10 replies to this topic

[blueheron]

Once again my refill is being held up by the insurance co. Anybody else go through this on a regular basis? I have to get overrrides for my Sprycal every few months, and this time there seems to be some real problem, but nobody can really tell me much more than "we're still waiting for the override" Refill ran out last week, and no meds have been sent yet.

[Gail's]

Good grief. Let the pharmacy know. Occasionally they can give you an emergency supply and then deduct it from your supply when you pick it up. I would notify the dr office right away. They will want you to stay on it continuously and may be able to kick some butt with your insurance.

[blueheron]

Thanks Gail's, I appreciate the response. I just wish for once I didn't have to fight for a basic continuous supply of meds.

[dchicago]

I'm on Gleevec. Seems like every 6 months there is a price increase that triggers a insurance reject that requires another prior authorization. When that happens, I contact my Dr's office and ask them to contact insurance company to try to speed things up.

[blueheron]

Thanks dchicago, I was able to escalate this today so hopefully it will go through like normal. This just feels really wrong that they can delay like this, cause this kind of needless anxiety, like we don't have enough to worry about already!

[chriskuo]

Who do you get your insurance through?  If it is your employer, you should escalate with them.

 

I found that to work well when the insurance company (which the employer contracts with) was not pricing the copay correctly.

Eventually, the insurance company assigned me a real person who gave me her direct phone number if I had any future problems 

and I have contacted her several times since.  The customer (your employer) can often carry more weight than you youself.

[blueheron]

Thanks Chris, it's an individual policy, grandfathered in under the ACA. But my understanding is that since it was grandfathered, it meets the standard of the ACA and as such the Sprycel should be covered. It seems the account manager is unreachable, or ignoring the override request.Hopefully yesterdays conversation with the supervisor at the specialty pharmacy will yield resuts.

[blueheron]

UPDATE - resolved! Getting shipment for tomorrow. $20 copay! Thanks everybody for your input, suggestions and support, I really really appreciate it. What a relief!

[rcase13]

It is just cancer medication. I don't see the need to rush. It isn't like we need it to survive...

[Gail's]

Or that we would be cheaper to supply with pills instead of ICU bills when we suffer then die.

[rcase13]

Actually, hmmm it would be cheaper if we up and died... Considering it cost roughly 10k per month for TKIs...