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Author Topic: More on mail order  (Read 920 times)

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Offline vertigo

  • Member
  • Posts: 142
More on mail order
« on: May 27, 2014, 08:17:39 PM »
So here's a new wrinkle in the mail-order pharmacy game.  I'm wondering if anyone else has encountered this.

I've been on Isentress/Truvada for a year.  Originally I picked up both at a retail pharmacy.  For my first refill, I was informed that Isentress was classified as specialty drug, and I would have to get it thru a mail order pharmacy (one owned by my insurance carrier).  Since then I've continued getting Truvada thru the retail pharmacy, with Isentress coming by mail.

But now the retail location says my insurance carrier has dropped Truvada reimbursement rates so low that it doesn't even cover acquisition costs.  In other words, they could only sell to me at a loss.  I was told this is a common strategy the insurance companies use to ice out the retail pharmacies.  So I'll try to fill Truvada thru the mail as well.

I recognize this is all a dollars game.  I'm waiting to see if any of the savings gets passed on to me, or if they continue to calculate the co-pay as a percentage of full retail price.

Offline vertigo

  • Member
  • Posts: 142
Re: More on mail order
« Reply #1 on: May 28, 2014, 04:46:45 PM »
Update: my Truvada co-pay is unchanged.  So the savings are being wholly retained by the insurance carrier.  Seems like at least a piece of it (consistent with my co-pay percentage) should be passed along, but no, not the case.

I bet this is how insurance companies will go about switching even more people to mail order.  They won't tell you that you have to do it, they'll just change the reimbursement rates so that local pharmacies won't be able to take your business.

On a positive note, I have to say that the customer service people have been very nice, and so far no real problems getting my meds by mail.  But no real savings, either.

Offline mitch777

  • Member
  • Posts: 3,596
Re: More on mail order
« Reply #2 on: May 28, 2014, 07:24:17 PM »
No surprise to me. The cattle are being herded by corporate greed regardless of the consequences.

Hope your mail order company will be as flawless as your local pharmacy. The trouble I've found is that if when a problem occurs, the solution has taken days to correct and with our meds it can put us at risk.

Best of luck!

m.
32 years hiv+ (oct. 2013) with a curtsy.

Offline ARMANDO

  • Member
  • Posts: 251
Re: More on mail order
« Reply #3 on: May 29, 2014, 07:40:13 AM »
before my meds were classified as speciality drugs,i use to get a 90 day supply from my retail pharmacy,then  i was told that i could only get a 30 day supply because they were just not making any profit by filling a 90 day supply.I was shocked by this and then i realized THAT IT IS ALL ABOUT MAKING MONEY!!!

Offline zach

  • Member
  • Posts: 1,599
  • built to last
Re: More on mail order
« Reply #4 on: May 29, 2014, 11:01:56 AM »
in the last couple days, my fathers insurance company has deemed some of his heart medication specialty meds too

it ain't just us they want to do this too. i see an attempt at a big shift coming in how meds are distributed.
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline ChavinKnight

  • Member
  • Posts: 15
Re: More on mail order
« Reply #5 on: September 13, 2014, 04:59:44 PM »
It is a case of many people with chronic conditions requiring expensive treatment being diverted to mail order.  So called specialty pharmacies are not necessary for any for any drug that does not require special handling, storage, administration, etc.  I've dealt with this problem by playing along for a couple of fills, then complaining when the inevitable problems surface (late shipments, violations of privacy, risk of medication being stolen in mail, medications baking in 115 degree heat in a mailbox, etc.).  So you file a grievance with your insurance company and/or pharmacy benefit manager.  Include a copy of any lawsuits related to the issue with the grievance.  Also ask the representative that you are dealing with what state the company is headquartered in and tell them that you intend it file a compliant with the relevant state board of pharmacy and the office of civil rights.  Sooner or later (sooner in my experience), you will be allowed to go back to filling your prescription at your local retail pharmacy.  It takes legwork and effort up front, but it is worth it.    8)
No pharmaceutical treatment for ~ 9 years; VL never above 450, half the time undetectable, cd4 >= 622
November 2013--Began treatment with Stribild; VL 120, cd4 585
December 2013--VL undetectable, cd4 = 722 (32.8%)
March 2014--VL undetectable, cd4 = 695 (30.2%)
June 2014--VL undetectable, cd4 = 602 (33.7%)

 


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