A few weeks ago I started a new job (hooray!), which of course has the downside of changing my medical insurance. I’ve been through this game before, so I know the drill: couple weeks to let the enrollment processing get done, a week or two to get my medications re-ordered from my doctor and the expensive one to be yanked away from my local pharmacy to the insurance plan’s specialty pharmacy, a week or two for their bureaucracy to work through, and viola! I’m overdue taking my med by 2-6 weeks (depending on how many BS delays there are). So, yes, I’m going through that again now.
I have a special pitting for pharmacy management companies. They claim they’re there to help patients get cost-effective care, but I’m convinced they’re there to save money by dragging their heels. But that’s a digression, today my beef is with my doctor’s office. The expensive medication in question is Enbrel, a refrigerated biologic that’s dosed in once a week injection.
I’m now 4 weeks overdue in taking my “next” dose because of the insurance change. I called the specialty pharmacy last Friday and they said they were waiting for clarification from my doctor. I tried asking them what they needed, and the lady just hemmed and hawed. I gave up and called my doctor’s office. They didn’t give me any clues either, but said they’d fax the rx again.
I called the pharmacy again today (Tuesday) and they were still “waiting for clarification”. This time I told the lady that I was 4 weeks overdue on my meds so I just wanted to facilitate this as best I could, so what exactly did they need. She said they needed to know the dosage, refill amount, etc. Typical info that’s on every prescription so in my head I was like “wut?” So I got their fax number and called the doctor’s office again.
As I was trying to explain the problem to the doctor’s office I realized what the problem might be. I speculated that they were faxing the rx to my local Wegman’s pharmacy instead of to CVS specialty pharmacy. She looked it up and confirmed that’s what they were doing. So I gave her the CVS specialty fax number, and I think - HOPE - the problem is solved.
But come on people… you’re a rheumatology doctor’s office, so you prescribe things like Enbrel on a daily basis, and you don’t KNOW that the insurance companies only fill it through their specialty pharmacies? Worse, you were not responding to them when they contacted you!? Asshats!