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Medical Forum / Diseases and Disorders / Hepatitis / January 2007

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NEED URGENT ADVICE!! PHARMACY WON'T SEND OUT MEDS

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j_r_5@hotmail.com - 09 Jan 2007 03:58 GMT
Hi group, my gf has hep c and has been on treatment for 8 weeks.  The
pharmacy called her on Friday and told her that the prescription had a
typo and they wouldn't fill it til they got the Dr. to send over
another one.  Well that happened today but now the pharmacy is saying
the insurance company won't pay.  The first 2 bills said they hadn't
payed yet but she was hoping the insurance was just slow paying.   I
mean the insurance said they'd pay,  the pharmacy was the one who
called her up in the beginning told her they contacted the insurance
company and that her co-pay would be $35 a month.  She really never
talked to the insurance company herself as the Dr. told her all that
would be taken care of for her and it seemed like that was the case.
Now the insurance isn't paying and she is freaking out because she
doesn't have anymore shots left and her next dose is due this Thursday.
This has be very rough for her as you probably all know and I've had
to convince her to not quit a few times already and she doesn't need
this bullshit.   Is there anything I can tell her to do?  To me this
sounds like its illegal to do this to someone say there gonna pay and
then not.  Her insurance btw is Horizon Blue Cross Blue Shield of NJ.
She did ask her Dr. if they had any spares to least give her more time
to sort this mess out but they didn't so thats out of the question.
The pharmacy suggested going to the emergency room will they have
peg-intron shots there?   Any suggestions would be extremely
appreciated.  Thanks you all.
greyhackles - 09 Jan 2007 04:18 GMT
>Hi group, my gf has hep c and has been on treatment for 8 weeks.  The
>pharmacy called her on Friday and told her that the prescription had a
[quoted text clipped - 19 lines]
>peg-intron shots there?   Any suggestions would be extremely
>appreciated.  Thanks you all.

If I followed that correctly, neither of you has actually spoken to the
insurance company yet. I suggest you do so promptly. If she has pharmacy
coverage (at all), see if BC/BS has a "specialty pharmacy" group that covers
this type of very expensive drug.

As to whether you're going to score a Peg shot at an emergency room, I rather
suspect that has a low probability of success. It's not like there's any
actual use for Peg in an e-room, after all.

It's Monday night. FedEx can get a cooler filled with Peg and freeze packs
anywhere in the US by Friday if they get their hands on it by Thursday
morning...

/greyhackles
Sara - 09 Jan 2007 04:58 GMT
I wonder if an SOS call to the pharmacutical company who makes
her meds would get you at least a temporary supply

Sara

>>Hi group, my gf has hep c and has been on treatment for 8
>>weeks.  The
[quoted text clipped - 62 lines]
>
> /greyhackles
Russian - 09 Jan 2007 06:22 GMT
In terms of rapid delivery:

Last month, I realized on Friday that I hadn't received the meds
delivery Thursday AM.

I started calling the pharmacy at 3:30pm on a Friday afternoon, freaking
out and all because I take my shot Friday evenings.

My usual contact didn't answer, so I started dialing sequential numbers.
 I finally reached someone, and that person referred me someone who
handles "special" meds.

He apologized, took care of the fulfillment, and sent the meds by
courier that went out at 6pm on Friday night of a pre-holiday shopping
weekend.  The courier arrived about 9:30pm, looking very tired - I gave
him a 20 and thanked him for the above-and-beyond-the-call-of-duty
committment (sitting in a trafic for what normally would be a 1 hour drive).

Got my shot in Friday at 10pm.

Learned one very important thing:  it's not about right or fair, it's
about being proactive and managing your own treatment outcomes.  Many
people here will tell you the same thing.

Focus on resolution and remember that if you get the right people on the
phone, they WILL know and understand how critical this is not to miss
on-time meds.

Take firm but polite action, but feel free to come here and bitch about
how unfair it all is to get it off your chest - you can't bottle it all
up - but just don't expect that venting will make any difference to the
insurance company, the doctors, the pharmacy, or the microscopic goddamn
viruses that are the real freaking problem.

Good luck.  Make sure you win in terms of the outcome you want.
Paul - 09 Jan 2007 15:24 GMT
On Tue, 09 Jan 2007 06:22:32 GMT, Russian <nobody@nowhere.com>, in
message ID <IwGoh.15037$rz3.8963@trnddc03>, in the newsgroup
alt.support.hepatitis-c wrote:

>In terms of rapid delivery:
>
[quoted text clipped - 31 lines]
>
>Good luck.  Make sure you win in terms of the outcome you want.

I haven't said this before on here but I pulled a crafty one before I
started tx.  It was a lesson I learned from old.  Although it is
mainly socialised medicine here in the UK (so payment wasn't an
issue), I knew damn well how unreliable drug companies can sometimes
be.  I took advantage of the very poor communication between the
hospital and the drug company.  I actually did not start my tx until I
had received delivery of the SECOND 4-week box so if there was a foul
up, I at least had plenty of time to sort it out.  I always had a
minimum of 4 weeks worth of meds in my fridge (except for the last 4
weeks of course when it started running down).  Of course the hospital
knew which week of tx I was on.  It would be pretty stupid (and
potentially dangerous)  lying to them due to all the bloodwork etc but
as far as the drug company were concerned, I started tx 4 weeks before
I actually did.  You know what happened of course.  They were late on
their delivery when I would have run out of meds.  I would have had
one of my shots two days late and would have run out of ribavirin for
a couple of days.  Anyway, I just picked up the phone and told them I
hadn't received my drugs and they were flying around trying to put it
right for me.  They must have been baffled why I seemed so laid back
about it :-) .
This was a lesson I learned from thew old days of seeing a private
doctor for a methadone script.  I used to have 6-weekly appointments
and with things like that pharmacists can be quite picky if there is
an error on the prescription.  So I used to work it with the doctor
that I had two weeks prescriptions in hand each time I saw him.
Funny how I carried that old experience through to my interferon
script many years later.
Terry - 09 Jan 2007 18:27 GMT
On Jan 8, 10:58 pm, j...@hotmail.com wrote:
> Hi group, my gf has hep c and has been on treatment for 8 weeks.  The
> pharmacy called her on Friday and told her that the prescription had a
[quoted text clipped - 19 lines]
> peg-intron shots there?   Any suggestions would be extremely
> appreciated.  Thanks you all.

Contact your hospital's social worker.
elmoemerson@webtv.net - 10 Jan 2007 14:27 GMT
If you get into a jam, you might ask your doc to call Dr. Stein in
Florham Park to ask him if he can spare a dose til you get things sorted
out.  He routinely participates in clinical trials and usually has spare
doses in his fridge.  It's worth a shot, so to speak.  Paul's advice
about not waiting til you get in a crunch before asking for refills is
wise.  
elmo  
 

http://community.webtv.net/elmoemerson/DocElmosHepFile

http://community.webtv.net/elmoemerson/TheFamilyAlbum
elmoemerson@webtv.net - 12 Jan 2007 14:40 GMT
Did you ever get your drugs?
elmo

http://community.webtv.net/elmoemerson/DocElmosHepFile

http://community.webtv.net/elmoemerson/TheFamilyAlbum
john - 12 Jan 2007 23:59 GMT
Hi,
Don't worry i have Horizon Blue cross in New Jersey also.They paid for
2 treatments so far.
My copay went up on this last treatment to 40 for 1 month of Pegasys
and 20 for 160 pills of ribavirin.......john

> Hi group, my gf has hep c and has been on treatment for 8 weeks.  The
> pharmacy called her on Friday and told her that the prescription had a
[quoted text clipped - 19 lines]
> peg-intron shots there?   Any suggestions would be extremely
> appreciated.  Thanks you all.
 
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