Insurance Codes for Peg-Intron?

[HowieB]

My pharmacy tells me that Blue Cross knows that Peg-Intron is an injectable and, therefore, they cannot "adjust" the insurance codes to get a little more for themselves (which means I would pay a little less).

Anyone know which codes can be used to stick it to the insurance company so that I can continue sticking without fear of bankruptcy?

In a similar vein, does anyone know of a pharmarcy in California that will accept whatever Blue Cross will pay them without requiring me to pay the difference?

Thanks in advance.

-HB

[Nann]

I'm not sure what you are paying at the pharmacy you now use, but Savon and Walgreens take Blue Cross.  I have Blue Cross and am now paying $75 for a month's supply of pegasys from Walgreens. That is three times what I paid last year at the same pharmacy but the prices went up.  I understand that a month of pegasys costs $1,550. There is also a mail order pharmacy, Fisher Pharmacy in P.A. that takes Blue Cross. They have a web site, I believe.

[Kevin560]

I'm not sure about the insurance codes, but I have Blue Cross Blue Shield PPO insurance. A few months back the required that I purchase all of my Peg-Intron and Rebetol from aAdvancedPCS SpecialtyRx, LLC. I can no longer get it from the local phamacy, who always have it in stock. The Company has been good about sending my meds on time, except during the holidays. They sent it to me almost a week late, and my injection night moved three days forward because of it. I had a tough time having the next injection on my regular night, but I had to go back to Saturday nights because I am working full time in order to have insurance coverage to begin with. (This pharmacy charges my insurance company about $400. per injection, and about $8.00 per rebetol.)My co-pay is $25.00 each, per month.

[Fubarcat]

I have Blue Cross/Blue Shield in Florida.  I'm getting my Peg/Riba mailed to me through Wal-Mart Specialty Pharmacy.  When I got my first shipment, Wal-Mart told me they got approval through BC/BS.  It is paid under my major medical and I have a deductible of $1,500.00.  Then BC/BS kicks in 100%.   I figured, OK, I can do that.  Then about two weeks after getting my first shipment, I got a notice from BC/BS saying they needed "more information to substantiate that the drugs were necessary" (Duh! I'm taking them for the pure love of feeling like **** every day!).  I called my doc and sent him the notice from BC/BS and he said he would handle it.  I got another call from my doc and said that BC/BS called back and wanted more info and then they would take it before the committee for approval.  I am disappointed in Wal-Mart because they assured me that they had gotten approval for the drugs from BC/BS before they even shipped the first month's shipment.  I'm hoping BC/BS sticks to the deal and only charges the $1,500.00 and then kicks in 100%.  Otherwise, I will have to discontinue the meds because it costs $1,236.00 per month.

[Teres]

I'm having a similar problem finding a pharmacy that will accept what the insurance company is willing to pay. The Riba is covered pretty much ($30 copay), but I still have to pay over $400 for a month's supply of Peg-Intron. The pharmacy I use was recommended by my doctor's office, and they never gave me an opportunity to search out my options. I sometimes wonder if it's a conspiracy among the doctors, pharmacies and insurance companies to keep us in the dark.

Question: Does anyone know whether Canadian companies can be covered by California insurance and, if so, which ones ship to the U.S.?