19 replies to this topic

[r06ue1]

Is this a yearly thing?  CVS Caremark is refusing to send this months medicine because they want another one.  Had to go through this last year when I started Gleevec and this year is no better.  Just want to see if everyone's insurance requires this or if it is CVS Caremark only.  

 

If I had to guess, this is a cost savings measure only (got to keep those profit margins in good shape).

[Frogiegirl]

It's a yearly thing. ....always something.

[rcase13]

Yeah been on CVS Caremark for two years. I am not impressed. I did find if i used my local cancer centers pharmacy it is a lot easier. They are use to dealing with prescription plans that are less than scrupulous.

[r06ue1]

I may try that, thanks rcase13!

[Marnie]

Yes, it's a yearly thing, but it's not that big a deal.  Just have your oncologist fill out the paperwork and send it in.  His/her nurse or PA should be able to do it in a matter of moments.

[Frogiegirl]

Fortunately the mail order pharmacy I'm required to use usually sends a notice to my oncologist a month before I need the prior authorization, so it doesn't become a problem. But they dropped the ball on that one last year. I wish it only took a matter of seconds. I went 3 or so days without meds, they have to communicate with the doc the insurance company and the mail order or specailty pharmacy. The only way its quick is if your treatment center is the one filing your perscription:( they just call up to the doc.

[Billie Murawski]

Hi Frogie, Every so often I get a bunch of bs about prior authorization on prescricptions that I have been on for years, and my doc calls them in about every year to refill the script, then I get a letter saying my script was denied because of prior auth from my doc. What the hell! My doc just called them and told them to fill it. So then I have to bother my doc again. Yup CVS. Then every month I have to order my sprycel and go through the same thing over and over. That's cvs specialty drugs. There have been times when I had a problem getting one of my scripts and I call they take my info again, I'm told that everything is straightened out then I get denied again.UGGh!!

I request that they give me the same operator every time so we can talk one one on one, they say they can't do that but all the info goes into the same computer system. There are times when I have been reduced to tears out of frustration. Good luck Billie

 

I'm so thankful I have the ins coverage, but sometimes I feel like I'll lose my mind dealing with these operators 

[hannibellemo]

Maybe there is an upside to Medicare, I can order my drugs from my regular pharmacy and bypass specialty pharmacies. I will still need prior authorization yearly but I've never really had a problem with that in the past.
I use HyVee Specialty and just like the HyVee grocery chain they are very customer oriented. I've used several others in the past that weren't so helpful.

[Gail's]

I know some insurance companies require that CVS but from what I am reading from you all, I'd use any other pharmacy if possible. I hope your insurance company is getting lots and lots of feedback about the crappy care from CVS. Maybe when their contract expires with CVS they would choose another pharmacy to direct their members to. The insurance companies are intensely competitive with each other and member satisfaction sells.

[Buzzm1]

For 2017, the generic imatinib mesylate is the only TKI included in the Kaiser Permanente Formulary.

[rcase13]

Well my luck ran out. As you know from my story above I was unable to get CVS Specialty to fill my prescription. I ended up getting the pharmacy at my cancer center to fill it. But CVS Caremark won't allow that anymore. It has to be filled from CVS Specialty. So far we have been unable to do that and I have been unable to figure out why. They just tell me it isn't in the system correctly but won't tell me  how to correct it. My doctor is at a loss as he sends it in the way he does for everyone else. The manager of the pharmacy at my cancer center is going to see what they can do.

 

So if you have the choice when picking plans I would stay far away from CVS Caremark. Which I guess in the end is what they really want. They don't want cancer patients on their plans. So if they can make the process difficult they will. I hate to be a conspiracy theorist but the timing of all this is suspicious as it is that time of year when everyone is picking plans from their work providers.

 

it make me so mad because i will more than likely will end up missing some days. I haven't missed a day in the two years since diagnosis.

[Buzzm1]

For 2017, the generic imatinib mesylate is the only TKI included in the Kaiser Permanente Formulary.

 

The good news, if it holds true, is that for 2017 generic imatinib mesylate is scheduled as a Tier 2 drug in the Kaiser Permanente Formulary.  Tier 2 drugs are $15 per Rx.  Kaiser only allows costly prescriptions, such as TKIs, to be filled on a 30 day basis and they must be picked up at the pharmacy as they don't permit mailing of costly prescriptions.

 

Forgot to mention that, for Medicare, Tier 5 drugs, which Gleevec is, required a 25% copay up to the Donut Hole (for 2016, the Donut Hole is $3,310 to $4,850, with a 45% copay during it).  For 2017, Gleevec, will require a 33% copay up to the Donut Hole (for 2017, the Donut Hole is $3,700 to $4,950, with a 40% copay during it).

[jrb666]

CVS Specialty is the worst. I've had nothing but problems. I finally got them to fill my Tasigna Rx, but it was a struggle. The paragraph below is from their website. I called the number, and asked for  the "Department of Performance Improvement", as instructed. The person who handled my call had no idea what I was talking about, but eventually transferred me to someone I could complain to. They had all my information, prior authorization, etc., but my claim was rejected because of a "computer problem", which made no sense. The claim was approved by the time I got off the phone.

 

If you have a complaint or concern about the care you are receiving, please contact the manager at your designated CVS Specialty pharmacy. If the designated CVS Specialty pharmacy does not handle your issue to your satisfaction, you can call toll-free 1-800-237-2767 and ask for the Department of Performance Improvement. CVS Specialty is committed to providing the highest quality of care available to patients. In a continuing effort to improve our services, you may be contacted by a third party for the purpose of assessing your satisfaction with our services. If you believe that you have pertinent and valid information regarding the services provided by CVS Specialty, you may call the Joint Commission toll-free at 1-800-994-6610 or write to The Office of Quality Monitoring, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181.

 

I spent almost 45 minutes with them on the phone today. My co-pay assistance card expired. Instead of contacting me to let me know, they sent me an invoice for my copay. I straightened it out, got re-enrolled, provided them with my new copay info, or so I thought. When I called today I found out that nothing has been updated.

 

That has been an ongoing theme....I update my insurance info, copay info, contact info, etc., they assure me it's been taken care of, then when I go for a refill it's like nothing ever happened!!!

 

Also, they always call me at home. I have asked them repeatedly to call my cell phone. I am rarely home before 7pm so I always have to call them the next day. They have my cell number, so WTF?? It's like shouting into a big empty hole!!

 

I hate them!

[Billie Murawski]

We are on Medicare Plan A&B&D cvs,cvs specialty and Silverscript I have no idea what all that is and I wouldn't understand it if they told me. My husband retired from the Pa Fish&Boat Commision and so far they have handled everything for us and we have Aetna Supplemental and we have hit a few roadblocks with them. 

[r06ue1]

I wonder if Canadians have to get prior authorizations?  

[rcase13]

I am still dealing with my issues with CVS Specialty. They finally got my PA and Co-Pay assistance card iron out or really I did. You just have to keep calling. They shipped my Tasigna but only shipped half. So back on the phone I go. 

[r06ue1]

Had the same issues, next year I will know to work on it sooner.  CVS said they sent the forms to my doctor but he said they never received anything from them and I waited a week before calling for status before I found out about that.  

 

So my medicine which was supposed to be delivered on the 10th, took 7 more days and this was after CVS notified me on the 5th that I needed another prior authorization.  After all of that, they sent me generic, which I was on brand, and now have to get that fixed, and I ran out of medicine and had to skip two days to make up for it.  

 

But I bet they saved some money!  

[hannibellemo]

I just called to re-order my Sprycel and found out that my prior authorization has been extended to 2039! I wonder if I will still be around then?  

 

We have BC/BS Wellmark and I use HyVee Specialty Pharmacies. Of course, that will all change in January when I retire and start Medicare. 

 

Yuck!

[rcase13]

Had the same issues, next year I will know to work on it sooner.  CVS said they sent the forms to my doctor but he said they never received anything from them and I waited a week before calling for status before I found out about that.  

 

So my medicine which was supposed to be delivered on the 10th, took 7 more days and this was after CVS notified me on the 5th that I needed another prior authorization.  After all of that, they sent me generic, which I was on brand, and now have to get that fixed, and I ran out of medicine and had to skip two days to make up for it.  

 

But I bet they saved some money!  

 

Yeah I think this is the entire game plan with them. Come PA time they ring the door bell, wait 10 secs and then run away. So they can say hey we tried to contact your doctor but he never came to the door... LOL

 

My PA expires on my birthday every year. So I will remember to follow up closely with CVS Specialty and my doctor.

[story]

CVS specialty was really awful to deal with, even their in-store pharmacies are awful. The only way to deal w/ them is to keep calling until you get what you need. They are the future of pharmacies, huge and impersonal.