Totally Frustrated

[HappyByChoice]

With only four weeks to go, my RX has been denied and I can't get the drugs I need to finish!!  The doctor's office blames it on insurance... the pharmacy blames it on the doctor's office... insurance says there's no request for authorization...  everyone is so busy blaming everyone else that no one has bothered to help fix the problem so that I can finish!!

So... after being on the phone literally all week with anyone and everyone that would listen, I found the problem myself!!  The last request for authorization on file from my doctor's office is for Jan. 8th thru Jan. 14th but should be Jan. 8th thru MARCH 14th!!!  All this stress from a stupid type-o?!?!?  Really!?!?!?

Now the race is on to get the doctor's office to resubmit the request for authorization and to get the drugs by 6:00 AM on Friday... and, of course, no one will return my call!!!

This has to be some kind of test of my resolve!!  Maybe God wants to know just how badly I want to be rid of this virus and how hard I'm willing to fight for it!!

Someday I hope to be able to look back and laugh at this situation.  But for today, I am in dire need of a "-------------" (insert your favorite stress reliever here!)!!!!

Not giving up!!
Janette

[Advocate1955]

Glad you got your meds.  My hubby had a similar experience when his insurance company decided that they didn't want to use the specialty pharmacy that the doctor had used previously and the insurance company had previously approved.  From one month to the next, in the middle of tx, the insurance company didn't approve the re-fill on the meds, and didn't notify us.  Luckily the specialty pharmacy called to let us know that the insurance company didn't want to use them any more and helped to facilitate transferring the prescriptions to the specialty pharmacy that the insurance company did want to use.  We couldn't get it all set up in time for his next shipment of meds, so I was on the phone off and on for 6 hours that day with doctor's office (very helpful), previous specialty pharmacy(also very helpful, woman stayed after hours to make sure it was taken care of for us), and new specialty pharmacy (also very helpful).  In the meantime, I wouldn't let up until the insurance company authorized one more month's supply of meds from the previous specialty pharmacy by informing them in no uncertain terms that if he had to stop treatment due to their lack of proper communication, and if he failed treatment, since there were no other treatments available, we would make sure that they were held responsible for jeopardizing his treatment.  I had everything documented, and I just didn't let up.  We got one more month's supply authorized for the former pharmacy to send, giving us time to transition the prescription to the new pharmacy, and everything was smooth after that.  It was very stressful, and very upsetting, but thanks to other peoples' concern and attention and help, we got through it.
Advocate1955

[heart_in_the_keyes]

All good advice above...have run in to similar situations over the last 20 years and please keep in mind, your doctor writes an order...hands it off to his staff and there you go...have found more if not all of all issues were from administrative staff not following through or setting aside...even if you are on top of them..somehow it gets messed up so you have to when you hardly feel up to it, be more viligent in monitoring your own care.  Just don't think someone is doing it for you. As kind as everyone is when you are at the hospital, there are just way too many patients and the staff makes human errors like the one listed that started this post.  I could tell you stories right now but I won't. Just will say to everyone....be very, very involved in your own care. And save everything to file...make a record of all interaction.  When you called, who you spoke to, etc.

[kittyluvr420]

Glad you got your drugs. Sorry you had to go thru that.

[BoceprevirGal]

  Ah, I am so happy that you got your meds on time!  There needs to be some kind of Hep C Task Force set up to help us during these emergency situations, where they have a stock-pile of these meds on hand, until the Insurance snafus are worked out.
    One day a forgot to pick up my Victrelis from my Clinic, and didn't realize until I got home. Well, I raced back and got there, just before the clinic closed, so I was safe. But if I had gone a whole night and the next morning without it, the virus could have mutated.
   After that I began having the Specialty Pharmacy deliver my Tx meds directly to my home, instead of to the clinic. I also would call a week early, to make sure all was well.
   People who havent been thru this, have no idea about the strress we go thru. All my hair is white now!

[PJ1966]

I went through the same thing month after month until my new Nurse Practitioner finally worked it out with insurance to not go through their specialty mail order pharmacy and to get direct from the Univ. of Calif pharmacy.  It was a life saver.  I finally got everything on time and finished the treatment with extra medicines.  

[HappyByChoice]

Well... I managed to get the drugs I needed and avoided going to jail!!

Flcyclist is right... there was no notification.  If I hadn't called to ask about the delivery of my last shipment no one would have bothered to tell me there was a problem.  And, even though I pointed out the obvious problem, no one wants to take the blame for it!  I guess it doesn't matter anyway... it was never about the blame but about getting the drugs necessary to finish TX.

It shouldn't have to be this hard!?!?!?!

I'm back on track with no missed doses and only 4 weeks to go!

[flcyclist]

Janette, just seeing this and hope you have it all resolved by the time you read this.  This delay can be extremely frustrating and create a tremendous amount of anxiety.  This unfortunately (as mentioned) isn't so uncommon to occur.  It happened more than once to me also.

If those critical "request for authorizations" don't go through as they should, it messes everything up, sometimes without any notification.  Then suddenly, you're the one picking up the pieces, correcting everyone's mistakes, just to be sure you get the meds on time.  

I'd suggest to call the specialty pharmacy, speak to the head nurse on duty, and request that they overnight the meds to you.  They will need the corrected authorization from your doctor faxed prior to doing this.  Hopefully, you'll get it in time, or at most one day late.  If not, ask your doctor if they, or anyone they know, has whatever meds necessary to keep you on schedule.  It was their screw-up, so they should be making a serious effort to correct it.  Simple errors can lead to serious potential problems and you should give the doc's office an earful.  Be persistent!!  I sympathize with you and hope this works out.

[jules2551]

Hopefully you will get all of this straightened out today!  I wish you the best.  Hang in there girl

Jules

[HappyByChoice]

Thanks for the kind responses!!  I've tried everything that has been suggested... I spoke at length to my insurance company, to the pharmacy, to a rep of the ACT program through Merck, to a nurse at the Be In Charge program, and even to the practice manager at the doctor's office.  Merck and the pharmacy were willing to help, but there was going to be an application process that would put me into next week before I could get any drugs.  Everyone else is still trying to pass the buck!!

I finally told the practice manager that I was going to drive the 2 1/2 hours to Houston today and that I would not be leaving their office unescorted until I had four weeks worth of drugs to take with me!!  She agreed to have the drugs ready and that an escort would not be necessary... why couldn't they just offer the drugs in the first place?!?

How many patients just give up?  And how many of those fail TX?  This is so unacceptable to me!!  I'm going to take the drugs and finish my TX for now, but there will be an investigation when I'm done.

Thanks, again, for allowing me to vent!!  

[dontworry_behappy]

Call the drug company like Pooh said.  The drug company will call your
Doctor for you.  Stuff like this happens to me too.  For example, Incivek
has a great website that offers help.  Also, doctors offices often have the
drug your taking in the office (provided by drug companies).  Go down there
and sit in the office.  I bet you get what you need.  Talking loud seems to
add to the success : )

[belle19]

i can't believe that something like this could happen.  don't they realize the stress that they've put on you while you're on tx.  it seems like no one gives a s**t about their responsibilities.  hang in there.  best of luck.  belle

[Advocate1955]

Sorry you're having to go through this. I would probably go to the doc's office and not leave until the authorization was faxed in and I had enough meds in hand to last til the pharmacy ships the meds. I would also be all over the pharmacy demanding to know why they didn't contact me to alert me to the problem when they first received it.
Advocate1955

[pooh55811]

Call the drug companies. They can send out enough meds to cover you until you get yours.

Also, this same thing happened to me, the doc screwed up on the authorization request. I finally told them that since they screwed up, then they could pay for the drugs until my ins. co. approved the new auth. request (which took them 2.5 weeks to do). Well, the doc and the pharmacy found me some drugs for free. They have samples floating around so they should be able to get their hands on some.

However, I would try the drug companies themselves and see if they can overnight some meds for you.

[srw920]

Grrr! So frustrating.   Call the nursing hotline for the pharma company maybe they can work with the docs office to make this happen.  Since they are not answering the phone, are you close enough to go to the docs office to ensure they get this done.   Hang in there.

[kittyluvr420]

Good grief! I went thru the same thing with my incivek after one month on tx. I got the drugs just in the nick of time, but, boyoboy did I sweat bullets.
Praying for you!
Rhonda