Anyone ever deal with a Medication not in the Drug Formulary?

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Anyone ever deal with a Medication not in the Drug Formulary?

Post by atarijedi on Thu 13 Jul 2017, 17:55

I've been prescribed 3 medications, 2 of which are in the formulary but VAC won't cover for me yet (appeals are so slow). But one of them, called Durela (Tramadol), isn't in the formulary at all. All 3 medications are for my entitled condition, the 2 which are in the formulary, but not covered, VAC said they could't link it to my condition (one is a muscle relaxant with significant drowsiness side-effects, the other is a wakefulness promoter).

I've already contacted VAC via MyVAC to try and get the process started. I have moved (VAC knows) and I don't know who my new Case worker is, I've tried contacting them through MyVAC as well, no response yet.

So I was wondering if anyone else has dealt with this situation, and whether they had a good/bad outcome, and about how long it took? I feel like I'm going to have to start contacting the Ombudsmen, my MP, and MP Kent Hehr if it continues to take so much time. Paying full price for medication ain't cheap!

atarijedi
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Number of posts : 12
Location : Greater Toronto Area
Registration date : 2017-02-28

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Re: Anyone ever deal with a Medication not in the Drug Formulary?

Post by Guest on Thu 13 Jul 2017, 18:49

atarijedi wrote:I've been prescribed 3 medications, 2 of which are in the formulary but VAC won't cover for me yet (appeals are so slow). But one of them, called Durela (Tramadol), isn't in the formulary at all. All 3 medications are for my entitled condition, the 2 which are in the formulary, but not covered, VAC said they could't link it to my condition (one is a muscle relaxant with significant drowsiness side-effects, the other is a wakefulness promoter).

I've already contacted VAC via MyVAC to try and get the process started. I have moved (VAC knows) and I don't know who my new Case worker is, I've tried contacting them through MyVAC as well, no response yet.

So I was wondering if anyone else has dealt with this situation, and whether they had a good/bad outcome, and about how long it took? I feel like I'm going to have to start contacting the Ombudsmen, my MP, and MP Kent Hehr if it continues to take so much time. Paying full price for medication ain't cheap!

You are dealing with Treatment Benefits under prescription medication.

Each time you are prescribed a medication for your pension condition you need to have the doctor who filled the prescription state that the prescription is for your pension condition. You need to have a letter written by your doctor stating that. You contact VAC through my VAC Account asking them to send you an approval form for that medication, you fill and send along with the doctors letter to VAC and wait for the response. If not approved, appeal on the basis of the letter written by your doctor.

This is what I was told to do a couple of years ago, I never bothered as their process is so screwed up, they can take their process and shove it. Mind you, the meds were not expensive.

At one time back in the old PA days, it was just a matter of your doctor faxes or sending a letter to Medavie Blue Cross and bob's your uncle, it was as simple as that. Now days, they want to make things real hard on the disabled Veteran, why? so they can ensure enough long term employment for themselves. Those in charge, like Hehr, have no clue what's going on, and they themselves, cannot be bothered with it as they believe what they are told by the bureaucrats, cushioning their own security.

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