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Monday, April 11, 2011

The Need to VENT!!

I just want to vent that Insurance company and doctor’s office is driving me crazy. For over a week, I tried to have my prescriptions filled with no luck. My doctor uses Freedom Fertility Pharmacy and my prescription carrier (CVS/Caremark) does not cover the pharmacy. So Freedom had to transfer my prescription over to Caremark Specialty Pharmacy to fill my order. The following is my progression so far.

Monday (4/4/2011) at 9:00 am – Freedom Fertility Pharmacy said my insurance would not cover the drugs and they need to transfer my prescription to Caremark Specialty Pharmacy. Freedom said Caremark would have the prescription within one hour.

I called Caremark Specialty Pharmacy at 10:45 am- They said it would be two hours before they would get my prescription into the system and I was to call back at 1:00 pm.
I again called Caremark Specialty Pharmacy at 3:45 pm and my prescription was still not in the system; however, they entered my information in the system.

Tuesday (4/5/2011) – I called Caremark Specialty Pharmacy – My information is still no in the system. They called my doctor to verify my information.

Wednesday (4/6/2011) – Caremark is still trying to verify my information with my doctor’s office.

Thursday (4/7/2011) - Caremark is still trying to verify my information with my doctor and now I received an e-mail that my mail service prescriptions cannot be filled. I called Caremark back and the Specialty Pharmacy said my prescription had went to mail order. I was told I needed to call and cancel the prescriptions or I would be charged. I called CVS Customer Service and they said they could cancel everything. I called the Specialty Pharmacy to ensure that the mail service did not cancel anything the Specialty Pharmacy needs. The Specialty Pharmacy said they are still trying to take care of everything with my prescriptions and a representative would call me to confirm my medications.

Friday (4/8/2011) – Our benefits coordinator contacted our account manager with CVS/Caremark. We were told that my doctor’s office told them they were too busy to verify my prescription. AT THIS POINT I AM FRUSTRATED! I called my doctor’s office but they were closed for the day.

Monday (4/11/2011) – I receive this from the account manager with CVS/Caremark:

I have confirmed that the scripts have been verified by the doctor and that the delivery is scheduled for delivery on the 12th. 

Regarding the Progesterone powder it is a plan exclusion as bulk chemicals are not covered.  Some compounds are covered under the plan when mixed with a federal legend drug and based on the drug code the pharmacy submits.  Compounds can be a mix of several drug and it is hard to determine if there is an alternative because her doctor would now better on the specifics for the compound.

If the code for Progesterone powder is at Mail or Specialty it will reject due to it being a bulk powder. Specialty is unable to run the claim until they fill the order. 

What???? Yes, that is my exact words. Our benefits coordinator contacted the account manager again. If I want the progesterone caps I have to pay 100% out of pocket; however, our plan covers injections. I remember my doctor saying he was not going to give my injections because they were too expensive.

I contacted the doctor’s office and the nurse (the one who told CVS she was too busy to verify my prescription) told me they only give injections to IVF patients. I reiterated my story again. She said kept trying to convince me that I did not need them. I told her I have a Luteal Phase Defect (LPD) and need progesterone. She said the progesterone caps are only $50 to $60 and I said my co-pay is only $20 for the injections. Then she said I would have to be taught how to give the shots and my husband will have to give them ever night (What is the difference between giving myself progesterone shots and the gonal-f shots that I will be giving myself before the progesterone?). I said my best friend is a Labor and Deliver Nurse and can administer them. She said Oh, let me talk to the doctor and I will get back to you tomorrow.

Can I please just scream over this madness????????????????

If you are pursuing advanced fertility treatments, ask your benefits coordinator how to process specialty drugs for your insurance plan. I work in HR and still missed this one minor detail that has caused me a great bit of grief.

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