This is the biggest run around I've gone through in a long time, if ever.
My doctor gave me a script for weekly Humira, I gave that to my pharmacist, who submitted it to my insurance, where it was denied. Pharmacist called me, I called doctor, doctor called insurance, insurance asked for more info, doctor submitted more info, insurance asked for even more info, doctor submitted even more info.... That's all normal and expected, it's expensive and I don't blame the insurance for having a rigorous approval process.
Then it gets ridiculous.
The insurance company's mail-order pharmacy group called me earlier this week to tell me my weekly dose of Humira was approved. Hurray! They wanted me to get it through them, I said I prefered to continue using my local pharmacy. They said they could send it to me that day, I said I'd think about it for the future but did not want to switch to mail-order right now. They said okay. I called to get my script filled and my local pharmacist says it would not go through! What?!?!?!?
He gave me an 800 number to call. I went through three automated options each time entering my member ID, confirming it was entered properly, stating my birth date, and being transferred, only to then hear the office is closed until Monday morning. Finally I chose the option for the mail-order pharmacy group who had told me my prescription was approved. They said they could not help me, that I had to call the insurance company directly. I called them, choosing several options to reach a person, each time entering my member ID, confirming it was entered properly, stating my birth date, and being transferred, only to then hear the office is closed until Monday morning.
Ahhhhhhh!!!!!!!!!!!!!
Posted by
Jennie
on
November 01, 2008 at 7:08 AM
Categories:
Insurance,
medications
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4 comments:
Ahhh! indeed. So sorry for these complications.
Do you get a better co-pay rate when you order by mail? That's how it is with mine. I'm sorry about it because I like my local pharmacist.
Damn insurance companies!
You will have to keep me posted on Humira. My RA doc just increased my methotrexate because I am not feeling better and I have had two major flares in October. She is considering Humira or Embrol. Another is Rituxan, which my mom is using for lymphoma.
I hope you will start to feel better soon.
I've been getting my Humira through the mail delivery system and it's been working out fine. They call ahead to schedule the day it will be delivered by UPS. A few days after I receive it they call again to authorize for my co-pay. You can choose to go through your drug store, but it's very convenient to use the mail order system.
Some insurance programs will provide you with biologics only through a mail-order system they have set up with. Local pharmacies do not always manage the keeping it cold part correctly, and it is much too expensive to be mishandled. Mine always arrives in a cold pack and they check with me ahead of time for the right delivery time that will work for me. You should feel very lucky that you can get this medication paid for by your insurance. Many. many people cannot. (RA for 19 years now, on Enbrel since 1998)
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