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14 Replies Latest reply: May 25, 2012 12:18 PM by Susan61 RSS

trouble with insurance and speciality pharmacy

dee145 Registered Users
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Does anyone else get their Gleevec from a company called Accredo?  I was told in march I needed a new prior authorazation so in April my onc. and his nurse did it while I was there.  I called for my Gleevec yesterday and now they say my onc. has to go thru a place called Coventry first for the authorzation then fax paperwork back then call Accredo after that.  This is the first time I have ever had to do this.  I just called Accredo and got my Gleevec.  I have been PCRU since July of 2010 but now with this mess and the holiday coming up I may run out of Gleevec....I dont want to come out of remission cause of this mess and missing pills.  I was there when my onc. and his nurse did this in April so I don't know why they don't have it.  I am so worried!!!!  It was so much easier with the insurance that my husband had before this one.  We have Health America since Oct. of 2011 and I have never had to do this before.  Was just wondering if anyone has these issues to and if anyone has this company Coventry and Accredo.  I think Coventry is my health insurance and they have to approve it and then send to the speciality pharmacy called Accredo if I understood right.  Then I have to call Accredo and order it.  My onc. is working on it as we speak but hes not happy cause he did it in April and they should of gotten everything.  I am really worried about missing pills....

                                         Thanks, Dee

I have anxiety already and now this just makes it worse!!!!!

  • Re: trouble with insurance and speciality pharmacy
    CML_in_ATL Registered Users
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    I dealt with this mess when getting my initial script in place post-dx (when anxiety was at its highest!), and what I found was that I had to be the broker and make all of the calls, and I had to be insanely persistent with everyone (doc, speciality pharm, insurance, etc.) until it got done.  Multiple calls per day to everyone to make sure the process didn't break down.

     

    Although your onc is "working on it", their office is probably juggling a lot of stuff in parallel, so my advice is to take matters in your own hands and start calling everyone to broker this efficiently.  That's what I had to do, because I found that the onc's office had poor communication with the insurance company which caused early delays, etc.  Once I jumped in and started hammering everyone, the script was approved and in place within 48 hours.

     

    Of course, you don't want your own involvement to slow things down, but if it were me, I wouldn't rely on the onc's office to handle this swiftly ... although they might.  Calls to insurance to understand the process, who needs to talk to whom and when, what they are waiting on - find all of this out, then start calling and push folks to make things happen.

     

    Good luck! 

    • Re: trouble with insurance and speciality pharmacy
      dee145 Registered Users
      Currently Being Moderated

      I did call all these places I listed last evening and i can't do anything myself....onc. office has to do it all.  believe me I was on the phone right away!!!!  I am so worried if my pills don't come on time i will come out of remission..all I can do today is shake and cry.  My onc. is very good on getting things to me if I need them so I am hoping it's working the same on this matter.  He saved my life from a bad onc. i had so I trust him and he calls me himself when I have a question about stuff..not many drs do that so I hope he is doing this for me and fast too.....thanks for your reply..

                                               Dee

      • Re: trouble with insurance and speciality pharmacy
        Tedsey Registered Users
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        Dee,

        I don't think missing a few pills will change your PCRU status.  Try not to stress out about that!  And even at the remotest chance it does, as soon as you take the TKI again, you will likely return to PCRU.  I just don't thing things work that fast with this disease.  I think you would have to be off the drug much longer. 

         

        Take care.

  • Re: trouble with insurance and speciality pharmacy
    cberwick Registered Users
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    Accredo is a speciality pharmacy. The insurance companies go through a single pharmacy for expensive medications (brings their costs down by getting volume discounts). From time to time they can also change speciality pharmacies. That said, it is unacceptable that you should run out of Gleevec. It's not like this is allergy medication!

     

    Call your insurance company informing them that you are about to run out of Gleevec and go without treatment. Explain what you've done to get your prescription filled. I would stress that due to their "red tape" you are about to start missing doses of this life saving medication. Request emergency assistance. You should probably ask to speak to the supervisor. Tell them about your remission. Make it very clear. You should also follow up with a letter, you can probably fax it to them, putting them on record of the situation.

  • Re: trouble with insurance and speciality pharmacy
    billronm@roadrunner.com Registered Users
    Currently Being Moderated

    Hi Dee,

    I get my scripts from medco, and my Sprycel from Accredo.  I got a letter from Medco in April, that they are switching  us to cvs caremark. July 1, and I just got a letter from cvs specialty care that they will be taking over for Accredo,July 1,.And that I do not need to take any action at this time (yeah right). This ought to be fun. But in the 5 years that I have been with Accredo they have always been very considerate, and very concerned that I don't run out of my Sprycel. They even sent me my Sprycel early in December,because I was going to Florida, and my refill wasn't to be refilled until January. So I'm sure if you call them and tell them how worried you are about running out of your Gleevac, they will make sure that doesn't happen. I sure hope cvs is as understanding as Accredo was to me. Try to calm down, I know it isn't easy,but everything will be fine.

                                                                                                        Sincerely Billie

    When I went off Gleevac,My Onc didn't have me start Sprycel for 5 weeks. That was a nice 5 week break!

    • Re: trouble with insurance and speciality pharmacy
      Marnie Registered Users
      Currently Being Moderated

      Hi, Dee. . .prior authorization is a pain. . .been there, done that.  Make sure you put the date on your calendar, because typically you need to do a new one each year.  So I always started the process well before the year was up.  Your doc will have to do the work, but (as others have said) you can do a lot by being vigilent and persistent with phone calls.  It may take a lot of phone calls.  Different insurance carriers have different rules for meds.  My current plan does not require prior authorization, which was a surprise to me.

       

      Try not to worry (easier said than done).  Missing a few doses of Gleevec won't affect your numbers much, if at all.  Being off your meds for months might. 

       

      Some policies allow for a 90-day supply, which is a lot handier than ordering every month.  You can even build up a little bit of a cushion by finding out how many days must pass before you can order your new meds.  With my plan, I can order a 30-day supply every 25 days.  I order as early as I can and try to build up a little cushion, which would give you peace of mind in a situation like the one you have now. 

       

      Good luck,

      Marnie

      • Re: trouble with insurance and speciality pharmacy
        billronm@roadrunner.com Registered Users
        Currently Being Moderated

        Hi Marnie,

          How are you doing?  Good I hope. I want to send you an e-mail, but my goofie Aunt from Arizona came out to visit me last Saturday,and she grabbed my laptop to check her e-mails at home, and ever since that I haven't been able to receive any e-mails,and I don't know if anybody receives e-mails I send out. Everytime somebody touches my computer they screw it up. And this windows 7 seems to be a mystery to everyone.

        She's very good with computers (hers). So I'm trying to track her down, she's been visiting different relatives. She has her laptop with her, but I guess she hasn't had access to wireless where she is visiting. And she's not checking her messages on her cell.Uggg.

        I'm curious to see how crazy this new prescription plan is going to be for me. When someone sends me a letter and says don't worry,we'll take care of everything, that's when I start to worry! Did you get your ins. straightened out again? I sure hope Dee hears something tomorrow,poor Lady doesn't need any more on her plate. I'm thankful for Ins. Companies, but I wonder how many people they kill every year just by the stress they cause us.Well last months bw didn't let me get the decrease in S, but I had the bw done again today so I'm hoping this month will be better. And YOU have to hang up your Kayak, 3 cases of flesh eating bacteria in a month! That's scary. I'm glad I didn't go swimming in Ga. You're fighting cml so you're probably prime meat for those little flesh eating little bastards! Ron is just starting to feel better now, ever since he stepped on that

        jellyfish in Fla. he really hasn't been up to par. And that was in Feb. of course he wouldn't go to the doctors. Take Care and stay out of the water. Lots o Luv Billie

        • Re: trouble with insurance and speciality pharmacy
          Marnie Registered Users
          Currently Being Moderated

          HI, Billie. . .I sent you an e-mail a week or so ago, but maybe you didn't get it.  I have been crazy busy with end-of-year stuff and packing up the classroom, but today is the first real day of summer vacation so life is good.  Now tell me why I got up at 6:30 and started working on school stuff.  Next order of business is to clean the house.  It's a disaster.  Then pack up for a weekend motorcycle/camping trip.  Hope you get your e-mail figured out.  Then I won't have to hijack an LLS thread to chat!

           

          Take care, and I hope Ron recovers fully soon.  Dang!  That must have been some jellyfish!

           

          Marnie

    • Re: trouble with insurance and speciality pharmacy
      HeatherZ Registered Users
      Currently Being Moderated

      My specailty pharmacy is CVS Caremark and I have nothing but good things to say about them.  I have not had to call for a refill - they call me about a week before it is due and set up a day for delivery.  That is noce because I can then make sure it is delivered on a day me or my husband will be home.  They also ask if I want it left on the porch or if I want to sign for it.  I have only been going through them for a few months but so far everything has been smooth sailing.  I have to admit though, the first time I got my pills from them and saw the ziploc baggie with the biohazard symbol and "Caution Cemotherapy Material" I was taken aback (and my husband freaked a little too) but it has been so much better than going to my local retail pharmacy for my pills.  Hopefully you will have the same experience I do with them.

  • Re: trouble with insurance and speciality pharmacy
    Susan61 Registered Users
    Currently Being Moderated

    Hi Dee:  I have Accredo Pharmacy, and I just had to do the same thing.  They sent a authorization to me, and I had to forward it onto the doctor, and she took care of it immediatelly.  They notified me that it has been received and approved.  Did they tell you when you will get your Gleevec.?  If you are PCRU since 2010, and just have to wait a few days for your pills you will not lose your response.  Sometimes people need to take a vacation from their TKI drugs for various reasons.  Sometimes due to other sicknesses etc.  Before you get yourself all worked up, find out just how long you have to wait.  They overnight it to you once its all set up.  When they call me to tell me I am due for a refill, I let them know what day I can be home for it. I get my order UPS, and I have to sign for it.  They are never late when they give me a day that they will be here.

         I know they are switching to that Caremark soon like Billie said, and I wonder how efficient they will be then.

         There have been a lot of people having problems with insurance and getting their meds on time.  Please let us know how you make out.

    Susan

  • Re: trouble with insurance and speciality pharmacy
    Tedsey Registered Users
    Currently Being Moderated

    Dee,

     

    Dee,

     

    I know how annoying this is.  I have to use Accredo too.  They used to leave me messages to reorder the TKI.  When I talked to them, they happily refilled my order.  Then, I would get a call minutes later saying if I didn't pay the amount in full, (some insanely high number), they would withhold sending the drug.  Nice words to hear when you need the drug to live (and esp. when you are first dx and your world is falling apart).  Very cruel.  They have screwed up my script processing before, (but they actually admitted this, so at least they took responsibility).  It caused a delay in getting my meds (that's why I always tell them I have much less than what I do when they call and ask).  Anyway, check and see if your insurance will dispense medication in an emergency (you doctor should know how to do this).  That is what I have had to do a couple times.  It means your doctor tells them you need the meds immediately and you pick it up locally within hours.  They may only pay for 2 or 3  pills, but the amount will cover you until they will send you your whole order.  Clearly, this costs Accredo more because they have to pay for the meds through another pharmacy.  Nevertheless, it a consequence of sorts (for them) due to their illogical policies and and management's incomprehensible problem solving skills.  Wishing you the best of luck with this.  You will get your meds!  Just keep on it.  I always end up getting mine.  You just need your onc on your side.  By the way, I take this all in stride now.  It used to make me cry and go into a panic attack.  It doesn't anymore.  It is annoying, but I know how to get the meds.  There is absolutely nothing personal in it. 

     

    Take care,

    Tedsey 

  • Re: trouble with insurance and speciality pharmacy
    HeatherZ Registered Users
    Currently Being Moderated

    If you are worried about missing some doses, you can come over to my house and I'll give you the number you need until your arrive.  I have a couple week cushion that I have built up because the specialty pharmacy always sends mine out more than a week before I actually need them.  You can return the pills when yours arrive

  • Re: trouble with insurance and speciality pharmacy
    dee145 Registered Users
    Currently Being Moderated

    Well, my onc. must of done his job cause my pills will be here tomorrow!!!!   Thanks to all the advice and to Heather Z for offering me some meds till mine got here.  I am now good until Sept. for authorzation...big relief!!!!!

                                             THANKS AGAIN TO EVERYONE!!!!!               Dee

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