Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
i'm seriously having trouble with this right now. i've been a fairly organized and responsible adult for the past few years (while i've been on my psychoactive medication). my mother was a customer service rep for a major health insurer for 26 years, most of my life. i know how to navigate the system.
until now.
the rheumy's office says they electronically sent the prescription. the specialty pharmacy has no idea what i'm talking about. the rheumy's office calls it in. the specialty pharma doesn't have it but requires it to be faxed in. the rheumy's office closes for FOUR DAMN DAYS because of a few inches of snow. this morning they said they'd fax it in. i call the specialty pharma and they said it could take up to 72 hours for someone to TAKE IT OFF THE FAX MACHINE.
flabbergasted. i'm calling you and telling you they said they faxed it - get up and walk to the damn fax machine and pick it up and PROCESS IT.
then the rep from the specialty pharma says i probably need prior authorization so it won't matter anyway. but she can't see that part of my benefits so i have to check with someone else.
i'm supposed to take enbrel again the day after tomorrow. i've been fighting this back and forth crap since 12/27.
i called the member services number on my card for pharmacy services and they TRANSFERRED ME TO THE SPECIALTY PHARMA WHO CAN'T HELP ME.
at this point i was ready to gouge my own eyes out. i called the regular member services number. i give her the very short version - i've been going back and forth with the dr and the specialty pharma and i want to see if enbrel requires prior auth. she says i see the rx here, your dr sent it to the wrong place. she put me on hold for a bit and just came back on letting me know that she's going to get the regular pharma and specialty pharma on the call together and have them transfer the rx from the regular place to the specialty pharmacy. but they can't conference more than three lines so i have to drop off and she'll call me back.
um, what? so my rx has been sitting there doing nothing and no one noticed. a script was sent to the regular mail order pharmacy - a script they couldn't handle - and no one thought to call and follow up on it.
i really hope this giovanna calls me back. otherwise i'm going to lose my damn mind. as it is, i'll probably have to skip this week's enbrel dose - which freaks me out because what if that messes everything up? seriously. so my script for enbrel syringes has been sitting there since 12/18/13 and just sat there. no one did anything. even with the five calls to aetna that i've made, no one thought to check with the 'regular' pharma team. i told them every time my doctor electronically transmitted it in front of me on 12/18/13.
anyway. i think i deserve a nap now. of course, the phone will ring as soon as i drop off, i'm sure. damn it.
until now.
the rheumy's office says they electronically sent the prescription. the specialty pharmacy has no idea what i'm talking about. the rheumy's office calls it in. the specialty pharma doesn't have it but requires it to be faxed in. the rheumy's office closes for FOUR DAMN DAYS because of a few inches of snow. this morning they said they'd fax it in. i call the specialty pharma and they said it could take up to 72 hours for someone to TAKE IT OFF THE FAX MACHINE.
flabbergasted. i'm calling you and telling you they said they faxed it - get up and walk to the damn fax machine and pick it up and PROCESS IT.
then the rep from the specialty pharma says i probably need prior authorization so it won't matter anyway. but she can't see that part of my benefits so i have to check with someone else.
i'm supposed to take enbrel again the day after tomorrow. i've been fighting this back and forth crap since 12/27.
i called the member services number on my card for pharmacy services and they TRANSFERRED ME TO THE SPECIALTY PHARMA WHO CAN'T HELP ME.
at this point i was ready to gouge my own eyes out. i called the regular member services number. i give her the very short version - i've been going back and forth with the dr and the specialty pharma and i want to see if enbrel requires prior auth. she says i see the rx here, your dr sent it to the wrong place. she put me on hold for a bit and just came back on letting me know that she's going to get the regular pharma and specialty pharma on the call together and have them transfer the rx from the regular place to the specialty pharmacy. but they can't conference more than three lines so i have to drop off and she'll call me back.
um, what? so my rx has been sitting there doing nothing and no one noticed. a script was sent to the regular mail order pharmacy - a script they couldn't handle - and no one thought to call and follow up on it.
i really hope this giovanna calls me back. otherwise i'm going to lose my damn mind. as it is, i'll probably have to skip this week's enbrel dose - which freaks me out because what if that messes everything up? seriously. so my script for enbrel syringes has been sitting there since 12/18/13 and just sat there. no one did anything. even with the five calls to aetna that i've made, no one thought to check with the 'regular' pharma team. i told them every time my doctor electronically transmitted it in front of me on 12/18/13.
anyway. i think i deserve a nap now. of course, the phone will ring as soon as i drop off, i'm sure. damn it.
How do people afford these part payments?
i'm literally on the phone with them now to confirm this crap. they said someone would call me today with the copay info and it would deliver tomorrow. she just confirmed the script is there but now they want precertification. aetna states they called my doctor's office for it and my doctor's office has no record of it.
i don't even know what to do anymore. i was able to get through to my rheumy's office moments before they closed and they said they have a couple of samples set aside for me that i can pick up tomorrow. which i appreciate, i do.
my problem is that no one except me knows what anyone else is doing. last night my prescription was confirmed to me that it would be delivered via UPS tomorrow. and now i'm being told that was erroneous information i call the rheumy and they said they resubmitted the entire thing to start the process over because it was so messed up. if i hadn't called today to verify the info and ask about my copay, i would be sitting at home tomorrow waiting for UPS to deliver my enbrel. if i didn't know how f*cked up the system is, i would never have called to verify the info.
we each need to be our own advocate. no one at the insurance company gives a shit about us - we have to do the work ourselves.
One call after another.
Speciality pharmacy blamed Dr office & vice versa.
2 days of calls back & forth.
Any one would loose their patience. It always comes down to someone not doing their job.
Depending on my mood & the attitudes I'll ask for the supervisor.
At the very least I get to complain.
It's bad enough to be in pain & feel like crap. Who wants to deal with that mess.
Sammy
I am very lucky with my insurance and my pharmacy. I don't know if this is an option, but maybe try to find a small, local pharmacy that can take better care of the prescriptions, refills, authorizations, and plan formulary, etc. Mine doesn't keep enbrel in stock, but I call and give a few days notice and they have it for me. When try tried to run it at first they told me about authorizations and costs involved, rather than my having to deal with the insurance. Small pharmacies often work harder for their customers and I always find them to be more personal and helpful. Keep strong everyone and keep fighting.
i touched base with my rheumy's office *again* on thursday or friday and told them they had to call in the prior authorization. i called the specialty pharmacy today and IT IS THERE. it's been authorized, with a $40 copay (thank whatever prescription gods) and can be delivered tomorrow, which is when my next shot is supposed to be. HOWEVER we have that ridiculous storm going on here so we thought delivery thursday would be a better idea, just in case.
i confirmed my information, they asked if i wanted alcohol wipes or a sharps container, took my payment, asked if i had any questions, and that was it. it was that easy.
really? all this crap, this back and forth, this people-not-calling-me-back, and we're done?
so thursday i'll have my pre-filled enbrel syringes for the month. and a fancy sharps container instead of the empty protein powder container i've been using. i'm hoping to decorate it with stickers.
I currently (and for the past 3 years) receive my Humira FREE through Abbvie Patient Assistance Foundation. Every year, my doctor and I have to resubmit the paperwork, and every year I have the same issues you mentioned. It is so frustrating?!?!?!M#ON$Oi
This last time I was in tears, thinking I was receiving my 3 month supply the next day, only to be told they needed a scrip from the dr. I was already 2 weeks late on my shot, and in so much pain. I called my doctor's office and told them the issue, which we had been working on issues with the pharmacy for over a month. I begged them to let me come in the next day for a sample of Humira, and she gladly obliged.
I felt like an idiot, but dealing with this shit can drive me insane!
I have not yet signed up for ACA, but have looked into several of the plans and get exhausted trying to figure it out.
My advice is to remember that your doctor's office receives sample drugs from the pharma reps, and they should be willing to give it to you when in desperate need.
i COMPLETELY forgot about the assistance program. guess i should call them and see what i should do.
Definitely check on the assistance program. I just started on Humira (after Blue Cross denied Orencia, which caused a 5 week delay-don't get me started!). The company sent me a card, which when activated, leaves me with a $5 copay on a 3 month prescription which is over $9000. Walgreens then sent a "talking trainer injector" for me to practice with. Want the red biohazard container for my used needles-that would be really cool! Meanwhile, my family knows not to touch the $8500 worth of drugs in the fridge! Hope that things are going better,
Patrice
You stay warm and cozy up there on LI - looks like a doozy headed in there - I saw these puppies when I was working out of Clifton Park and they ain't no fun
Stay safe
Bluedogs2