Insurance and Pharmacy issues

[aideen33]

just... Argh....
Doctor wrote rx for Humira.
Yesterday I go to pick it up, no problem... get home... open box, 2 pens, instructions "1 every 28 days".... I know this isnt right as doc and i discussed the initial loading dose.
Call doc. Doc says no no thats a maintenance kit for after the loading dose, they need to give you the starter kit i wrote for, call them back.
I did, they say they did not get rx for starter kit (sent at same time as rx for maintenance kit) and will contact doc.
Okay fine. I call insurance and say "I know this requires only 1 retail fill before moving to the specialty by mail program" Explain mix up with pharmacy. Specifically ask them is this going to create and issue. Am told no no, it will be fine, hang onto that kit, get starter, will go to mail order afterwards and they'll get it all set up.
Talk to doc. Confirm rx has been resent.
Go to pharmacy. Insurance rejects fill of starter kit because, only 1 allowed retail. Explain to pharmacy the deal, they call insurance. Insurance says, bring them BACK the initial kit, they reverse that charge, and put through the starter kit, that will fix it.
Drive home. Bring back kit. Go eat dinner while they do all the paperwork to reverse and resubmit correctly etc.
Get back..... Insurance rejected it again. Apparently the charged amount of 9000 for the starter kit exceeds the plans allowed charge of 8500 and therefore requires another form to be filled by doc. One i would have had taken care of had anyone bothered to mention this was going to be an issue. I cannot figure out why no one at insurance company thought "hey.... if 2 pens is 3000, 6 will be 9000, maybe the allowed charge limit should be at least 9000"
Now additional form has been sent to doc, who i will call during business hours in an attempt to FINALLY get this rx filled .....

I am thankful for coverage.. I really really am... but god if i dont hate insurance companies and their stupid rules sometimes

 

[aideen33]

Now on day 3 of repeatedly running between the pharmacy and the insurance and the doctors office because apparently no one can talk to each other, they send me to call everyone as the errand girl -_-

 

[aideen33]

We ended up finally finding someone at Prime Therapeutics who A. knew what she was doing and B. actually cared enough to spend a long time working with me to find a solution, which turned out to be... Fill the 2 pen kit at retail, then have retail pharmacy send them the rx for the 6 pen kit to the "specialty mail program" whcih apparently does NOT require the high dollar amount prior auth. paper work but no one had bothered to tell ME that, they can override the "refill too soon" and fill it and get the rest of my pens out before im due for the next shot..... why no one suggested this oh say... Monday, or tuesday, or yesterday I do not know... but i finally get to start my humira so theres that