mlynn
"It was obvious in January that my treatment had failed - Cimzia, along with methotrexate and a low dose daily steroid. It took 5 months to see my rheumatologist in spite of messaging his office every month.
My rheumatologist finally prescribed Inflectra in June.
I was hopeful that I would finally feel better until my specialty pharmacy, one I have not used before, started playing silly games. I was to have my first infusion on 7/16 with the next loading dose on 7/30. So far, in spite of repeated calls to the pharmacy, who promise shipment, and calls to my insurance company, I have not yet had a single dose of Inflectra. I am physically struggling and mentally exhausted.
How can pharmacies get away with this? Why do insurance companies use these problem ridden pharmacies ? Delaying medication can make people sicker. And sicker.
I have promise number 3 that my medication will be delivered. I don't believe them."
It takes so long to get things approved and paperwork etc these days, it is bonkers. It can be overwhelming at times for sure, especially when you are waiting for medications. A real pain, literally and figuratively! You are not alone in that. Let us know if there's anything we can do to help from here. Keep on keepin' on, DPM
I have an update that would be funny if I wasn't so miserable going without medication for so long.
The dance continues with the specialty pharmacy so my husband called our insurance company yesterday. Our insurance company put him on hold while they called the specialty pharmacy. Toni, the insurance rep, was told by the pharmacy that my drug and infusion were not covered by insurance. Toni, of course, could view my insurance approval letter. Toni was so mad she hung up on the pharmacy. She then escalated the issue to a National Priority Service Response Team within our insurance provider, who spoke with my husband and the pharmacy for well over an hour to get this resolved. We have her email address and she will handle any and all issues with the pharmacy going forward.
I truly hope no one else has to go through this to get a medication. But the reviews for this company tell me its common. My advice is to call, and call, and escalate the problem if you get the run around. But I know it hard to to if you're in pain and tired.
Dan Malito, thanks for your words of support. This site with people who understand keeps me somewhat sane 😀Hi
. Your reaction about all of this being funny (in the absurd), if it wasn't leading to real life pain is so apt. They are literally telling the person who does the coverage that the medication is not covered. This all sounds so familiar. I recall several years ago having these conversations with the insurance company and getting the specialty pharmacy or pharmacy benefits manager on a third party call and going round and round. Since when did pharmacies become gatekeepers to a negotiation that has nothing to do with them? The whole situation is mind boggling. On our end, other than reassuring each other to keep advocating and don't give up, there is basically nothing we can do for each other because one person's success does nothing to stop it from happening again or make the go-arounds any shorter or easier. You would think the pharmacy wants to move product to make money and yet they don't want to listen to the company that is guaranteeing the money - go figure or as the kids say "make it make sense." Best, Richard (Team Member) , thank you for sharing your own nightmare experience with a pharmacy. While I am sorry that you and Kelly endured it, I felt less alone in trying to do battle with a company that holds the keys to the medicine cabinet. Indeed - make it make sense! , good grief! I am so sorry you and your husband had to go through all that. This isn't the same, but when my daughter was born (almost 25 years ago) it took TEN MONTHS to clear up the medical bills from her birth. I still joke that it took longer to square away the bills than it took to make her.
That said, I acknowledge that my overall health was not in jeopardy from delayed treatment, like your situation. That's unacceptable!
I am so glad you finally have someone in your corner (Toni) fighting for you and not taking any excuses! And maybe she can put in a complaint to have this pharmacy removed fromthe list of your insurance's partner pharmacies?
It shouldn't be this hard, should it?
Best, Erin, Team Member.
, your comment about clearing up the bills taking longer than it took to make your daughter cracked me up! I needed to laugh yesterday.
The medical establishment, at least parts of it, seem to have forgotten that we are real people with real lives, not just names or clinic numbers on a screen.
I think I should organize a party today or maybe not since party planning is not my forte. But moments ago I received a delivery date from the specialty pharmacy for Inflectra. I can hardly believe this ordeal is over.
I sure appreciate the support that I got here. I was about to lose my mind., I feel like you almost SHOULD have a party when the Inflectra arrives! Lord knows you have waited and struggled long enough!
Best, Erin, Team Member.That's great news
. I don't know if it is possible for you to get refills as soon as they become available and build up any kind of supply for when the authorization comes around again, but I know it can be helpful to have some cushion, however small, when those gaps come. Let's hope they simply don't come. Best, Richard (Team Member)