Annoyed with ExpressScripts

[Deanne]

My neph submitted a prescription for Sensipar on 2/22 or 2/25. It was late in the day on 2/22 when I called to tell her I needed a new prescription. I'm now out of pills and called my neph's office to see if they knew anything about my not receiving it yet. The only information they have is confirmation that the prescription was submitted, so ExpressScripts has just ignored it instead of following up to let anyone know if they need additional authoration or something else is holding it up. It was a hassle getting it filled last year, too. Do the insurance companies think the patients will just go away if they ignore us? (don't answer that - I guess we would go away. But if they kill us off by ignoring us, they wouldn't collect their premiums anymore) 

[MooseMom]

   How do people who are really, really sick cope with this sort of bureaucratic nightmare?

I swear, coping with CKD is a full time job, and the pay is crap.  And absolutely no vacation nor benefits, whatsoever.

[SooMK]

Having just "crossed over" to Medicare this year (due to being 65) and then having a transplant a month later I have asked myself (and other, non listening people) the same question--how on earth do people deal with this stuff? It's like we take the people least able to process this information and heap on all sorts of rules and co-pays and doughnut holes and smoke and mirrors and say "good luck with that". I've been reeling from the cost of Valcyte, thinking I must be in the doughnut hole, but no, $776 is my cost BEFORE I go into the doughnut hole. At least with Medicare I can go online and see my status but with Part D I have to wait for the summary. Or I can call my Part D provider where I can speak to someone who pretty much implies I'm some kind of moron as I struggle to understand what's going on. I had ExpressScripts before Medicare but since I never had dialysis it was just the usual CKD Stage 4 meds. I still didn't like them. A doctor inadvertently submitted a prescription for me when it should have been for someone else (there's good things and bad things about having a common name) and Express Scripts was sympathetic but useless. My credit card was charged and the drug sent to me and that was that. Fortunately it was only $10 but it doesn't take a genius to see that all of us could get excellent health care if we weren't paying for so much administration--complex, inefficient, paper destroying administration.

[Simon Dog]

My credit card was charged and the drug sent to me and that was that.

Did you file a claim for an unauthorized charge with your credit card company?

[Simon Dog]

My credit card was charged and the drug sent to me and that was that.

Did you file a claim for an unauthorized charge with your credit card company?

But if they kill us off by ignoring us, they wouldn't collect their premiums anymore

A parasitic organism needs to live off the host, but not suck so much blood that the host dies.

[Shaks24]

I use Wellcare Extra PDP. 57 bucks a month on the premium. So far 6 of my prescriptions are no charge at all. One is like 28 for a 3 month supply. The best thing is that I do everything online and they have never missed a beat. The only thing I do not get from them is Calcitriol which I get from Fresenius as part of the bundle program.

[SooMK]

Simon Dog: I didn't file a claim with my credit card company. I thought about it but I just didn't want to be bothered.

[Ninanna]

I've been reeling from the cost of Valcyte, thinking I must be in the doughnut hole, but no, $776 is my cost BEFORE I go into the doughnut hole.

My insurance paid out $7,811 for a one month supply of that. It is by far the most expensive drug I've taken.

[Shaks24]

Sounds like its something beyond a Tier 4 drug.

[Ninanna]

It's a specialty drug and it doesn't have a huge market, which is why it costs so much (the smaller the market combined with short patent periods then the more expensive the drug).  You won't be on it long term though and besides which the patent expires this time next year.

[SooMK]

I am grateful my transplant was early in the year. I'll be done with Valcyte by year's end. I think of people who are transplanted toward the end of the year and all the counters get reset with the new year. Yikes! Although it sounds like that shouldn't be an issue next year with the patent expiring. Yah!