Oooh, I am so furious I could scream!!!

[disneymom3]

DH started a new job in Aug and consquently our prescription coverage changed. DS takes a medication that literally he would die without. To make a very long story somewhat short, after two months of using our reg pharmacy we were required to switch to mail order. I sent in the Rx from his Dr early LAST month. We had three weeks of medicine left and they said that would be enough time. After numerous calls between them and the Dr and eventually his specialist with calls to me from his Dr in between, basically what happened is that the pharmacy coverage place required us to change to a different medication because they said they couldn't fill that one. This child is 5 and a half and has been taking the medication since he was 6 weeks old. Okay, a few more phone calls and the specialist gets a new script written and we are supposedly good to go.

Now, the old medication was supposed to cost $26 for a three month supply. At our local pharmacy where we have purchased it with no insurance in the past, it costs $18 per month. Okay, a bit of savings, whatever. Today I get the new medication in the mail and an accompanying bill for $156!!!! WTH???? Let me point out that this is $130 more than they told me the original medication would cost and never once in all of these phone calls was it mentioned that this medication would cost so much more. If he had to have this particular one, I would not complain one iota. This is my child's life we are talking about and no price is too great, however, the one he has been taking for 5.5 years has worked just fine and would cost me $100 less for the three months just paying for it myself. When I pointed this out to the oh so helpful mgr at the prescription coverage place, she asked me well why hadn't I just done that then? EXCUSE ME???? I pointed out that I called to get a price of the old medication and since then no one had said a word about the fact that the new one that we are only getting because THEY could not fill the original one cost way more.

I talked to them and was very polite and clear. I asked if I could send the medication back, I asked about a refund, asked about honoring the price I was quoted for the other medication. I got a stone wall in response. There is nothing I can do for you. I could send it back, but I would have to pay shipping and they won't give me a credit.

Ooooh, I realy want to just strangle someone. Needless to say,after this very expensive medication is used up, we will be switching back to the kind he used to take.

 

[tubachick]

Sorry about the Meds.

 

[jodifla]

That is infuriating. Sorry you're having to go through that!

How do people in the health insurance industry live with themselves? If Dante were writing today, surely they'd be on at least the sixth circle of hell.

 

[vivilasvegas]

That is infuriating. Sorry you're having to go through that!

How do people in the health insurance industry live with themselves? If Dante were writing today, surely they'd be on at least the sixth circle of hell.

Well, I don't think everyone who works in health insurance are evil!

 

[eeyore74]

Express Scripts?

That really sucks. They owe you a refund, but that would be the nice thing for them to do.

 

[golfgal]

4 of the 5 largest employers in our town switched to a mail order system, Dh's old company was one of them. It was more expensive for me to order through the mail then it was to get it at the local pharmacy. Some of the employees have made contracts with some of the pharmacies to honor the mail order price so people can get their meds through them. It is really sad. We have a mail order option with the new company but we can also buy it at a local pharmacy. If we buy it at the local pharmacy we can only get one months supply at a time, if we do mail order, then we can get 3 months worth.

Last year Dh's company instituted a prescription plan where when you signed up for coverage you had to select a formulary and only the drugs on that formulary were covered. There wasn't a single formulary that has all the prescriptions we were taking, nothing odd even, some asthma and allergy meds and synthroid. If it wasn't on your formulary, you paid 100% of the cost. Well, we all had to get our psychic powers running so we could predict which meds we would need in the upcoming year and sign up for that formulary. This was a company of over 50,000 employees, too, not a small mom and pop kind of place. Unreal!

 

[Disney Doll]

Sorry about the frustration. We jsut went through a similar thing with DH's meds. He has mail order or can get them from a local pharmacy, but the mail order is cheaper, so for maintenance meds it makes sense. Called to get his maintenance meds delivered...sorry, but they are out of stock, so I was told to get them at a regular pharmacy. Of course, that means paying the higher co-pay. I said to the customer service rep(who was really very lovely) "So basically, because your pharmacy screwed up, I have to paya higher co-pay, even though I am trying to do the right thing". She said yes and apologized profusely. The difference between co-pays id $10, and, quite frankly, not worth the hours it would take to fight it, so I "let it go".

 

[bicker]

It is horrible how this country doesn't have an effective means of addressing the hills and valleys of its health care system. We're faced with the choice of either striving to become better able to achieve things it could not achieve before, versus striving to make sure everyone can be assured of getting everything that is available now that they need. There seems to be no way to achieve both, and situations like the one we're discussing here are the ramifications of that fact, and the decision to strive for progress.

In the end, we have to remember that, at the start, we are each responsible for everything, ourselves, and the only time someone else is unconditionally responsible for something is when they explicitly agree to be unconditionally responsible, as evidenced by their willing to put the guarantee in writing. Barring that, we have to go forward based on the knowledge that we are responsible, ourselves. That sucks, especially when we don't have it within our capability to address our needs in the absence of the specific action of someone else.

If we don't like this, we should change it, but with full knowledge of what we'd be losing by doing so.

 

[The Mystery Machine]

I wanted to say that my dd gets her genotropin thru our insurance. It is a part of the insurance company that does this, I don't understand why.

Now our insurance is changing as of Jan. 1 and we are shaking in our shoes....her meds cost 7,543.19 for a 3 month shipment.
We called and asked.

I think we have to pay the first 10,000 (doc's & meds) of our insurance so we are preparing to shell it out.

Don't know what they are going to do about the genotropin.....

 

[delilah]

I understand your frustration, and alot of times, I wonder what actually makes the medical insurance industry tick. Several times a week, I get faxes asking me to change medications for patients. I think the biggest offenders are Medco and Express script, although medicaid is not far behind. The fax says something like "Change the medication xxx to yyy or zzz. Estimated patient savings $0.00". Are they kidding me? Those faxes go right into the shredder.

My son uses a prescription tooth paste. I know that our co-payment at the beginning of next year will go up to $35 from $5. The toothpaste costs less than $35 if I get it without insurance! I am looking to see where I can buy the stuff wholesale; I am sure I can. The dentist has cases of the stuff, and I write the prescription we fill at the pharmacy.

 

[jodifla]

Well, I don't think everyone who works in health insurance are evil!

Then you haven't gotten caught up in their evil web yet.

 

[C.Ann]

Before my DH passed away there was one medication that he needed to take every day (very important for him to get the full dose) and the VA decided it would be cheaper if they sent him a different form - double the dosage, to be cut in half.. They were even so "kind" as to send us a pill cutter (the ones that cost a buck at the Dollar Store).. You know how tiny the absolute smallest birth control pill is? Well - that was the size of this pill - with no scoring.. It was IMPOSSIBLE to cut it in half.. He would end up with a half to 3/4's and the rest in powdery crumbs.. They still refused to change back to the original pill so basically he never got the correct dosage again..

Just recently the pharmacy has pulled some pill nonsense with my DD.. She has a medication that needs to be taken in the morning and in the evening (50 mgs. each).. The pharmacy will only prescribe it in 100 mg form now and said she will just have to take the full pill once a day.. Her doctor has been fighting with the ins. co. and the pharmacy as EVERYONE who has taken it in the 100 mg form has developed vomiting, severe diarrhea, and fainting spells.. The response? "Sorry, but it's cheaper this way and this is the ONLY way we're going to fill it..........."

Even when it comes to health, MONEY is still the bottom line...........

 

[tarmand]

OP, I actually went through something similar and fought it through my credit card company. I won. So, if you paid by credit card, it might be worth your time to file for a chargeback.

 

[Keggy]

What is the mail order pharmacy?

 

[The Mystery Machine]

What is the mail order pharmacy?

When you get on maintenance meds most insurance companies force you to get a 3 month supply through the mail, at least ours does.

 

[mickman1962]

MEDCO

 

[AllyandJack]

I don't know if ours forces us, but they give us some kind of discount on the co-payments if we do (I believe it's 3 months for $20., which is the co-payment for a 2 month supply). I've never had to take anything long enough to find out, thankfully.

 

[disneymom3]

Yep, it is Medco. Delilah, interesting that you mentioned them as one of the worst. DH is writing a note to his HR department to complain about it. We figure they need to at least know that employees are unhappy with the stupid thing. Right now I am still baffled that they required a change in medication to something more expensive for no apparent reason. Supposedly they cannot GET the one he used to take. The addtional annoyance is that his kidney specialist who did agree to change to medication also now says he needs to come in in Feb for a blood test to make sure the new med is adequately covering the issue. So, now, not only do I have medication that is more expensive and we have to really focus on making sure we give him the right amount at the right time (after 5.5 years of the other one, we work on automatic pilot and this one is totally different) but I have to pay for a $500 blood test in addtion to the very expensive specialist appt which he wouldn't have had to have until Aug if we didn't switch the medication.

I am calling the Dr today to see if he thinks I should bother with the new one. Seems dumb to pour $150 worth of medicine down the drain, but I don't know. I am also wondering if our old pediatrician who was more familiar with his condition would have fought this harder for me. It just seems impossible that they CAN'T get that medicine.