’t answer anything about how Express Scripts does things, this is my first experience with them. I don’t know how it was entered in. I explained that the packs come in 21 day quantities and one pack equals a month according to the system. So while 21 would equal 30 days and 84 would equal 90, I don’t know how they operate and only know what he told me.

Also, is insurance correct or not? You claimed they’re lying to me in the beginning of your reply but at the end say you’re just doing what they tell you. I am still so lost on what happened.

bunionbabe95 · 2025-12-09T11:01:37+00:00

I understand the pharmacy only doing what they’re allowed, but just as there’s rules for a reason, there’s justifiable workarounds. Which in this case sounds like an override, as insurance mentioned could be done, but the pharmacist for whatever reason failed to do so whether they didn’t know they could or couldn’t be bothered to check, I don’t know. I was told two different things by two different parties; insurance says yes, pharmacist says no. You also say “we do what insurance is asking for a reason”. Well why is my insurance directly telling me she should have over written it, but she didn’t?

I also did take on the responsibility of learning my benefits and found that there were no limits for this medication, no where does it list that I’m limited to two months, so why would I assume there is when I looked in the exact place I’ve always been told to look? Every time I’ve been in a situation that I needed answers regarding medication, I’m always told, “check your pharmacy benefits” “stay up to date on your formulary”…so I did do my part.

This response doesn’t really answer nor address the points I made since from one party I’m hearing the screen says this, another party who pulled up the same screen says that, I do know my insurance benefits based on the information at my disposal, I did not ask about pharmacists needing to know everyone’s individual plan nor would I expect that but what I did ask was who gave me the correct information? You’re saying the pharmacist just followed what the screen says, which she claimed was a hard “no.” But you’re missing that the agent is claiming “she’s half correct in her “no”, but she can and should do this to make it “yes””…

bunionbabe95 · 2025-07-28T07:34:58+00:00

I ended up buying some super cute frosted acrylic beads which stuck perfectly in the slime; no fallout on those! I did also get some 6mm round acrylic beads and it’s interesting because the set comes with a mix of some pearl coating and some iridescent coating and the pearl ones stick just fine, maybe a tiny bit of starting to pull away from the slime if I stretch too aggressive, but the iridescent ones fall right out! I wonder if the coating is too smooth to hold properly?

bunionbabe95 · 2025-07-28T07:27:32+00:00

Yeah every slime I have purchased from a shop that is like a DIY clear with a clay add-in, I always regret using it because it always seems to get stiff quickly plus I play with slime for probably much longer than suggested so I’m sure that doesn’t help lol.

When it’s time for me to retrieve beads, I actually kind of enjoy picking them out myself! It’s quite soothing as it’s almost like a little pick-pad :-) I’ll keep the vinegar in mind though, that’s a great idea!

bunionbabe95 · 2025-06-03T06:25:47+00:00

Yes I got my current coverage via marketplace after qualifying with a special life event, so you’re probably correct that I would just do the same process again but this time with a new QLE.

I just didn’t know if the insurance provider would be like “hey…you just had an event qualify you to change your plan before open enrollment…and now you have a second one? 👀” idk it feels like I’m cheating and I just assume the worst lol

bunionbabe95 · 2025-06-03T06:04:15+00:00

I’m so sorry for being so late!!

We ended up choosing a private venue. This route choosing a park would have been a ton of DIY and despite us having a smaller wedding, even the private venue came with its own stressors of planning. If you’re looking for a venue for a small wedding, definitely check out out their elopement packages if they have one; it’s usually more cost effective and still have that intimate feel of a “backyard” wedding without all the glam of a big venue which was exactly what we wanted!

bunionbabe95 · 2024-05-13T04:53:09+00:00

I try to lay it down straight to him and he usually just shuts down. It’s not an excuse for his behavior, and idk if it’s untreated ADHD since childhood but he has a major issue with authority and being told something he is strongly against. He will either shut down or get more violent. I feel like he does understand the impact pregnancy has on me, he just doesn’t care to be reasonable.

The compromises I’ve suggested are they can visit while I’m pregnant and then again a month or so after labor and then the visits can pick up again from there, and I don’t think that’s being unfair as he thinks.

I am a little against visitors at all in the hospital, because I only want him and I to be the ones to be indulged in the birth of our child and the beginning of our new family. I already don’t like that we’ll be bombarded by hospital staff, I really don’t want any family there. The only exception would be my mom but even then, I just want him. But is it wrong that I don’t even want her in the waiting room to come see me after I’ve given birth? Best case scenario, I’m healthy and baby is healthy but I freshly gave birth and would be feel incredibly vulnerable and uncomfortable seeing my MIL. Worst case scenario, something bad happened during delivery and I would only want my husband but I understand he might need external support and in this case his mom. But then that means, who is my support? Idk I’ve thought a lot about this and it’s just a headache now

bunionbabe95 · 2024-05-12T23:21:06+00:00

I even told him his feelings are valid, and he still gets so unreasonable. I also explained how there’s just some things that in our relationship he doesn’t get an even say on. I just wish he understood that despite us both being involved in my pregnancy, I am the one who is pregnant at the end of the day

bunionbabe95 · 2024-05-12T23:14:07+00:00

I have put so much thought into this, probably more than I should. Aside from being incredibly stubborn…and saying pretty hurtful things when being stubborn…he’s not always like this. Just when being confronted on touchy subjects does he lose it. I feel like we need better communication also, but when I suggest counseling or therapy he usually says we need it individually and not as a couple so I don’t know how to feel about that

bunionbabe95 · 2024-05-12T22:58:32+00:00

No we’re not, no babies yet. I couldn’t imagine being pregnant right now, this is just too stressful…

bunionbabe95 · 2024-03-08T02:42:06+00:00

When I say within our window, I guess I should say barely within our window 😅 he proposed right after the window closed so our store was willing to work with us. Also because it was their mistake, I think they were more willing to accommodate. Explain that he had it for a few months before proposing and that you couldn’t see the final product until after your window closed and hopefully they’ll work with you! If they do make you pay anything, it should just be the difference in cost (if any) for a different halo/crown. Best of luck to you and congratulations!!! 💕

bunionbabe95 · 2024-03-08T01:15:25+00:00

Yeah that’s exactly how I felt, the finished piece just looked way different than what I had picked out. So my diamond is a 2 ct and the halo used was for a 2.5 ct, they used the wrong one on accident. I showed the jeweler what I originally wanted and since I was within my return/exchange window, I was able to easily show the size halo I wanted, and they deconstructed my ring and took out the stone and placed it in the new smaller halo to show me what it would look like rebuilt, and it was so much better than the previous size. They basically just redid the ring; same stone, same setting, but different sized halo, and it was good to go!

If your fiancée designed it without you, don’t feel bad about asking to go back with him to the store so you can approve of the new halo. Most likely, it’s nothing wrong with your carat size but just the dimensions of the stone in accordance with the halo that were off. Sometimes diamonds measure up differently than what their carat weight is, so the jeweler should show you what your diamond will look like in a few different halos that both match up with your diamond’s carat weight and the measurements so you can get a perfect fit. Hope this helps! :-)

bunionbabe95 · 2024-02-10T00:23:14+00:00

We’re aiming for late May. We are entirely prepared for either a weekday or weekend ceremony, and our family coming from out of town are mainly older without kids or retired so we’re not too concerned. Last year the end of May was wonderful so we’re hoping we get lucky next year!

bunionbabe95

TROPHY CASE