Hi all, I haven't been sent Pegasys that I need for this Friday. I'm talking to the specialty pharmacy and the doc's office but there's been no progress, at least that I can see. I called the pharmacy and they need something from the doc's office. The doc sent stuff yesterday. Aaaargh. Does anyone have suggestions for a contingency plan? Can I get Pegasys locally as a one time deal?
After talking to the pharmacy yesterday, I got the impression that the sticking point has been that my 12 week PCR result said <5 IU/mll and didn't say UND.
unfreakingbelievable i am having the same problem dam insurance company wants to see my 12 week PCR before they will approve any more peg but i dont go for that until tomorrow they wont have results until next week i have no shots left and i need one friday only one day left of riba...
Talk to your doctor's office and see if they hold any interferon in reserve for these situations. My doctor does. I've been in exactly the same situation and this is extremely frustrating and very stressful.
At certain periods the insco/specialty pharmacy needs to review your PCR results in order to give authorization to continue trt. This must be sent by your doctor and then reviewed by the spec pharma nurse. If either one drops the ball, the authorization and delivery can be delayed.
First, make certain that your doctor sent the proper paperwork requested by the specialty pharmacy. Then ask to speak to a supervisor at the specialty pharmacy and express your concern and urgency of this situation. Once they have the required paperwork, authorization should be immediate, and shipment is overnighted. If you get this resolved today, you could have this delivered by Friday. Press hard. Hope this works out for you.
Since the specialty pharmacies are required to review and authorize the meds to continue trt at certain points (12, 24, ? weeks), this situation of not having the proper paperwork in hand probably happens more often than we think. It happened to me twice. If there's poor communication between the doctor's and specialty pharmacy office, this approval will be delayed, and you might not even be aware of it until its too late.
Because of this, instead of waiting until the beginning of the week of the last of the 4 shots, the pharma allows me to order late in the week prior. This provide several additional days just in case something need to be straightened out.
i caled this monday for a refill, i told the girl that the label said no refills they said oh we will take care of it call today because i have no meds and now they are telling me this ****... WHAT THE FKKKKKKKKKKKKKK
This problem has been around as long as I have been..............it almost always works out so just don't give up keep calling the doctors office and ask THEM to call the pharm co and tell them stand next to the fax I'm sending it NOW or tell them to scan it and send it via email to whoever they talk to = surely they have to understand the urgency.
Just so you know even when it was just SOC this was a problem. Recertifications always messed up - I was lucky I was finally able to order a week in advance so I had the meds, an extra week on supply.
I can surely understand your panic! That is awful that you have to stress out over this. That is why I get 2 months supply at the beginning of treatment and then monthly after so I always have a 4 weeks supply on hand...I would check into seeing if that is possible for you...or at least one WEEKs extra. I do not have to deal with an insurance company though, as I am at a clinic and they keep extra there on hand. Sure hope you get this resolved soon!
I order when I have 2 weeks left too. My PegIntron shipment will be here tomorrow along with the riba and neupogen (boo) and I still have 2 RediPens in the fridge. I call and schedule deliveries and the pharma tells me when the earliest date is for the particular rx.
However, if the issue is authorization that cannot be done without seeing the 12 week VL it does present a problem. My doctor has said from day one that this was a big issue. They just cannot get the labs done quickly enough to get the authorization timely.
I am so sad to see this happening to you. One of the hardest parts for me has been dealing with ins. Companies and pharmacy. My husband agreed to take over all phone calls, paper work for me, I could not take it anymore. And yes, I was not very nice on the phone sometimes but to bad. I also now order meds ten days before I run out but I also go through a liver clinic in Seattle that has these drugs on hand.
Good luck and keep us informed. This is good inf. for the new comer.
For the most part, we have had good service from our specialty pharmacy through my husband's three treatments. His doctor's office is very efficient in submitting forms and faxing prescriptions, and the specialty pharmacy has been very accurate with phoning us to schedule deliveries, following up with feedback and questions, and delivering on time. The only glitch we had during my husband's 2nd treatment was that we started with a particular specialty pharmacy, his insurance company covered it for 1 - 2 months and then suddenly out of the blue we got a call saying that we would need to switch to a different specialty pharmacy and they wouldn't cover that particular one. All of that happened on the day before we were due to schedule a delivery for medication that he needed a couple of days later. I panicked, since I'm the one who handles all of the phone calls and paperwork for my husband. I spent several hours on the phone and really let everyone I talked to have an earful of how changing pharmacies right now would delay his shipment which would put his treatment in jeopardy. One woman at the specialty pharmacy stayed past her work hours to help me resolve the issue. She got approval from his insurance company to cover one more month while they transitioned his prescriptions to the new specialty pharmacy. At 6 or 7 PM that same night, it all got resolved, and his meds were shipped and then we switched to the new specialty pharmacy over the next 4 weeks. Both pharmacies were fine, it was the insurance company that threw a monkey wrench in the works by not providing a transition time. I think the main difference is that the old specialty pharmacy was located in Florida and the new specialty pharmacy is located in Oregon and we are in Washington, so I think the insurance company just wanted it handled by a company that was closer to us. Maybe it had to do with the cost of shipping by air vs. shipping by truck. Anyway, thanks to a very kind person who stayed late at work, it all got straightened out.
I like the idea that starshine and frijole mentioned of getting medications early so that if there is a glitch you don't have to panic. I did that prior to the Thanksgiving holiday just to make sure nothing went wrong. When we refill this month, I will call and see if I can order one to two weeks before he needs the meds rather than same week.
I LOVE MY SPECIALTY PHARMA PEOPLE ... lol... stupid pre cert for the peg expired 11/7 and of course the insurance company didnt tell anyone so when it was denied everyone had to rush around like idiots last minute fax to the dr etc etc everyhing is cool getting my stuff manyana wootwoot
I agree with the early shipments. After two close calls of stressing about late deliveries, I order just prior to the 3rd injection. The pharma doesn't allow me to order any earlier or deliver any more than a 4 weeks supply at a time. Those few extra days gives a little wiggle room if there's any hickups in the system.
As long as everyone is doing their job all works well. All it takes is for one person in the doctors office to forget to fax the paperwork and things fall apart. It usually does work out, but creates a tremendous amount of stress and time on the phone to work it out.
Wow, I thought I had a lousy specialty pharm. I had to go to the head of HR where I work and was given a special patient advocate. Don't just listen to these worthless customer rep who just read the rules, you need someone above them. The doc office should fax a script or call in as a STAT order. The ship overnight. When I was needing all these different drugs with auth, etc I felt the hassles with pharm company was as bad as treatment. Everyone at Aetna Specialty Pharmacy knew me. I wrote down everyone I spoke to, because each one told me something else. I have a file as thick as my labwork with dates, issues and who said what. Luckily now I have enough procrit and neuogin to last 2 rounds of treatment. I was never asked for a VL to get peg. I always had 1-2 weeks supply.
Late Thursday morning my insurance company finally approved sending me Pegasys.... but I found out they haven't approved my Ribavirin yet. Luckily I have extra.
Thanks for all the suggestions everybody. I'm going to suggest that my doc keep some Pegasys on hand for emergency patient use. I'm also going to ask that my meds be ordered a week earlier. What a frustrating distraction to chase down approvals when the doc, insurance company and pharmacy are all involved.
Phew! Now you can breath again ;-) You should also find out when the specialty pharmacy the date of their next authorization. Follow up with your doctor prior to that date to make sure the proper paperwork was submitted and all should be good. But always good to call the pharma as a follow-up to make sure. Good deal.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.