Unfamiliar with biologics, do you have to go through mail order? I get everything down the street at my local pharmacy, and like it that way. You all have had nothing but horror stories from mail orders.

I try to get everything locally too, but yes, the insurance comapnies dictate who you can get biologics from, and it's almost always mail-order, unless your name is Coaltrain, I guess. (They're telling him he HAS to go local.)

Thought I would add a link to my thread with my ongoing problems...

http://www.dailystrength.org/c/Rheumatoid_Arthritis/forum/18316143-update-rheumatologist-visit-today

Good idea for a thread altoclef - maybe some of the information shared here might help some folks avoid some of the agony of it all!

I saw that post. Optum rx or whoever is mine. Oh joy. If I switch, I can't wait to deal with them *insert sarcasm*

Thanks be to god only one problem with my last mail order pharmacy.
Optum RX.
The new one is ACCREDO with express scripts. Never been real fond of Express scripts although does save $$.

Not sure if have to use mail order, think it's up to insurance as it's considered Speciality pharmacy for biologics.
Trust me one of the forts people I spoke to at Express scripts didn't even know what Orencia was & never heard of it.
Wouldn't want her dealing with my med.

Accredo is new to me so can't say how it will go but thus far Optum RX was better to deal with. Just saying.......
Sammy

Forgot to add Accredo never sent the extra supplies they were suppose to send, also sent my Orencia when I ask them to hold off till I researched whether I would qualify for co pay assistance.
Not great start..
Then again hearing Coal & Christina's problems I'll make do...
Bless them both.
Sammy

I have Accredo and have had no problems with them. I get 3 months of Humira at a time so only have to deal with this 4 times a year.... would so much like to get it at Wal-Mart like I was last year but insurance company says mail order is the only way.

Hubby is a type 1 diabetic, and after the new year we would get 1-2 calls a day from mail order pharmacies to get his test strips... where do these people get there info from?? Now I just hang up after quickly saying, "no interested"

Good luck with your company!
Cindy

lion
they are $4000 a month or whatever amount so the local pharmacy does not always have them. the insurance companies can barter a better price arrangement with these outrageously priced meds through the specialty pharmacy who is happy to gobble up your miniscule copay.

they are injections shipped on ice overnight.

Alto, everyone wants your 4K, don't you feel special?

I have now told walgreens specialty pharmacy about 5 times that my neurosurgeon has me on hold for injections but they still call me to say hi and shoot the shit every other week. i don't know why I answer. i ask politely if the note is in the system. they say, yes. i ask then why are you calling? they don't know. I am not going to order something for refill that is on hold for surgery.

oh yeah, must be something about the $4,000 maybe that's it?

no, couldn't be

Ros

I just started Humira yesterday and luckily for me it was not a bad process with the specialty pharmacy. They got the script sent to them right at closing time on Monday. They called me at 8:30 AM on Tuesday to get the details for shippment and I got it delivered at work at about 9 AM on Wednesday. I hope it is always this easy but I am not counting my eggs before they hatch!

altoclef it sounds like the third ins is phishing for your information-but wonder how they got your contact info??

Lori-stop teasing everyone with your story...I sincerely hope it does continue for you.

I have had a call in to Express Scripts for 2 months, spoke to a manager, have a case number and everything, about a copay issue and have yet to receive a reply even with 2 follow up phone calls I made.I told the last representative not to tell me how much she understood how I feel, that she would send a message (If I had a nickel for every time I've heard that), if I would take a satisfaction survey , etc. as it does not mask the fact they have dropped the ball and not resolved anything. This is the approach these places take to hide their incompetence. Don't fall for it any of you-are they really solving the problem ??

Prescription drugs swinging in the breeze on a doorknob..just keeps getting better.

I haven't started on biologics and am sure I will have to go through them for it, anything prescribed for more than 30 days is the rule.
Oh happy day.

Altoclef: you have a way with words. Who exactly is giving away free Prednisone and Leukovorin? Weird.

Do you think the pharmacies share information?

Ros: I'm pretty certain that the $4,000 has nothing to do with the phone calls. I'm sure the pharmacy just makes random calls!!!!

Seriously: I learn so much on this site. I'm taking my third DMARD now and if I fail this one, my Rheumy told me that my insurance company won't have a leg to stand on and will have to approve an anti-biologic. He is pretty sure my insurance will make me start on either Humira or Enbrel.

Does anyone have the time to explain the process of starting and obtaining the anti-biologics? I'm starting to wonder what steps I will need to take. I have Blue Cross/Blue Sheild.

And, of course, the biggest question of all: is there a general idea of how much I can expect to pay each month.

Thanks you'll, very much.
TheWino

I'll jump in with my silly story -

Hick town (picture hick town in Texas). Walgreens - 5 druggists - one for each day of the week (remember - hick town). 'ole Blue lives 29 miles from the collection of hicks in this Texas hick town where Walgreens has 5 druggists, one for each day of the week.

Endo calls in a Rx - Endo is not a Texas person by birth (28 letters in his name with lots of R's and Z's and O's) - he does not live in hick town. Walgreens calls 'ole Blue - "Your script is ready to be picked up". Thank you says I. Get dressed, colder than a well diggers belt buckle outside, warm the van, open the gates and drive 29 miles to Walgreen's in hick town.

Walgreen's in hick town has no drive up so, you're back side is out of the van and trundle across the icy parking lot with the walker (no handicap parking at Walgreen's in hick town, that parking is at the post office, but that's another story), into the store "Welcome to Walgreen's" - Thank you says I. Back to the back of the store and there are 9 good hicks standing in line in Walgreen's in hick town.
2 fellows from way south Texas are talking about the old guy and the walker, but they are talking their native tongue so no one can understand that they are making fun of the 'ole Bluedogs2 at the back of Walgreen's in hick town. I stand patiently for some 20 minutes as the lines stumbles forward talking with the clerk who is from hick town - how do I know you ask. Her apron is on backwards and inside out - a strong indicator she is a voting citizen of hick town.
The two fellas from way south Texas are talking with her using sign language and a 3rd walks up, jumps the line and says "What's the hold, dudes?" The 1st two say - she is a hick from hick town and does not understand us - AT THAT POINT I COULD NO LONGER HOLD MY COMPOSURE - I asked them if I could help using their language and you should have seen the look in their eyes - especially when I pulled the left side of my jacket back just slightly. They were very polite and simply said, in perfect English, "WE would like $12 of unleaded".
They left Walgreen's in hick town with no gas.
It's Bluedogs2 turn at the window with the clerk who is a voting citizen of hick town, I'm here to pick up my Rx, says Bluedogs2. She says, Yes Bluedogs2 - that will be 97 cents. I give her a dollar bill and she gives me back my change, a 5, 4 singles and 3 pennies.
I look at the bottle and it is for the ENDO and my name is listed as the prescribing doctor. I told her the following 1) you gave me too much change and 2) the script label is wrong. She started crying and telling me that her boyfriend stole her cat and ran off with her motorcycle. Blabbering like a wounded whatchamacallit - the pharmacists came over and asked what the problem was. I explained the change mistake and labeling error - and he said (and I quote) Sorry, Sir, but I just moved here and don't everyone's name yet.
I did not say another word - took my bottle and their money, walked my hinny out the front door of Walgreen's in hick town - on the way, the lady said "Be well" - driving home, I called MBDs2 and told her to grab her coat, the van was warm and that Walgreen's was taking us out to eat. We did not eat in hick town. Still don't what the H*LL these pills are

Giggle and smile - it's healthy
Bluedogs2

wino

the implication was the specialty pharmacies call us to keep our renewals going - it keeps THEIR company going. the biologics are the fasting growing million dollar pharmaceuticals.

My best buddy take a $28,000 dollar medication for her MS relapse. It's name is Acthar. We were discussing how this drug rose in prise last night for MS patients. She has a relapse and has to pay $10,000 to get the med. This is her co-pay. I was reading through a New York Times article about how helpful the Achtar pharmaceutical and specialty pharmacies are:

"Questcor shifts the cost onto insurance companies while staving off consumer protests. It has a staff of 30 people who do nothing but work on insurance reimbursements about one staff member for each of the roughly 30 prescriptions it gets in a typical day for all uses."

So there will be persons at humira or enbrel to run your mock claim and get you answers.

your doctor starts the process and you fill out authorization forms for the pharmaceuticals to start to investigate.

in my case they put through a "mock" claim to test my insurance (group employer health plan) and then returned what my co pay was. as soon as I passed out from the co-pay amount they informed they had a co-pay program. I applied for that separately three times. with Enbrel, with Humira, with Orencia. oh I did that four times. Because Orencia made me do it twice, once for the at home injection program. and just recently for the infusions. For the infusion co-pay assistance (which I did not know existed for Orencia) they had me give them:

my W-2
a copy of my tax return
the latest pay stub that I had

I am now waiting to hear but my infusions can't start on orencia until cleared which would be late April.

Enbrel or Humira are first. Either one.

they have good websites with the people running through fields of daisies, free sweatshirts, trips to Morocco (kidding) free disposable needle boxes and so on

With each plan it depends. You must be on a health insurance plan. And you apply for the co-pay assistance program with each program. And a trial claim has to be run through your insurance to see what the approval level is and at what co-pay

I used to feel for all of us. But now that I have talked to my bud who needs the MS med and found out that this med used to sell for $50 primarily for infant spasms of some kind, I am deep in thought. This med gives her remission. Admission to the hospital for solumedrol drip does not. I can see where 10K is problematic. Questcor told her they are giving her a 18K discount....the insurance does not cover.

we have it good.

Ros

Bleudogs2 - thanks for the story - you've helped start my day on the light side for sure!

Dear Dr. Bluedogs

can I visit? I want to go to that pharmacy.

I'll drive.

have your wife take snapshot of the bottle with you as the prescribing doctor. enlarge it and frame it. that will make a great wall hanging

Ros