POZ Community Forums
Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: Tim Horn on March 30, 2011, 11:04:26 am
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I'm wondering if any of you gals or gals are covered by a United Healthcare insurance policy for your prescription drug coverage. Most people living with HIV covered by a UHC policy are being forced to fill their ARV prescriptions via the company's "specialty pharmacy," Prescription Solutions.
Without going into details, I'm going to be writing something up and my experience with this program. If those of you also covered by United Healthcare and currently utilizing Prescription Solutions could provide me with details regarding your experiences -- either good or bad -- I'd appreciate it. I'd like to quote you in the piece I'm writing, either anonymously or using your Forums login name.
Thanks very much...
Tim
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I haven't had them tell me that yet. Jerry
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My partner and I have been with United for years. We have always received our ARV meds (Kaletra and Truvada for me, Truvada and Sustiva for him) through their Mail Order service and charged the Formulary maintenance drug copay rate of $60 for a 90 day supply for each med. No longer!!
About a month ago we received a letter and slick marketing brochure explaining these drugs were now classified as "Specialty" and would need to be filled by their "specialty" pharmacy (Prescription Solutions).The brochure touted all of the benefits of using this "specialty"pharmacy like additional support services and timely delivery.
What was buried in the text of the letter was the fact that they would no longer fill 90 days for the $60 copay but just 30 days instaed. The reason given : "This allows physicians to assess the drug's effectiveness and eliminate waste of these costly medications". Really??
We have been on our respective regimen for years. We know it works ...our doctors know it works. This has nothing to do with improving our doctor's ability to assess the effectiveness of the drugs and everything to do with improving United's bottom line. Overnight our co pays for our ARV's went from $240 every 90 days to $240 per month
To arbitrarily invent a new prescription classification that only applies to the most health compromised of an insured "group" does not feel right or fair even if it is ,in fact, legal. Is insulin now a "Specialty" prescription? I would guess not. How about blood pressure meds? Probably not. Yet often times a doctor will have to change prescriptions often to get the right drug/ dosing.
This sounds like a way for insurance companies to deal with the possibility of the elimination of their ability to discriminate against people with preexisting conditions. Simply make the co pays for vital meds unaffordable and you've accomplished the same thing.
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I use UHC. I was filling my prescription at the local Walgreens but as soon as I filled the prescription once they sent me a letter demanding that I fill it with them. I was a bit hesitant to do so but there were a couple of distinct advantages to doing it this way. They call me to remind me to fill my prescription so I will never get down to just one or two pills, they mail it to me directly, and they have all of my information (including my copay assistance) on file so it made it a lot more convenient for me. They also sent me a letter after my first round of labs stating that I would have to use "in network" labs for my results the next time (which is quickly approaching). The only thing about this that bothers me is I'm not sure if I need to inform my doctor of where to send the lab work or if they will inform him for me. My coverage is also extremely cheap so jumping through a couple of hoops in order to be medically insured as well as I am is fine by me.
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What was buried in the text of the letter was the fact that they would no longer fill 90 days for the $60 copay but just 30 days instaed. The reason given : "This allows physicians to assess the drug's effectiveness and eliminate waste of these costly medications". Really??
We have been on our respective regimen for years. We know it works ...our doctors know it works. This has nothing to do with improving our doctor's ability to assess the effectiveness of the drugs and everything to do with improving United's bottom line. Overnight our co pays for our ARV's went from $240 every 90 days to $240 per month
Are you sure about this? The copay for Atripla was 30 for a one month supply or 75 for a 3 month supply. They also told me I could no longer receive a three month supply and they gave me some reasons for it, but I'm completely certain it is for their financial gain. Although they were honest enough to say that if I did change regimens the remaining quantity of a 90 day supply would be wasted. This is valid for me because I am definitely aiming to change my regimen soon.
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Absolutely certain. I just received my first order through Prescription Solutions and the cost was $60 for each 30 day supply for the the same meds I was paying $60 for a 90 day supply over the past few years.
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My prescription coverage is through DC37, my wife's union. The mail order option used to be serviced by Innoviant Pharmacy and as of this year is serviced by Prescription Solutions.
My first experience with them was setting up my online account. The web site is unacceptably, painfully, frustratingly slow and often times down due to a high volume of traffic.
Upon contacting customer service by telephone to address the website issues, I realized this was going to be a bumpy ride. The several reps I spoke to were ALL rude and unhelpful.
I placed my first order for Levothyroxine, Crestor, Sertraline, Noorvir, Truvada, Lexiva and Testim on 01/10/11.
After several days I checked the website to confirm receipt of the prescriptions as I usually did with the old mail order and nothing. And nothing for two weeks. Calls to the customer service number resulted in being told they were "exceptionally busy this time of year". The order finally appeared "as received and in process" online on 01/25/11 over two weeks after submitting the prescriptions.
As an aside, I called DC37 Health and Benefits department to complain and request help in getting my meds. When I told the woman I had AIDS and these medications needed to be taken without interruption she replied, " You know some people wish they had AIDS, "I have to take medication too", what the fuck???
After daily calls repeating the same information over and over again I finally did speak to a pharmacist who actually gave me his direct telephone number and was truly compassionate and very apologetic. I ended up feeling bad for him as his feelings of frustration and helplessness were palpable.
I received my meds on 02/07/11, a full four weeks after submitting the order. If I had not stockpiled meds I would have run out.
Unconscionable.
Richard
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I use them and they have been amazing. Great customer service. They have gone above and beyond in my experience.
At first I was hesitant but they have totally won me over. If you'd like any specific info, please feel free to PM me.
To Gary S: you can use co-pay assistance programs to cover your co-pays, it's no big deal to do 30 days and the co-pay assistance covers the payments.
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hi folks, long time no see ;D i'll dive in on this one
i work for a great big airline, we have united health , and medco for prescriptions (they have horrible customer service) they would fill 90 days with a prepay of $175, but the big downer is they don't participate in the copay assistance program
as an option we can also use prescription solutions as a "specialty pharmacy" but then can only get a 30 day supply at $75
prescription solutions actually helped me get set up with the copay program and in my experience have been wonderful to deal with even considering the short supply
but, i'm still new to all this, ymmv
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This is really great feedback and a lot more mixed than I thought it would be.
When it comes down to it, it's clear that the disbursement of ARVs through UH's "Specialty Pharmacy" is a cost-cutting measure. UH probably pays a discounted price for ARVs and, instead of depending on retail markups, finds its profits in savings.
I don't begrudge UH for this, actually. I mean, did Gilead really need to jack up the price of Atripla yet another 5 percent (http://online.wsj.com/article/BT-CO-20110404-708185.html)? Wasn't $1.9 billion in Atripla sales in 2010 alone enough? Such greed. While UH is undoubtedly interested in protecting its own bottom line, efforts such as this also help control the costs of our health care expenses.
My first experiences over the course of four months with Prescription Solutions was pretty bad -- long story short, due to delays on their end (as well as mine, admittedly), I ended up missing a few days of doses two months in a row. I ended up going back to my regular pharmacy for a while, but now I've officially been cut off and have no choice but to use UH's Specialty Pharmacy.
What's more, I think that filling scripts via two pharmacies -- my ARVs through Prescription Solutions and my other meds through my regular pharmacy (UH's Prescription Solutions won't fill non-"specialty" meds) -- is a tad dangerous. By filling all of my prescriptions at one pharmacy, all of the meds I'm taking are in my file, hence warnings pop up if my doc writes a prescription for a med that interacts with another drug I'm taking. This won't happen via Prescription Solutions, unless I'm really careful about keeping my file with them up-to-date.
Gary, the co-pay situation is also important. I would definitely get a co-pay card, activate it, and give the relevant numbers on the card to the Prescription Solutions rep -- I was surprised to find it worked, without any trouble, upon switching back to Prescription Solutions last week. But it's an issue nonetheless.
Thanks guys... lots of food for thought here.
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Thanks for all of your suggestions about the copay card. I've been positive since 1988 and have never used/ heard of it? Is the ability to get it based on low income? Who is it through?
On another note, I just discovered this sight. I recently went out of work on disability and was looking for information when by chance (through a Google search) i came upon this forum. It has been an AWESOME discovery with a great deal of helpful info./ advise.
Thank you.
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Gary:
Your health care providers should have all of the necessary co-pay cards -- these are not dependent on income.
You can learn more about these programs by clicking here (http://www.aidsmeds.com/articles/PAPs_Copays_19740.shtml).
Tim
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When I told the woman I had AIDS and these medications needed to be taken without interruption she replied, " You know some people wish they had AIDS, "I have to take medication too", what the fuck???
Wow Richard, that made my jaw drop. What a bitch! I hope you reported her. "Some people wish they had aids...." Really? Damn.
I'm glad you were able to get in touch with the compassionate pharmacist. There are still some good people in the world, thank goodness.
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I received word on short notice about the change to Prescription Solutions a couple of months ago, and I was concerned because I was about to go on vacation for a week, so I found out that even though the CVS in NYC will no longer fill my prescriptions, I could go to a CVS in NJ (because they have a mail order service there) and I can pick them up there. So that's what I've been doing. I'm not comfortable having them mailed to me since i live in an apartment building and have a faulty mailbox, and also sometimes the mailman leaves packages outside my mailbox in the lobby if it's too full. I don't want my meds delivered at my job either because the storage room where mail is kept is not secure (long story), and a co-worker has had prescription drugs disappear from there.
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another nice thing about prescription solutions, they don't use the us mail... i worked out with my fed ex guy to drop my package in a slot on the back door, i feel more comfortable that way than the last mail order company having the mail man put it in my black metal mail box for all the crack heads to see
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another nice thing about prescription solutions, they don't use the us mail... i worked out with my fed ex guy to drop my package in a slot on the back door, i feel more comfortable that way than the last mail order company having the mail man put it in my black metal mail box for all the crack heads to see
They actually do use the US Postal Service if that's what you request. It's my preferred way to get the meds b/c my mailbox is big and has a lock so the mail carrier just leaves them in there.
I wanted to add to what I said above. In my experience, not only are they normally very prompt, professional and courteous but I recently had an insurance issue when my employer suddenly changed policies. Rx Solutions was extremely helpful, really going out of their way to such an extent that I asked to speak to a supervisor so that I could express how satisfied I was with the way they helped me out.
One thing that annoyed me when first using them is that they always have to ask those same 3 questions ("Do you ever forget to take your medications?" etc). But I realize it's the person's job to ask and I just answer nicely, it's no big deal.
Gary, the link Tim gave you has all the pertinent info. Co-pay assistance programs have no income criteria. They are for people who have regular health insurance that covers their meds but they still have to pay a co-pay. These programs, for the most part, basically cover the co-pay amount. It's extremely easy to sign up for and to use.
I'm on Isentress and Truvada and would normally have a $30. co-pay for each, so these programs save me $60. per month. Basically the pharmaceutical companies reimburse the pharmacy.
When you sign up I'm pretty sure you can get a month or two retroactive if you fill out a form and send to whatever pharmaceutical company makes your meds. Not sure if it's worth the trouble, depending on your co-pay etc.
Patient assistance programs, also in Tim's link, are slightly different and some do have income restrictions.
This is a previous thread with info:
http://forums.poz.com/index.php?topic=35582.0
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Inch i have a question concerning the copay assistance .. If i wanted to take advantage of the mail order will they accept the copay assistance
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Inch i have a question concerning the copay assistance .. If i wanted to take advantage of the mail order will they accept the copay assistance
Yes, no problem. What meds are you on? Feel free to PM me if you want.
If you're on Atripla, which I think you are, here is the info:
http://www.atripla.com/copay-assistance.aspx
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Here’s the way my doctor explained the difficulties I was having with my mail order pharmacy:
With retail pharmacies, you are their customers. With mail order pharmacies, the insurance companies are their customers.
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Here’s the way my doctor explained the difficulties I was having with my mail order pharmacy:
With retail pharmacies, you are their customers. With mail order pharmacies, the insurance companies are their customers.
It doesn't feel that way when I deal with Prescriptions Solutions.
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I use CVS Procare mail order to deliver my prescriptions. I got many calls from Aetna US Healthcare asking me to change to there prescription service. I refused because I was happy with the service I had. My plan only fills prescriptions every 30 days, but my copay for Atripla is only $10.
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I use CVS Procare mail order to deliver my prescriptions. I got many calls from Aetna US Healthcare asking me to change to there prescription service. I refused because I was happy with the service I had. My plan only fills prescriptions every 30 days, but my copay for Atripla is only $10.
Even though that's a low co-pay you can still use the co-pay assistance and it would be free. Why not let Bristol-Myers Squibb and Gilead pick up the tab?
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other organizations have started this type of "level" involving special meds... my meds are usually provided thru Express Scripts under contract to the Dept of Defense.... my latest med showed up in a "new" level and now only provides one 30 days supply by mail order under one of their "sister companies" called CURASCRIPT same copay but only 30 days not 90 none of the local drug store/pharmacies carry Egrifta..and are reluctant to order it
just one more way to give us "efficiency" and "improved service" as their cover letter said...
Nick
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Even though that's a low co-pay you can still use the co-pay assistance and it would be free. Why not let Bristol-Myers Squibb and Gilead pick up the tab?
Thanks, I just called them up and signed up.
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I got the news last June that UHC was requiring me to use Prescription Solutions for my "specialty" medications - Truvada and Viramune - to control costs. I had always been prescribed 30 day supplies - so I didn't miss the 60 or 90 day option. I thought I would miss the convenience, and the human touch, of going to my local Walgreens - where I know the Pharmacy staff by name. But as it turns out - I have had nothing but great interaction with the Prescription Solution folks on the phone, I've never had a service issue, and the phone call reminder to refill is great too. I don't know why they wouldn't consider Valcyte a "specialty" med - it's the most expensive thing I take - but I still enjoy seeing my friends at Walgreens! Prescription Solutions has been fine for me.