I’m even sure who’s to blame.
I have a specialty injectable medication I take for GI problems. I’ve been taking it for years. It has to be shipped from a specialty pharmacy.
I’ve sometimes had problems with getting it filled in the past, so what I’m about to describe isn’t something new, although it’s on a whole new level of FUBAR this time.
On December 17, I called the specialty pharmacy because I only had a couple of weeks worth of medicine left. I had 9 refills left. They said they would okay it with my insurance and call me back about shipping.
A little while later they called me back and said that it required a new authorization and that they would be calling my doctor’s office.
This set off alarm bells in my head because I’ve had problems getting this medicine numerous times in the past. Several times I’ve ran into huge drawn out bureaucratic snafus when attempting to get this medicine.
The last several times, the broker that I get my insurance through has managed to quickly straighten it out (they serve as a healthcare advocate). One woman in particular has always been extremely good at straightening things out. So I immediately sent off an email to her explaining the situation. A while late I got a response from a different person saying that she was no longer with the company but they’d be happy to help me. They said that they would contact the doctor’s office to make sure that the proper authorization was sent.
Over the next couple of weeks I went back and forth between the broker, the pharmacy, and the doctor’s office. The pharmacy repeatedly told me that they had not received the authorization while the doctor’s office repeatedly told me that they had sent it. This dragged out for so long partly because that time period spanned two long holiday weekends.
Finally, the broker found what was apparently the problem. The pharmacy was sending the doctor the wrong fax number when asking for the authorization. She said she had given the correct number to the doctor’s office and that they said that they would take care of it.
So then the doctor’s office sent the authorization to the proper number… I think.
The pharmacy then, after days of this, realized that “Oh hey, we don’t ship that medication any more, you have to contact the insurance company to find out who does”. Why didn’t they realize that right away, and why didn’t Blue Cross tell them that when they asked for authorization?
So then the question was, where do I get the medicine from? The broker, after checking with BC, told me that I could get it filled at my local pharmacy. I was skeptical but I figured fine, I’ll call them.
I called my local CVS, which I use regularly for other prescriptions, and explained the situation. I also explained that it was a specialty medication that they would have to order. They told me to call the other pharmacy and have them transfer the prescription to them.
I did so and a while later CVS called and said that they could not order that particular medication and that they would transfer the prescription back to the original pharmacy.
After throwing things around and kicking things for a while I managed to calm down… I emailed the broker and explained the situation. She said that she would look into it and get back to me. That was yesterday. Last night, around 7:00 (she actually worked overtime on this) she called and said that it should be ordered from CVS specialty mail order pharmacy. This sounded right to me because this was the pharmacy BC used to have me use before switching me to Acro. The broker told me that I would be contacted in the morning by a gentleman (presumably from CVS) to arrange things.
This morning, no one called, so I emailed the broker. She said that she would look into it. Around 5:00 this evening she finally got back to me. She asked me if the type I used was LAR (long acting release) or not. My first response was something like “they have the freaking prescription, can’t they read it? No, it is not LAR”. She then said that if it was LAR then it would be direct ship, otherwise I should just get a prescription and take it to my local pharmacy. :eek:
I explained to her that I had already tried that per her colleague’s instructions and that they were unable to order it. She said that she will look into it in the morning.
So I tried to get a refill in plenty of time. Now I’m down to a tiny bit at the bottom of the bottle. I normally titrate the amount I take based on symptoms, so I’ve been rationing it and suffering somewhat in an attempt to not run out completely. As a result I’ve been feeling poorly for the last few days, I’m eating nothing but things like yogurt, jello, and poached eggs, and I’ve lost 6 pounds, probably due to fluid loss.
And at this point I have little hope that this will be resovled tomorrow and the weekend is approaching.
I think I may call CVS Specialty Pharmacy and see if they can get the prescription and sell me one vial that I’ll pay for out of pocket.
This is fucking ridiculous. I am at my wit’s end.