Medication Troubles

I have been taking the same medication for my Crohn’s for the last six years. It is different than my oral medication. This medication comes in the form of a needle that I inject into my muscle once a week. I will have to take this medication for the rest of my life. I try to stay routine, in that I want to make sure I am injecting on the same day, week in and week out. Since being hired by the Philadelphia School District, I am able to get my injectable medication free of cost once a month. So, when I am having a bad day at work, that last statement is what I think about.  Recently, I ran into some issues between my doctor’s office, the specialty drug company, and my insurance. Here is my story...

A new prior authorization

I usually call to renew my prescription once I inject that last needle for the month. It is pretty routine, and I basically know the ladies that work at the specialty pharmacy. This month, I called as I usually do and they told me that, “I would need a prior authorization.” They told me that they reached out to my doctor’s office and are waiting for them to fill out the paper. I thought to my self, “No problem, this is what usually happens once a year.” A few days later (two days before I needed to inject), I reached out to the specialty pharmacy to see what was taking so long.  They told me that they have not heard from my doctor’s office in over a week, and I should call them myself.

Great! I am going to be late to inject. I called my doctor’s office, who swore that they never received the prior authorization. I explained to them that I needed my medication and that they were delaying it! They then told me that I don’t need to go through my usual specialty pharmacy, as they found another specialty pharmacy that did not require a prior authorization. Although this seemed odd, I figured let’s give it a shot.

Running out of time

Overnight, I started to really think. Nothing has changed with my job, so nothing should have changed with my insurance. I was never notified from the first specialty pharmacy about the switch so I started to really question the creditability of the situation. And just for the record, now I was down to one day until I needed to inject.

The next morning, I reached back out to my doctor’s office who told me that the new specialty pharmacy did need a prior authorization and they sent it. I was still so confused since  I never heard from them.  When I called them, they told me that, “They keep receiving the same prior authorization from the doctor’s office, but it it is getting denied because they are trying to bill my prescription plan." That would be good if my needles went through on my prescription plan, but it goes through my medical benefits. Now I am down to the day of the injection with no needles in sight... To be continued... Read on for part 2...