Getting out of ACCREDO

[jumpingjacks99]

hey folks, I have crohn's disease and like many people in the USA my insurance only allows me to get my Humira through Accredo/Medco/Express scripts. As I'm sure many of you know, this company is the most vile, dishonest pain in the butt company on the entire planet. Every month I have to call these people and what should be a fast and easy transaction turns into a two hour shakedown. And it's not just inconvenience, they sent me bills for ridiculous amounts of money because they refuse to run my co-pay assistance until they've already billed me.

ANYWAY, I'm through just being mad about it. What are the solutions? Does anyone know how to get Humira without having to deal with Accredo? My insurance is blue cross -- has anyone had any luck with this specialty pharmacy exception form? http://www.anthem.com/ca/provider/f0/s0/t0/pw_a134674.pdf?refer=provider&refer=provider

Has anyone gotten out from under the thumb of Accredo? And how?

Please share your wisdom with me and the rest of my fellow crohn's sufferers.

 

[afidz]

ugh. I have the same insurance. I was about to start Humira and the insurance company through a fit as to where the script could be filled. I am pretty sure that was the company. When I finally do start Humira, I am not looking forward to dealing with them.

 

[mallowpufft]

I used Anthem BCBS specialty pharmacy the first year and a half I was on humira. Literally a five minute phone call once a month. After 6 months they offered to put me on auto refill so they would just send an automated call twice the week before they sent it so that if I needed to change delivery date/address, I could.

I also recommend checking out the Humira Protection Plan (I think that's what Abbott calls it). On the BCBS plan it brought ny monthly co pay from $25-$0 (yes, it was an amazing prescription plan and I miss it). On my current insurance it brought the co pay from $100 monthly to $5 monthly.

 

[jumpingjacks99]

I used Anthem BCBS specialty pharmacy the first year and a half I was on humira. Literally a five minute phone call once a month. After 6 months they offered to put me on auto refill so they would just send an automated call twice the week before they sent it so that if I needed to change delivery date/address, I could.

I also recommend checking out the Humira Protection Plan (I think that's what Abbott calls it). On the BCBS plan it brought ny monthly co pay from $25-$0 (yes, it was an amazing prescription plan and I miss it). On my current insurance it brought the co pay from $100 monthly to $5 monthly.

Yeah, this is not my experience at all. It was okay until Jan 1 of this year when Accredo was acquired by Medco. First, I am on the humira protection plan. Accredo sends me a bill every month for $300, and demands that I pay this bill before they will run the secondary insurance on the promise that they will 'refund me' once the secondary insurance goes through. I tried this -- they conveniently lost the record of the transaction and refused to ever run the secondary insurance, forcing me to go into the new strategy of not paying the bill and then having a two hour conversation with someone in billing every so often so that they run the secondary insurance before sending a bill. I have to do this for every shipment.

Secondly, it is not a five minute phone call every month. Every single time I call them they come up with some reason why I need to jump through a series of hoops. Here is what happened this last time: quick phone call, they say 'Great, it'll be delivered next Tuesday'; and I think 'well that was easier than I've come to expect.' Tuesday comes -- late Tuesday afternoon I get one of their oh-so-fun robo calls where they call YOU and you answer and hear a robot voice saying 'This is Accredo. Please hold.' and then I wait for 15 minutes and someone comes along to tell me my medication won't be coming, and by the way they canceled my prescription (this customer service rep, after a 15 minute hold, can't figure out WHY). No worries they say, there's a new prescription and I can renew my order at double the cost and half the amount. After a frustrating conversation they tell me I can get the previous amount at the new cost but they will have to run a new prescription. It will take 24 hours at most, they say, and they will call me the next day. The next day comes, and they don't call. I call them. 'There's a record of your previous conversation,' they say, 'But no one ever ran the request. Let me get that started for you. Call back tomorrow.'

Every single time they come up with some nonsense like this. The time before that, in January, when I was filling a new prescription, they made my doctor send the prescription seven times before they finally get it. And of course, they end every phone call saying 'We'll call your doctor right away', then I call my doctor the next day and he says they never called. So I am the one who has to call my doctor over and over again saying 'Sorry to bug you again, but Accredo didn't get the prescription.' By the by, once the prescription finally went through I was assured by Accredo that they confirmed it was good for 1 year. Three months later, they randomly canceled it and couldn't come up with any explanation why (see above).

I'm glad they treated you right. Unfortunately that is not the norm. Here are a series of reviews for Accredo Specialty Pharmacy service:
- 'The Evil Pharmacy Strikes Again' http://mixedupmommy.com/2013/01/11/the-evil-pharmacy-strikes-again/
- "Accredo Lies" http://www.yelp.com/biz/accredo-health-group-memphis
- "Consumer Affairs" ("Let me start off by saying that I work for one of the largest hospitals in the country, and our doctors warn the patients against using this service, my own included") http://www.consumeraffairs.com/rx/medco.html
- Better Business Bureau http://www.bbb.org/stlouis/business...-in-saint-louis-mo-110132662/customer-reviews
- Medco specialty pharmacy unethical http://www.pissedconsumer.com/compa...cialty-pharmacy-unethical-20091026160177.html
- "Ripoff Report" http://www.ripoffreport.com/r/Accre...-work-for-ever-Warrendlae-Pennsylvania-867595
- "Accredo bills wrong insurance after repeatedly confirming they have the right insurance" http://www.justanswer.com/consumer-...billed-wrong-insurance-assuring-multiple.html
- This is from the same website as the first one but it's'a big collection of reviews that blogger got via email after posting about Accredo http://mixedupmommy.com/2013/11/12/how-is-accredo-pharmacy-getting-away-with-this/

I used to get my medication through CURASCRIPT, which was fine. It was bought by Accredo. Accredo is the only game in town, and it is a nightmare. I assure you it is an absolute nightmare.

 

[mallowpufft]

Yeah, this is not my experience at all. It was okay until Jan 1 of this year when Accredo was acquired by Medco. First, I am on the humira protection plan. Accredo sends me a bill every month for $300, and demands that I pay this bill before they will run the secondary insurance on the promise that they will 'refund me' once the secondary insurance goes through. I tried this -- they conveniently lost the record of the transaction and refused to ever run the secondary insurance, forcing me to go into the new strategy of not paying the bill and then having a two hour conversation with someone in billing every so often so that they run the secondary insurance before sending a bill. I have to do this for every shipment.

Secondly, it is not a five minute phone call every month. Every single time I call them they come up with some reason why I need to jump through a series of hoops. Here is what happened this last time: quick phone call, they say 'Great, it'll be delivered next Tuesday'; and I think 'well that was easier than I've come to expect.' Tuesday comes -- late Tuesday afternoon I get one of there oh-so-fun robo calls where they call YOU and you answer and hear a robot voice saying 'This is Accredo. Please hold.' and then I wait for 15 minutes and someone comes along to tell me my medication won't be coming, and by the way they canceled my prescription (this customer service rep, after a 15 minute hold, can't figure out WHY). No worries they say, there's a new prescription and I can renew my order at double the cost and half the amount. After a frustrating conversation they tell me I can get the previous amount at the new cost but they will have to run a new prescription. It will take 24 hours at most, they say, and they will call me the next day. The next day comes, and they don't call. I call them. 'There's a record of your previous conversation,' they say, 'But no one ever ran the request. Let me get that started for you. Call back tomorrow.'

Every single time they come up with some nonsense like this. The time before that, in January, when I was filling a new prescription, they made my doctor send the prescription seven times before they finally get it. And of course, they end every phone call saying 'We'll call your doctor right away', then I call my doctor the next day and he says they never called. So I am the one who has to call my doctor over and over again saying 'Sorry to bug you again, but Accredo didn't get the prescription.' By the by, once the prescription finally went through I was assured by Accredo that they confirmed it was good for 1 year. Three months later, they randomly canceled it and couldn't come up with any explanation why (see above).

I'm glad they treated you right. Unfortunately that is not the norm. Here are a series of reviews for Accredo Specialty Pharmacy service:
- 'The Evil Pharmacy Strikes Again' http://mixedupmommy.com/2013/01/11/the-evil-pharmacy-strikes-again/
- "Accredo Lies" http://www.yelp.com/biz/accredo-health-group-memphis
- "Consumer Affairs" ("Let me start off by saying that I work for one of the largest hospitals in the country, and our doctors warn the patients against using this service, my own included") http://www.consumeraffairs.com/rx/medco.html
- Better Business Bureau http://www.bbb.org/stlouis/business...-in-saint-louis-mo-110132662/customer-reviews
- Medco specialty pharmacy unethical http://www.pissedconsumer.com/compa...cialty-pharmacy-unethical-20091026160177.html
- "Ripoff Report" http://www.ripoffreport.com/r/Accre...-work-for-ever-Warrendlae-Pennsylvania-867595
- "Accredo bills wrong insurance after repeatedly confirming they have the right insurance" http://www.justanswer.com/consumer-...billed-wrong-insurance-assuring-multiple.html

I used to get my medication through CURASCRIPT, which was fine. It was bought by Accredo. Accredo is the only game in town, and it is a nightmare. I assure you it is an absolute nightmare.

Holeeeeee Crap! That sounds like a scenario from a horror movie... although I can think of maybe three people I would wish that on. Definitely try the Anthem route. I know Anthem is split into different regions but it seems like their underlying structure should be about the same.

 

[DougUte]

I have Acreedo and have not had a problem like this. Hmmm. Acreedo bills my insurance and the copay assistance program. Each month they send me a bill for $150.00 (my copay) and I am sure if I talked to them I would be told I have to pay it then wait for a refund, but I only pay the $5.00 with the bill. I have never had a billing problem because of this.

 

[McM17]

I'm having trouble with them as well! I called them on the 9th to get my Humira prescription. They marked my file as urgent and said I should have it delivered to me by the 15th at the latest. I got two automated calls telling me they were still waiting for information but needed nothing from me. When I finally called them they said that they had approved my maintenance dose of Humira but they never got a prescription for the loading doses (which is stupid, because the only prescription I have is for the loading doses). I had to call my doctor, who said that Accredo never called them, and last week on the 18th Accredo said that my medicine would be here the following Monday. So of course I call them today, and they voided my prescription. Apparently they tried to fill it before the doctor preauthorized it and then it was no good. But of course, the person who talked to me the week before said that with the authorization it would be sent to me in a few days.

I'm starting to worry that they're going to be way more of a pain to deal with than they should be. So far I am not a fan!

 

[Orchid]

On a similar note: My GI and I are discussing putting me on a biologic and the only way insurance will cover it is through BriovaRx, another specialty pharmacy. Has anyone used them? When I tried to use Google to find reviews of their services no one had any I could find.

 

[mallowpufft]

On a similar note: My GI and I are discussing putting me on a biologic and the only way insurance will cover it is through BriovaRx, another specialty pharmacy. Has anyone used them? When I tried to use Google to find reviews of their services no one had any I could find.

I've been using them for about a year. I haven't had any issues to speak of. When I had anthem they would auto refill it for me every month. I haven't been able to get Briova to do that for me but a quick phone call and I'm good to go.

 

[jumpingjacks99]

I'm having trouble with them as well! I called them on the 9th to get my Humira prescription. They marked my file as urgent and said I should have it delivered to me by the 15th at the latest. I got two automated calls telling me they were still waiting for information but needed nothing from me. When I finally called them they said that they had approved my maintenance dose of Humira but they never got a prescription for the loading doses (which is stupid, because the only prescription I have is for the loading doses). I had to call my doctor, who said that Accredo never called them, and last week on the 18th Accredo said that my medicine would be here the following Monday. So of course I call them today, and they voided my prescription. Apparently they tried to fill it before the doctor preauthorized it and then it was no good. But of course, the person who talked to me the week before said that with the authorization it would be sent to me in a few days.

I'm starting to worry that they're going to be way more of a pain to deal with than they should be. So far I am not a fan!

This is exactly what my first experience with them was like. It only gets worse, my friend. Today, while I am trying to switch to the other specialty pharmacy available under my plan, CVS Caremark, Express Scripts/Accredo decided to just randomly send me a prescription refill I didn't order, without asking, without any authorization (after telling me I don't even have an active prescription anymore), and as a result now I can't finalize my membership with the new pharmacy or get a prior authorization because it is 'too soon since previous order'. I hate them. So much.

 

[badbelly]

Sorry so many people are having trouble with them. I had Accredo for my first 5 moths on humira before my work switched to Express Scripts. I was actually surprised at how nice they were, calling me every couple of weeks to check on me and ask me when I wanted my next shipment to come. I had automated billing on my CC and never got shaken down or anything weird like that. Maybe I was just lucky.

Express scripts has been pretty good so far too and sends me bigger shipments so I don't have to talk to them as much.

 

[Patch]

Hmm, if Accredo is as bad as this thread seems to imply, that might explain why I'm having so much trouble getting my Humira prescription processed. The GI doctor's office gave me a call just today, and the girl I spoke with, who has been in contact with Accredo, commented on how difficult they were for her to work with.

Also it sounds like my insurance isn't going to cover the cost of the Humira (probably because it's not a generic), but she said I needed to wait and see what Accredo told me when they call me. They're supposed to call sometime today...

 

[ttowntiger87]

I have had a VERY bad experience with Accredo as well. I reported them to the two agencies they claim they have accreditation through. URAC and The Joint Commission of National Heath Affiliates. I was taking Remicade at the time. I had taken time off work for my infusion and they did not do the proper procedure required to get the medication delivered on that date. The hospital called me that day to let me know the medication was not there and that they were cancelling my appointment. I was FURIOUS!! It has been a nightmare since. Express Scripts now considers Imuran a specialty drug and has switched my prescription to Accredo. I have called several times to get my prescription filled and they say my Dr. office hasn't responded to their calls. This is bullshit because my GI doctor is one of the best in the country out of The University of Michigan. I HATE THIS COMPANY!!!:ymad:

 

[northwesterner]

There's a couple of Specialty Pharmacies out there that aren't very good. OptumRx stinks, looks liked Accredo does as well.

Fill out that exception form you linked too and check the boxes at the bottom about using a patient assistance card to subsidize, and then check the next box and outline that Accredo will no bill the patient assistance at the time the prescription is sent. There is no reason they can't do that as those patient assistance cards are set up to bill just like insurance.

For what its worth, I've used both Diplomat and CVS Caremark. They're both excellent. Fill out the form, appeal the decision if you're denied, keep at it, and move to a company that understands customer service.

 

[Lisat]

I have a question for ttowntiger87...
Why did you switch from remicade to humira? After 10 pretty successful years with remicade it stopped working. Colonoscopy showed active disease, inflammation , ulceration. And blood test showed high antibodies against remicade. My dr explained that cimzia would be my best choice, over humira because humira and remicade are derived from rat molecules, while cimzia is recombinant DNA. He believes I would fail on humira too, because of its composition being like remicade. I agreed but the process of getting setup on cimzia has been long. Meanwhile I'm getting worse.

Today I found out that my insurance co denied cimzia because pharmacy affairs said I must try humira first. I'm very upset because I'll be starting all over again, only to likely fail and waste another 8 weeks. At this rate I'm afraid I'll get so sick that I'll end up in hospital. I've been eating but think I'll replace a meal with a protein shake.

I'd really like to know why you switched. I feel very confident of my dr's skills and abilities, more than pharmacists that don't know me. So frustrated! Dr put me on 30mg of pred as a stop gap, but I've only been taking 20mg because I hate all of its side effects! I told dr the pred isn't helping so he wants me to up it to 40mg. Right now I'm so anxious and irritable with the 20mg. I realize the med problem has me stressed but I can tell my anxiety and irritability is caused by the prednisone. I really don't want to go,out to 40.

 

[ttowntiger87]

Lisat,

I was taken off Remicade due the fact that my body was not responding. I started developing antibodies even while taking Imuran. I also developed Ankylosing Spondylitis, and Cimzia is supposed to treat both Crohn's and the AS.

I went through a similar situation....my doc did NOT prescribe Humira, but according to THE PHARMACY's regulations, I had to try Humira before trying Cimzia. I tried the Humira and had an allergic reaction to it. Meanwhile, I was off biologic medication for over 10 weeks while the insurance company tried to figured it out. Thank goodness my doc prescribed me Entocort, and I am currently through my loading doses of Cimzia. I am feeling much better.

I really HATE ACCREDO!! I hope you feel better soon! I know how it feels to be on Prednisone for a prolonged period of time....IT SUCKS!!

 

[Lisat]

Wow. Your story is scary too. My last infusion of remicade was 2.5 months ago and I keep getting worse. I know I'm not taking the 40 mg of pred and only taking the 20, but I truly think it won't work for me! Last time in the hospital it did nothing. I always try to stay positive but the bleeding is getting worse daily plus the other symptoms. At this point, I'm afraid if I don't start a biologic soon, I will end up in hospital with serious issues. For some reason, I've never really been afraid of cancer before, but now I'm getting nervous about that too. I'm unsure why he didn't suggest entocort or Imuran while I'm waiting. I feel like I'm constantly on the verge of tears.
It is so hard to concentrate on my job with this looming.

 

[ttowntiger87]

Hang in there and keep calling your GI. Don't stop advocating for your health. Sometimes these insurance companies will make you crazy!

 

[24601]

Hi Lisat,
Remicade is the one that contains mouse (most definitely not rat) proteins but Humira is fully human. I understand that you wouldn't want to start a med that you think that you will fail but if you do go with Humira try to be reassured by the fact that many people do well on it after losing response to Remicade. I don't think there is any obvious reason for your doctor to want to try Cimzia first but perhaps he just hasn't explained. Humira and Cimzia are both anti-TNF-alpha inhibitors.

I would be open with your doctor that you are not taking the full dose of pred. I understand the difficulty of dealing with the side effects but you may find that you have no worse side effects with 40mg. I've mentioned before the option of EEN in reply to you as a fast acting treatment as an alternative to steroids so I won't talk about that more again here.

If you'd like to be on Imuran or another immunomodulator you should bring it up with your doctor and see what he thinks. Always better to get an answer to those questions than being left wondering.

Hope you start feeling better soon

Edit: you mentioned before coming off Imuran when on Remicade, was that under your doctor's advice?

 

[DougUte]

I have a question for ttowntiger87...
Why did you switch from remicade to humira? After 10 pretty successful years with remicade it stopped working. Colonoscopy showed active disease, inflammation , ulceration. And blood test showed high antibodies against remicade. My dr explained that cimzia would be my best choice, over humira because humira and remicade are derived from rat molecules, while cimzia is recombinant DNA. He believes I would fail on humira too, because of its composition being like remicade. I agreed but the process of getting setup on cimzia has been long. Meanwhile I'm getting worse.

Lisat

Humira is derived from human proteins. Remicade is derived from mouse proteins. Humira operates differently than Remicade. There are a lot who have moved from Remicade to Humira and had success. I hate it when the insurance company plays doctor though.

 

[Lisat]

Thanks for the info ttowntiger87, dougute Nd and 24601. I was honest with dr, and he said I MUST go up on the pred. So I did. I'm feeling chubby and retaining water, but...
I'm not sure it's helping but I'm listening and went up to 30mg.
I went off the Imuran many months ago because I thought that taking that plus the remicade was not necessary? I told my dr and he didn't seem thrilled but said ok, but I still took asacol (now delzicol). Now he stated that I shouldn't begin Imuran now because it will take at least 6 weeks to kick in. He said there's nothing else that can act fast except possibly the pred.
We lost the peer review so I'm approved for humira & waiting for Walgreens specialty pharm to send shipment. I'm hoping I can get the first dose by early next week!
I know they're anti-TNF alpha inhibitors.
I'm trying some protein shakes instead of some food but the darn pred makes me very hungry sometimes and nauseous other times. I still get those low grades fevers at times and that wears me out.
Best advice I read is to exercise no matter how crappy you feel. I had full intentions but then I worked too long because of time missed and I get so tired. I need to make sure that exercise happens every day!
On a brighter note, my daughter is home for the holiday, but she is frightened by reading these drug side effects--me too!
I hope walgreens is better and faster than Accredo!

 

[dreamintwilight]

Just wanted to give my 2 cents regarding Accredo!

When I started Humira5 years ago, I was under a different insurance plan and used Diplomat Pharmacy, which was AMAZING! Never had any issues and always paid a $2 co-pay with the Humira Protection Plan. I briefly switched to a different insurance and was forced to use a different specialty pharmacy, can't remember what it was now, but it was not as good as Diplomat and my co-pays kept changing from $50 to $10, then to $5. I jumped at the chance to switch my insurance back during the next open enrollment period and use Diplomat again.

Well, 2 years ago, my husband got a new job that required us to move from Illinois to Pennsylvania and under our new insurance we had to use Accredo for specialty pharmacy and Express Scripts as our regular mail order pharmacy. OMG. Transitioning to Accredo was the most stressful experience. It was right at the time that Medco and Accredo were merging, so I think that was a big reason things were as confusing. I had never had an issue with my Humira Protection plan benefits switching insurances during the year, but for some reason....maybe it was because our current insurance plan requires pharmacy deductibles whereas our old plans in IL only required co-pays. So, it was a huge surprise when we found out under our new plan that the Humira Protection Plan didn't completely cover the cost of Humira since we had a deductible. I think we ended up having to pay $750 for a month's supply and with our current insurance I wasn't allowed to get a 3 month supply of the medication. But, after we paid the $750, I had met my deductible, so I didn't have to pay for any other medications for the rest of the year. Thank goodness we had the $750, but it was an unexpected cost that didn't make us happy. The extended benefits for the Humira Protection Plan at the beginning of the year thankfully count toward our deductible now, so the most I pay for all prescriptions in a given year is $5, but getting Accredo to bill Humira properly when we first switched over was a pain.

I had similar issues with having to get people to confirm multiple times that they had my Humira Protection Plan information to bill as a secondary "insurance." I think I had to call on 3 separate occasions to give them the same info because they said they didn't have it. I also went through the confusion between who would be billing me, Express Scripts or Accredo. My husband ended up getting on the phone with Express Scripts after I had been given the run around all day being told to call Express Scripts or Accredo or Highmark Blue Shield. So, when they tried to put him through the same thing, he flipped his lid and went at it with the poor woman on the phone. She finally offered to conference call with Accredo to get things sorted out once and for all.

Ever since that time, things have been fine for the most part. I still get nervous at the beginning of the year, praying that the Humira Protection Plan benefits process correctly. They always bill insurance and then Humira, so when I go online it says my bill is $5. I specifically requested NOT to be set up for auto-pay in the off chance Humira isn't billed properly. I don't want them to bill me some crazy amount because they messed something up. When I talked to Humira, they said they get insurance bills faxed to them instantaneously and they have a special department that is devoted to processing them, so if specialty pharmacies ever try to tell you that they haven't heard back from Humira yet (they tried to tell me that in the beginning), they're either lying or someone didn't fax the request over properly, or at all.

Anyway...I'm looking forward to the day when we can possibly move back to IL and get back on insurance that uses Diplomat because I miss them so much! I agree that the process to reorder with them was max. 5 min. With Accredo, while I haven't experienced anymore real issues (besides not fulfilling my no signature request), it takes at least 15-20 to get through to someone and go through the whole confirmation of information and payment processing.

 

[Suzanne_2468]

@dreamintwilight - where online do you go to see your $5 balance?? I have been taking Humira for over a year now and get my meds from Accredo and have the Humira Copay Plan. I have yet to receive a bill from Accredo!! I have asked several times and they say they'll mail a statement but I never receive one. I never have a bill in my monthly shipment either. I am completely expecting them to tell me at some point that they can't ship my meds because I owe them money. They say I can pay them over the phone but I will have no proof of the payment then. I checked Accredo's website and have the option to order a refill, but even there I don't see anything about a balance or how to pay! Thanks for your help!