POZ Community Forums
Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: Peteskier on October 31, 2012, 11:58:40 am
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Cigna will not pay for my Atripla Tablet if I pick it up at a Pharmacy. They force me to use their Cigna Home Delivery Pharmacy.
When I called today to refill my medicine and pay 140.00 for three months supply. The automated system first said I could not fill my perscription and I had to talk to customer service Rep who also could not help me who directed my call to a special medication pharmacy within Cigna.
The person took my information and submitted my refill request. The person was not pleasant to talk to on the phone. I also was told that my medicine's actual cost was 5375.40 and once they ship it via UPS that I am responsible for it. I asked for a tracking number to be e mailed to me and the person said we don't do that you will have to call us back. I know the actual cost of my medicine and it bothers me that they have to tell me how much the actual cost is.
I feel Cigna is discriminating against HIV policy holders by requiring them to fill their perscriptions with their Home Delivery Pharmacy. I asked for a list of forced home delivery medicine and the list they sent me did not have Atripla listed on it at that time. Also Cigna Home Delivery Pharmacy does not bill so ADAP can not pay to help me with the copayment cost. Has anyone else been treated like this from Cigna and where can I go for help?
Thank You
Peteskier
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This may be a bit late, but it might still help you.
In Kansas where I live, the Kansas Department of Health & Environment has a Linkage to Care Coordinator. He helped me navigate my insurance and getting Medco's mail-order pharmacy to accept pharmaceutical companies' copay assistance programs.
The state you reside in should have the equivalent of this person. It may take a few calls or navigating your state government's website, but if you can find someone like this, they'll be able to help you battle Cigna on this issue.
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I hope you've gotten this taken care of by now, but I also have Cigna.
I recently switched to them and I did have to get a Pre-Auth for getting my Atripla and the doctor just let them know I'd been on it for years and that I wouldn't be changing. They did initially reject it (It's not a tier one or tier two drug for them). It did take an extra day.
I've never been told that I had to only use their pharmacy or anything of that nature. Odd.
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Hi Peteskier,
I have Cigna insurance as well. I actually just started treatment and my specialist prescribed Atripla. I had absolutely no issues getting my prescription filled. I did have to pay a $60 copay instead of the usual $10 because it is a 3rd tier non-preferred brand. On the information sheet given to me by the pharmacy, my 30 day supply's retail price is $2503.99.
I can only assume that there are one of two reasons why you've been forced to order them through home delivery. 1) You may have a different level of insurance coverage, 2) The cost of your supply is about 2 times as much as mine.
I hope this helps.
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Sounds like you are also stuck with Cigna's forcing us into filling all AIDS meds via the "specialty pharmacy" ... ("special" has apparently become a euphemism for HIV/AIDS). If you look on-line, the vast majority of the "special" meds are related to HIV/AIDS. The pharmacy you are no doubt being forced to use is OptumRX / Prescription Solutions.
My doctor thinks the purpose of OptumRX / Prescription Solutions may be to make filling HIV medication harder, resulting in lower costs for the insurance (this is the guy in the white coat with the MD suggesting this, not me). Cigna couldn't possibly want to use OptumRX for the RX costs themselves, as OptumRX / Prescription Solutions actually charges MORE than my local pharmacy (according to Cigna's web site). Yes, this is anti-HIV discrimination at its worst. If they can't get us off the insurance, they will just make it a huge pain in the ass to fill our meds.
Once my firm issues bonuses and I am slightly less afraid of getting fired, I am going to file congressional complaints (to my senators and congressmen/women over the web), an FTC complaint, BBB complaint, state attorney general complaint, federal ADA complaint, etc. Copy/Paste makes it very easy to complain to many state and federal agencies all at the same time. I suggest anyone else who is having these issues with OptumRX do the same. (Evidently in CA they were able to force Cigna to allow local pharmacies, but this was all based on local CA state law.) ACA does "protect" whistle-blowers, but I am not sure the extent of this protection.
OptumRX / Prescription Solutions has already screwed me over several times, including "accidentally" not filling my orders (twice now). I have a few suggestions on ways of dealing with them:
1) Always request a tracking number, even though they will not give you one on your first call (when you order).
2) Call back after you order to get the tracking number. If they've shipped something, at least you may get ONE of your meds.
3) Always order one med at a time. This ensures they don't screw up and ship you only one RX.
4) Make sure you are dealing with the specialty pharmacy, not the "regular" pharmacy. The regular pharmacy has actually flat out refused to fill an RX before, insisting that I wait several weeks (they also claimed my meds were not specialty meds). The "specialty" pharmacy has a direct number -- always call that.
5) Call your RX in as early as possible (usually at least 7-10 days before your RX is out, or about 21 days after your last fill). I think my insurance allows 10 days. Mark it on your calendar, as OptumRX will surely screw something up and you'll probably have to re-order.
6) OptumRX seems to prefer using UPS. You can sign up for the UPS delivery alerts on the UPS web site. The delivery alerts will send you an e-mail telling you when a package has being sent to you. If you don't get a delivery e-mail within a day or so after ordering from OptumRX, you will need to call and re-order. ::)
7) If you ever have issues, deal with your doctor and not OptumRX.
Hope that helps. Best of luck, and again I strongly suggest filing complaints. If enough of us raise hell for Cigna, we may be able to get them to back off of this shit pharmacy.
td
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American health care at its best! All the reason to hate the fact that Obama sold us out to these bastards.
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Cigna couldn't possibly want to use OptumRX for the RX costs themselves, as OptumRX / Prescription Solutions actually charges MORE than my local pharmacy (according to Cigna's web site). Yes, this is anti-HIV discrimination at its worst.
Having never dealt with this company or CIGNA, I can't comment on service issues. However, I can comment on this quoted section.
What a company CHARGES and what an insurance company has negotiated as payment are usually two very different things.
My ID doc CHARGES Aetna $175 for each of my visits -- Aenta only pays $79 (minus my copay, of course).
Mike
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I just started to order my Meds From OptumRX this year, have 14 medications included
Atripla and have not had any problem, they actually called me and reminded that it was time for refill.
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Can you not use a copayment card with mail order to eliminate the copayment?? Contact Gilead for copayment assistance and yes u can use co pay card with private insurance!
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I'm just going through this now with Cigna. My doc prescribed me stribild, so i go to the pharmacy, they tell me i need pre-authorization. So i get that only for them to turn around and tell me my deductable (for a single month) is 2100 something dollars. Obviously I can't afford that and did some prodding around and found out about Cigna's home delivery service (that charges me 66/month). I feel like this is such a scam that they are making us jump through these hoops. I still have to get it set up but im waiting on my doctor to send them the script -_-
I don't get it...*hits head against wall* :o
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Can you not use a copayment card with mail order to eliminate the copayment?? Contact Gilead for copayment assistance and yes u can use co pay card with private insurance!
I finally got everything sorted out with the mail delivery. The way i had it set up was to do 90 days at a time and then signed up for Gilead's co-payment assistance. Everything went through and totally wiped out my co-payment to zero. It's definitely worth jumping through the hoops (it took me maybe 10 minutes to sign up for the Gilead program).
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PeteSkier, my experience through Cigna has been the opposite of yours. (I'm actually shedding a small tear, no sarcasm, because I'm now switching health insurance in 2 days because of a new employer.) I've been going to Walgreen's and getting my prescriptions no problem.
EDIT: I have a PPO plan. I don't know if that makes a difference.
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I have Cigna. I pay $15 for a 90-day supply via mail-order. It sounds like it's the plan you've been assigned.