Hep C Discussion Forum

Groupergetter · Guru

Express Scripts Debacle....

jimbob · Senior Member

Kristen--
I feel for you, I really do as I know no one wants to deal with issues like that while on treatment. I do think I was fortunate after the first experience. I was given a number from the guy at BioPlus who told me it was the "higher IQ" number to call- hahaha!. He was very helpful and ask me to call him back if I needed assistance- which I did in the beginning. He was also the one who told me I needed to be 'proactive' with these companies. Might have been different story had he not intervened for me. I do hope it all smoothes out for you. I know I'd hate to have todeal with it at this stage of treatment....There are days I'm just "not at myself", if you know what I mean.

jimbob

Enavigo3891 · Senior Member

Hey Jimbob - glad to see your experience turned out okay unfortunately I think you are one of the few.

I did get additional phone calls today from Accredo and Curascripts both trying to send me a months supply of meds (so in essence, two months supply). Curascripts even had the audacity to call me at my job which is crossing the line as I have never authorized them to contact me there and this is a personal matter. I just got off a 45 minute call with a manager at Express Scripts who basically confirmed both pharmacies were a disaster after looking through the notes. She even noted that Accredo tried to put through the Rx yesterday but it was declined by Express Scripts as I no longer needed it yet they were still trying to schedule delivery of meds that had been declined. The ES manager stated she will call both pharmacies and ensure they void all existing Rx's and that they do not call me again.

jimbob · Senior Member

Hi all.
I feel safe enough to talk about this now that I just received my last shipment of meds for wks 9-12. Express Scripts is also my dispenser. ES first approved my order on 2/3/14 and I was told BioPlus wound dispense the order and I should have meds end of week. Called BioPlus and was told Acreedo would handle the orders. Called Acreedo and was told CuraScript would be my Pharmacy . Between the 3 of them trying to coordinate the order, and making an untold number of calls, I finally received the meds 2/21/13. I have to say I think my GI people were partly responsible for this as well. This put me 2weeks behind on my planned start date. To make matters worse, my GI claimed they couldn't schedule me for med training for another 2 weeks. So, I started the meds 3/10/14, my birthday. It'll be one I won't forget at least....
I have to say in fairness to Express Scripts/ CuraScript , once the first order was made, they've been right on time with the remaining orders. And, they have been a pleasure to work with. They have even called me every 2-3 weeks to check on me and helped any way they could. I think it's a 'hit or miss' thing. And I was told originally by BioPlus that I needed to be proactive. Also, CuraScrip called me every 3 weeks to remind me it was time to order.

-- Edited by jimbob on Friday 25th of April 2014 05:43:46 PM

LTChaos · Veteran Member

They have been calling me also trying to set up shipment on a refill I don't need. Scary they are involved in life or death decisions for so many people!

Fireman Rob · Senior Member

Apparently Express Scripts Has a Reputation to Uphold-

That's so awesome you're so close (11days) to completing your treatment! Congrats and please continue to keep us posted. I agree on Express Scripts- what a joke! My experience so far- after my insurance has denied me the newer treatment options (Sovaldi/Olysio), twice now, the good folks at Johnson & Johnson helped me out with Olysio and shipping is currently a HUGE MESS!

I finally got approval to ship the med to my local, home town pharmacy because Accredio is such a pain in the you-know-what to deal with and it sounds like the drug companies are sick and tired of dealing with them. After two weeks of trying to ship through Express Scripts (Accredo Specialty Pharmacy), no luck. I'm just glad my Dr. found a work-around to obtain the Olysio.

Now I'm pursuing Sovaldi again through insurance/Gilead, so we'll see if they can work something out together that will eventually allow me to start treatment. Hopefully I can operate through my local pharmacy again- much easier.

Stay Strong!

-Rob

Tig · Admin

That's just incredible! First they make you jump through the fire backwards, twice. Then the cries of expense fill the halls of Congress, to put out the fire and to make it fair and accessible for all. Now instead of controlling the flames, they close their eyes and ears and reverse the problem. You watch, people are going to end up with extra boxes of these high priced medications, either on their porch or sitting in a pharmacy. Then there will be a problem returning them and somewhere the bills for those prescriptions are being generated with the end users name on it. I hope they get a handle on this immediately.

Tig

PS: 11 days, Woot!!!!

Enavigo3891 · Senior Member

Figured I would revive this post today with this news....

Not counting tonight's Riba... I have 11 days of treatment left.

I got three voicemails today; 2 from Curascripts (Express Scripts original specialty pharmacy) and 1 from Accredo. I played stupid and called Curascripts back and they first confirmed they were calling as Curascripts and not as Accredo and that Accredo was still a separate entitity. Then they told me they received a prescription for me on 4/22/14 for Sovaldi and Riba, it had been approved by Express Scripts and they were ready to arrange shipment. I told them I'd call them back. I didn't need to call Accredo as they said in my voice mail they were calling to arrange my "next delivery" of Sovaldi and Riba. I guess they didn't get the memo when i called them back LAST TIME they called 5 days after my due date and told them to void my prescriptions! So... I have TWO bottles of Sovaldi and TWO bottles of Riba ready to ship!!!

I called and left a message for the social media relations person at Express Scripts as my concern has now moved from the incapable nature of Accredo and onto Express Scripts. If they're fighting so hard to control costs, why have they approved, now THREE addition fills or an entire treatment? I'm hoping that lady calls back tonight.

Anyone need meds?? LOL Just kidding! I'm too honest for that. Immensely frustrated but still too honest!

aprileee · Veteran Member

Wow...on the other hand, Accredo delivered my meds on time like they said they would today. Not sure how they got so mixed up with you? Strange!!

Gracie · Guru

Gee.. That makes 3 months, an entire treatment... Ok.... I'll inbox all of you....lol. It is nuts how many meds get wasted. I had three weeks of inteferon, RIBA left. They won't take it back, just trash....

Still nowhere near the price they are charging our insurance companies!

Tig · Admin

Kristen,

UNREAL!! Sounds like that outfit needs to be shutdown until they get someone in there that can figure out how to screw in a lightbulb...

Tig

Enavigo3891 · Senior Member

Make that three in a row folks!!! I got a call from Accredo at 3:17pm looking to set up my delivery!

I told them they missed the delivery deadline by 5 days and just offered me $28k worth of meds I don't need anymore .... i swear I heard crickets on the other end of the line. Then of course they gave me an attitude as if I did something wrong by being honest with them!!!

Groupergetter · Guru

They did the same with me. I got a voicemail saying they had meds ready to ship. I didn't bother to call them back. When I got a second voicemail, out of curiosity I called them. The lady I spoke to apologized saying it was a mistake. Makes me wonder if they have given some folks an extra 45k worth of meds?

Sad that some have to fight to get their meds, while others get called saying meds are ready to be shipped when they are not supposed to be?

LTChaos · Veteran Member

Just had to share a call I received from Accredo just now. They want to ship me another 28 day supply. I have already started my last 28 day supply of Sovaldi & Riba. I was tempted for a fraction of a second to have them ship it anyway & then give it to someone who needed it!! I am calling my Dr tomorrow to ask why they have another script??

What a fiasco they are putting everyone through!!

aprileee · Veteran Member

So they actually called ME yesterday evening to set up a delivery date. The price is a little more than they originally told me it would be, but still a lot cheaper than goofy US Bioservices! Did they deliver yours on time kristen??

Fireman Rob · Senior Member

Kristen,

Great news! I'm so glad your efforts paid off and now you can continue treatment with less stress. Thanks for sharing this experience as many of us will be working with this same company.

Thanks to you, I was able to request going through Express Scripts direct when the time comes.

Have a great weekend!

-Rob

Matt Chris · Guru

Hey Kristen

Hooray! Hooray! After you receive your meds Express Scripts should pay for a weekend stay at your favorite Spa, your favorite food, massage, and whole lot of relax. You deserve every bit to de-compress.

Thanks for showing us the way

matt

-- Edited by Matt Chris on Friday 28th of March 2014 04:25:59 AM

Tig · Admin

Hi Kristen,

This is great news! I'm so happy that you were finally able to convince the appropriate "blockhead" to do the job they promised to do. I'm very impressed with your ability to articulate your concerns in such a powerful manner. I believe your letter writing skills could make the difference for many here and elsewhere. I think you've got a lot of happy admirers right now, I sure am! Well done young lady, my hat's off to you! Now it's on to SVR and some well deserved time to relax. Good luck!!

Tig smile

aprileee · Veteran Member

Yes I have been keeping detailed notes of all calls ever since I read the first part of your post lol! I'll let you know what happens Monday! :)

Enavigo3891 · Senior Member

LOL ... good luck. Keep notes on when you call and who you speak to. That's how my situation started. Accredo would not "accept" the info as a transfer from my original pharmacy. Doctor had to call in... it all went down hill from there. Hope you have better luck. Keep us posted, would be interesting to keep this post as a database of sorts as to express scripts issues and resolutions.

aprileee · Veteran Member

I'm so glad you finally reached the right person!! I think I got my situation handled today as well, my nurse had to call in a new prescription (today) because US Bioservices did not send Accredo my prescription like they said they would. I'll call Monday to confirm and find out a shipment date.

Everyone should keep that email address handy for future reference...I know I wrote it down!! LOL

Enavigo3891 · Senior Member

As I mentioned in my last post. Here is the email address that I sent a note to last night. The email was sent at 8:52pm ET last night and I received a call from someone at 8:45am ET this morning. I had her email me her contact info and her signature said she is: Patient Response Officer/ Social Media Escalations

And as already stated in my post from this afternoon, by 10am my meds were being filled by my original specialty pharmacy at the hospital where I treat. So glad I found this email address online last night because clearly it's the right people to address these situations.

To:		ExpressRxHelp@express-scripts.com
Date:		Wed, Mar 26, 2014 at 8:52 PM
Subject:		URGENT: Refill due 3/31 - Accredo delaying with no answers...

To whom it may concern:

I respectfully request your most urgent review of my current situation. I am currently on Sovaldi and Ribavirin and as you can confirm in your system, my 3rd refill is due 3/31/2014. I have been back and forth with Accredo for 14 days now and they still have not filled my Rx and cannot guarantee when it will be done. Please see all my personal information and timeline below.

NAME

DOB

ID#

ADDRESS

PHONE

-- I INPUT THE TIMELINE (DATE/TIME) OF EACH CALL AND OUTCOME OF SAME --

Then at 6:09pm I called the Express Scripts Administrative Review Department. My intention was to ask for help as the only reason this Rx is at Accredo and not at my prior pharmacy (who can handle the filling without issue) is because Express Scripts said I had to move it. By 6:28pm, I was still waiting for "the next available representative" - I hung up.

I need my meds delivered on Saturday 3/29 by FedEx as they are the only carrier that will guarantee Saturday delivery. I cannot take off from work to stay home and wait for prescriptions as I have to miss enough work for my doctors appointments. I have no family here that can accept a delivery on my behalf and I cannot get deliveries at work.

My prior pharmacy, CHS handled my first and second fills with ease, efficiency and absolutely no stress to me. Express Scripts denied my request for ONE MORE fill at that pharmacy due to whatever bureaucratic reasons that were not disclosed to me. This is not medicine I will be on for 6 or 12 months. It was ONLY THREE FILLS and two were done. This transfer has been anything but seamless. I am tired and weak due to this medication and this stress is causing me significant headaches. This evening's calls made me so angry that I am sick to my stomach.

You, Express Scripts, are the reason I am going through this. You refused to provide a customer service and authorize one more fill at a pharmacy capable of handling the request. Your people have provided horrible customer service. You have required me to use a pharmacy that has deplorable operating practices and is currently engaging in borderline unethical practices; gambling with peoples' health. And You, Express Scripts, must be as aware as your patients are that Accredo is incapable of handling these specialty drugs and urgent situations. All you have to do is run a Google search and you will find thousands of (recent) complaints about Accredo and their inability to handle prescriptions in a timely manner.

Therefore, Express Scripts, I respectfully request of you, your assistance in getting YOUR pharmacy to provide the medication that YOU have approved and fulfill the service that my employer and myself pays for. I have already contacted My Support Path by Gilead, the manufacturer of Sovaldi and have provided them authorization to contact all involved parties on my behalf. At this point, I feel the only other option I have left is to retain the appropriate representation to pursue this matter and all available legal remedies as well as file another BBB complaint (which you have so many of) and notify the appropriate representatives, congressmen, and Insurance Commissioners. Put yourself in my shoes, what other options would you think you had if you were me? This is not a new Rx that I can sit back and wait to start. I'm 2/3 the way through treatment and nobody can say whether or not missing 1 pill could affect my chances of clearing this virus and achieving SVR. This could be a once in a lifetime opportunity and I am sincerely scared that my chances of beating this will be hampered by your refusal to grant my previous pharmacy authorization to fill these medications with coverage as well as by your assigned specialty pharmacy's inability to handle a prescription given to them 14 days ago.

Perhaps if you cannot get Accredo to explain themselves and get the meds to me on time you can approve them to be filled at the CHS Pharmacy and cover them as you did the first two. The CHS pharmacy can get them to me or I can go there and pick them up as they are only 20 minutes away and that would easily solve the issue AND guarantee I have the medications on time.

I look forward to hearing from someone in regards to this matter as soon as possible. As previously mentioned, you can see in your system this FINAL fill is due 3/31 (monday) therefore I need them here Saturday 3/29.

Thank you for your sincere and prompt attention to this matter.

Sincerely,

Kristen

------

And the rest is history! So moral of the story as we've been saying all along... STAY ON TOP OF YOUR REFILLS! BE YOUR OWN ADVOCATE! MAKE THE CALLS, DO WHAT YOU'RE SUPPOSED TO DO, AND IF NEED BE, INVOLVE ANYONE AND EVERYONE IN THE ISSUE. A strongly worded email to the appropriate individuals apparently helps after all else has failed!

Groupergetter · Guru

Glad this worked out for you. Sorry you had to go through so much aggravation. Hard to understand why they would do this when someone has already been on the meds for 2 months? Really makes no sense. 1 more month then on to SVR.

Enavigo3891 · Senior Member

SUCCESS!! I received a call at 8:45am this morning from Express Scripts in response to my email last night. They deeply apologized for everything. They said they would call Accredo and get a full accounting of the timeline and all actions on their part. They said that if Accredo could not explain their actions or guarantee meds will reach me by Saturday that Express Scripts would make other arrangements. I got a call back about 45 minutes later from Express Scripts advising they had contacted my original pharmacy and provided them with a one time retail override authorization (which I had previously applied for and was denied) and that the original pharmacy confirmed they could fill my meds and get them to me by Saturday. Express Scripts confirmed that there will be no monetary penalty for the retail fill. I asked what happened at Accredo and they would only say they have opened an investigative review into my file at Accredo and again apologized for the inconvenience. I then got a call from my original pharmacy at 10am saying they had received the approval and were going to get them filled. And I just now at 12pm received another call back from my pharmacy advising my meds have been filled. They will be shipped out tomorrow via FedEx overnight and will be delivered Saturday. I gave them my credit card info to charge my copays for the full 12 weeks. My out of pocket expense for the full treatment was $39.00!!!! I am posting this from my phone so I will post again when I get home from a real computer and share the email address I used for express Scripts and the content of my email should anyone else run into the same issues! Exhale.... aaahh!

pl1952 · Senior Member

Good luck tomorrow Kristen!

aprileee · Veteran Member

WOW...i cant even believe you are going through all of this. Hopefully my support path helps you!!

Dzdayscomin · Senior Member

My goodness, I feel really bad for you.

As if being plagued by the illness weren't enough, you can surely see who is making the $, and who is paying by the level of support they give.

You are very determined and in my experience it appears you are wearing them down, way to go on that.

Keep pus in ya got a mountain of supporters behind you on this.

Peace

Tig · Admin

Kristen,

I stand corrected! I still think from your description that you handled yourself impressively! I'm well aware of that NY attitude once it starts rolling, lol! Well done and good luck tomorrow. i have a feeling that it's going to be a bad day for the person that crosses you...

Tig

Enavigo3891 · Senior Member

Tig56 wrote:
Hi Kristen,
Good grief!! My hat is off to you for retaining your composure. Particularly in light of the potential for rage. I hope there is someone at Gilead that will help control, if not extinguish this fire for you tomorrow. It appears like Accredo hasn't got a clue...

HaHa Tig! I far from retained my composure with that supervisor, it was over for her when she started trying to blame my doctor. I have always been quick whited and being a born and raised NY'er I tend to start talking really quickly and loudly when angry. I think the riba rage makes me talk even faster and certainly with a sharper tongue. I also just sent a lengthy email to Express Scripts explaining the entire thing and suggesting they reconsider my previous appeal as if they just approve the final fill at my specialty pharmacy at the hospital (that did the first two fills), I can just go pick them up myself. Problem solved. Grrrr... furious bleh disbelief

I will update again tomorrow.

-- Edited by Enavigo3891 on Thursday 27th of March 2014 01:01:02 AM

Tig · Admin

Hi Kristen,

Good grief!! My hat is off to you for retaining your composure. Particularly in light of the potential for rage. I hope there is someone at Gilead that will help control, if not extinguish this fire for you tomorrow. It appears like Accredo hasn't got a clue... furious

@GG: So glad you got things moving forward! You post in' fool you, lol! biggrin

Tig

Groupergetter · Guru

Enavigo3891 wrote:
ANOTHER UPDATE: I, yet again, did not receive any phone calls from Accredo Pharmacy today. This evening at 5:10pm ET (they are on CT) I contacted Accredo. The first person I spoke with explained that per the notes in the system, my meds were not "profiled" until last night when the supervisor requested it be done. She could not explain what that meant. She stated there were notes in the system that stated the prescriptions were "invalid" and they called my doctor at 2:07pm CT and left a message requesting he call back. His nurse called them back at 3:39pm CT at which point they said they explained to her that the Rx's were "invalid as they were given on a verbal form" and that they would have to fax in new Rx's. This woman I was speaking with could not tell me why it has taken 13 days for someone to realize that the Rx's were "invalid" so she transferred me to her supervisor.
The supervisor stated that there was nothing she could do for me at this time as they've requested the information from my doctor and "it's up to them now, we can't do anything until they send the correct prescription". I asked her why it has taken 13 days to figure out the Rx was "invalid" and she could not explain that. She said that they accept verbal Rx's and she "guesses" my doctor wont do a verbal otherwise they "could have had it by now". I explained that was nice what she just said but the first person I spoke with today explained the doctor HAD provided a verbal Rx and THAT was what is now being claimed as invalid and that they were NOT going to put this delay on my doctor as he did the right thing 13 days ago. I confirmed it was before 5pm where she was and asked to speak to another manager, someone higher than her. She stated that she was the highest person I could speak with right now and would not transfer me to anyone else. I stated I wanted to know why the delay and she said that she wasn't going to go research state to state to find someone that might be able to answer that question as it wasn't going to solve the fact that I need my medication. I explained that she was partially correct - it would not help me get my medication on time but it WOULD help figure out who at Accredo is not doing their job and hopefully prevent this from happening in the future. She said that didn't matter, she will only try to assist now, "based on today's notes" and the best she can do is note the file urgent and that once the Rx's are received back from my doctor someone should look at that right away. She said it could take 24-48 hours. I explained that puts us at Friday evening and I need my meds Saturday. She said again that at this time it was up to my doctor and they will do what they can "but cannot promise anything" once my doctor gets the prescription over to them. I asked her what they will do if they miss my delivery, I miss doses and subsequently do not reach SVR (perhaps because of the missed doses). She had the audacity to say that she could transfer me to a pharmacist to ask about missed doses but they will probably say it's okay to miss a couple. That is where I ended the call with her.
I emailed my doctor and explained all of the above. I asked him to make sure that he fax whatever they are asking for first thing in the morning.
At 6:09pm I called the Express Scripts Administrative Review Department. I figured that since THEY are the ones making me use Accredo they could somehow assist. I was holding until 6:28pm when I finally gave up as nobody had answered. I hung up.
At 6:29pm I called My Support Path (Gilead) and explained the entire situation to them. They took all my info, my health insurance, my prescription plan, my doctor's info, etc. I gave them an authorization to speak to all of those people on my behalf. They explained that they will be contacting everyone involved and will see what they can do. They led me to believe that if Accredo cannot get me my prescriptions on time that they will get me an emergency supply. She assured me that someone will be in touch with me tomorrow after they speak with my doctor and Accredo.
The saga continues....

With all the new people taking these meds, maybe they've run out. biggrin

Just kidding, trying to make light of a bad situation. They will probably ship next day air as they did with mine. I would be doing much the same as you. I had similar bad experiences with Accredo. I wanted to set fire to the hoops they wanted me to jump through. They finally did get'er done....after multiple phone calls. They know how important it is for someone on treatment not to miss days. This will work out, keep focused on the SVR and how well the meds are working. Guess I'm a postin fool tonight, first time I've felt a little better for a loooong time. The meds seem to be working. If this is a preview, I want the full length feature. smile

Enavigo3891 · Senior Member

ANOTHER UPDATE: I, yet again, did not receive any phone calls from Accredo Pharmacy today. This evening at 5:10pm ET (they are on CT) I contacted Accredo. The first person I spoke with explained that per the notes in the system, my meds were not "profiled" until last night when the supervisor requested it be done. She could not explain what that meant. She stated there were notes in the system that stated the prescriptions were "invalid" and they called my doctor at 2:07pm CT and left a message requesting he call back. His nurse called them back at 3:39pm CT at which point they said they explained to her that the Rx's were "invalid as they were given on a verbal form" and that they would have to fax in new Rx's. This woman I was speaking with could not tell me why it has taken 13 days for someone to realize that the Rx's were "invalid" so she transferred me to her supervisor.

The supervisor stated that there was nothing she could do for me at this time as they've requested the information from my doctor and "it's up to them now, we can't do anything until they send the correct prescription". I asked her why it has taken 13 days to figure out the Rx was "invalid" and she could not explain that. She said that they accept verbal Rx's and she "guesses" my doctor wont do a verbal otherwise they "could have had it by now". I explained that was nice what she just said but the first person I spoke with today explained the doctor HAD provided a verbal Rx and THAT was what is now being claimed as invalid and that they were NOT going to put this delay on my doctor as he did the right thing 13 days ago. I confirmed it was before 5pm where she was and asked to speak to another manager, someone higher than her. She stated that she was the highest person I could speak with right now and would not transfer me to anyone else. I stated I wanted to know why the delay and she said that she wasn't going to go research state to state to find someone that might be able to answer that question as it wasn't going to solve the fact that I need my medication. I explained that she was partially correct - it would not help me get my medication on time but it WOULD help figure out who at Accredo is not doing their job and hopefully prevent this from happening in the future. She said that didn't matter, she will only try to assist now, "based on today's notes" and the best she can do is note the file urgent and that once the Rx's are received back from my doctor someone should look at that right away. She said it could take 24-48 hours. I explained that puts us at Friday evening and I need my meds Saturday. She said again that at this time it was up to my doctor and they will do what they can "but cannot promise anything" once my doctor gets the prescription over to them. I asked her what they will do if they miss my delivery, I miss doses and subsequently do not reach SVR (perhaps because of the missed doses). She had the audacity to say that she could transfer me to a pharmacist to ask about missed doses but they will probably say it's okay to miss a couple. That is where I ended the call with her.

I emailed my doctor and explained all of the above. I asked him to make sure that he fax whatever they are asking for first thing in the morning.

At 6:09pm I called the Express Scripts Administrative Review Department. I figured that since THEY are the ones making me use Accredo they could somehow assist. I was holding until 6:28pm when I finally gave up as nobody had answered. I hung up.

At 6:29pm I called My Support Path (Gilead) and explained the entire situation to them. They took all my info, my health insurance, my prescription plan, my doctor's info, etc. I gave them an authorization to speak to all of those people on my behalf. They explained that they will be contacting everyone involved and will see what they can do. They led me to believe that if Accredo cannot get me my prescriptions on time that they will get me an emergency supply. She assured me that someone will be in touch with me tomorrow after they speak with my doctor and Accredo.

The saga continues....

Tig · Admin

Thanks for the update Kristen and April! While there isn't anything set in stone or motion yet, they're well aware they aren't playing with amateurs! Keep us in the loop please, this is important for everyone. I'd get out my "Magic Eight Ball" for the answer, but I think I already know who's going to win this battle! YOU biggrin Good luck....

Tig

@LT: So glad you were able to get in touch with the right people and now have the meds and EOT/SVR in sight! Good luck!!

LTChaos · Veteran Member

Oh that sucks... I am so sorry to hear you are having such a problem with Express scripts. They are terrible to deal with.

You may want to consider getting your health plan administrator involved. They tried the same thing with me& it was only when I had my admin contact the plan manager & even the president of Express scripts that they were able to move mountains & get the meds I needed.

My last 28 day supply came in without incident, thankfully!

aprileee · Veteran Member

Good! Hopefully that is the end of it for you!! Yes i did follow up, US Bioservices called me back today (after calling them numerous times) to tell me that everything on their end has been sent over to express scripts. She told me that i should call them by Friday to make sure everything came through correctly. I think i will probably call on Thursday though! I also spoke to one of my nurses and she said that its not her fault that i overpaid for my co-payments, that i should have called my insurance in the beginning to see if im allowed to go through US Bioservices. Whatever, i think thats total BS but ya live and ya learn i guess. NOW- we'll see if im in for the same drama that you have been dealing with....i have about 20 days worth of Sovaldi left so the clock is ticking. Let us know what happens tomorrow!!

Enavigo3891 · Senior Member

UPDATE: .... Today is Tuesday, I have received no call from Acrido Specialty Pharmacy (Express Scripts) so I called them, again. I spoke with a very nice lady who basically said that she confirmed that a supervisor was involved following my discussion with them on Saturday. She stated she sees that an expedited request has been sent through the system and she really can't tell what else they need but will send another expedited request. She stated "Someone should call you tomorrow or Thursday". I nicely explained I was not hanging up the phone with another "someone should call you" because we're going on 13/14 days now and I still haven't received a call from this "Someone" character they speak of. I asked to speak with a Manager and was transferred to another lady who stated that she sees the Benefits have been verified and they are just waiting to be entered into the system by a tech. I explained that the "benefits have been verified and they are just waiting to be entered into the system" the last three times I called. I asked what else we can do? Who do we need to call on their cell phone or at home during dinner? Because instead of eating dinner I'm on the phone with them. Then I nicely explained again that this is NOT a NEW prescription, I am currently ON MEDICATION which means if they do not get their act together and miss my delivery date they are effectively gambling with my health and I will seek the appropriate representation to address the issue as well as contact the appropriate congressman/representatives. I further explained that I understand Express Scripts position on this medication as I read the news and I could care less about how they feel about the cost. They have approved 56 days worth of medication and if they do not approve and fill the final 28 as soon as humanly possible they are in violation of a contract. I was then placed on hold for an extended period of time. The manager came back and said that she has sent an expedited request to all of the techs, their supervisors, her supervisor, as well as the offline management team. She stated in the request the meds must be mailed tomorrow and requested that a member of management contact me directly to arrange shipment as soon as it's ready. She stated that is the most she can do for me today.

I thanked her for her time and stated she can also note my file that if I do not receive a call from someone tomorrow, I will be on the phone again this time tomorrow evening!

Stay Tuned...

@ April - did you follow up on yours? All go well?

aprileee · Veteran Member

When are these people going to learn not to mess with us Riba-ragers??!!?!? lol
Looking forward to making a couple calls tomorrow to make sure everything is on schedule, and you better believe my nurse is going to get an earful!!!!
Also, hope you chose not to punch any walls!! :)
Good luck!

Enavigo3891 · Senior Member

@ Wayne - I agree... Every new member welcome should end with that - "STAY ON YOUR REFILLS"!! LOL

@ April - I saw your other post the other day. I would definitely follow up. I have of course kept detailed records of every discussion I have had with everyone while on treatment. I have determined that Express Scripts has given grossly incorrect information every time I have spoken to them. Seriously I went back and checked, they've lied or been wrong about at least 75% of the topics discussed in each call.

@ Tig - In all other aspects of my day to day I have been able to keep the riba rage in check for the most part but it's not possible with Express Scripts. As for legal action and setting a precedent, I agree the precedent needs to be set. And the level of frustration does make me want to scream from the roof tops the level of unethical behavior that goes on at places like express scripts and I'd love to take them to court however that's a jurisdictional thing. Being that I am in the insurance field I unfortunately have vast knowledge on what can and cannot be won in courts due to the varying liability laws in each state. The only way this would even get into court would be for example, if they do blow my delivery date and I missed doses and then relapsed - I could try to blame it on that but I'd have to be able to prove it. You know as well as I do science can't prove SVR or lack there of based on missed doses or not. Perhaps that's what makes it even more frustrating is that I know I am at their mercy. I will become a thorn in their side beginning Tuesday though. In my opinion - this entire insurance/prescription issue is something that needs to go to the politicians and or the insurance commissioner. I am seriously tempted to do that. Or just punch a hole in the wall. I haven't decided yet. evileye

Tig · Admin

This infuriates me and I can feel the remnants of Riba boiling in my bones already! I don't know how you feel about legal action, but if you don't have an answer by Tuesday, I would contact an attorney. This needs to be elevated to the courts. A precedent needs to be established so these fools understand that they can't play with peoples lives. The potential complications of not getting your prescriptions on time are obvious and these bozos need to be made aware you will hold them liable. Let the pharmacies and insurance companies fight about nickles and dimes among themselves. You have the original approval in your hand and that was understood to mean your pharmacy costs were agreed on and authorized. You might give some of the payment assistance organizations/programs a call and chew on their ear awhile. Maybe they could provide you with some additional suggestions. Maybe enough to cover the month, or enough to provide an extra cushion until your pharmacy wakes up. Let me know if I can do anything, I'm ready to help!

Tig furious

aprileee · Veteran Member

Oh my...how confusing! Did you see my post yesterday about almost this same situation?? My current "retail pharmacy" is supposed to be sending the last 3 months of prescriptions over to express scripts because they are a "mail-order pharmacy" (so its cheaper for me) and they told me to make sure they have the correct phone number to call to transfer it over, so i did. However, after hearing your story, i better call on monday to make sure they did!! Sorry you've had to deal with all of this, the ribarage does not help the situation either. As was said in my post, our countrys system is totally messed up. And you are correct, we are our best advocates. All we can do is stay on top of it. Thanks for sharing!

OldenSlow · Senior Member

Enavigo3891 wrote:
GIVE YOURSELF PLENTY OF TIME TO MAKE SURE YOUR REFILLS ARE DONE ON TIME!!!!

Sorry for your ongoing troubles, Kristen. This is perhaps the single most important piece of advice we can impart to those undergoing or about to begin treatment with the new meds. Express Scripts has objected to the pricing structure from the very beginning and will continue to be a problem, as well as other pharmacies/insurors while this fiasco expands. We need to increase awareness about this. Think I'll incorporate it into my sig or otherwise into each postback to newer members. These companies are perfectly willing to cut off scripts mid-treatment, if they can get away with it. What a world.

wayne

-- Edited by OldenSlow on Saturday 22nd of March 2014 03:41:18 PM

-- Edited by OldenSlow on Saturday 22nd of March 2014 03:43:24 PM

Enavigo3891 · Senior Member

Hey everyone... It's been said a million times on this forum that we are our own best advocates. With more and more people starting treatment and Express Scripts holding some insane % of the American prescription coverage market I just wanted to reiterate the importance of being on top of your own refills . I wanted to share the current status of my back and forth between pharmacies and such due to Express Scripts "rules". The timeline is somewhat lengthy but I am 10 days into the process of moving my prescriptions from my original pharmacy to theirs and they have said it could take another 5-7 days until they actually fill the 3rd and final Rx.

I think people may benefit if they know what they may run into and/or what to expect:

Thursday 1/30/2014 - My doctor initiated the treatment/prescription process through the specialty pharmacy at the hospital where I treat.

Friday 1/31/2014 - Express Scripts requested prior auth/pre-approval (also known as more paperwork for the doc). My doctor completed all same day.

Monday 2/3/2014 - Express Scripts gave the specialty pharm approval for 84 days of Sovaldi/Ribavirin. Approval expiration 4/28/2014 - meaning all RX's needed to be filled by that date. The specialty Pharm filled both same day.

Tuesday 2/25/2014 - I received a letter from Express Scripts stating "To receive benefit coverage, you must order your medications listed below through CuraScript". I went online and logged into my Express Scripts account and learned that my plan only provides for 2 fills at a "Retail Pharmacy". Any additional fills would need to go through their specialty pharmacy. My original specialty pharmacy nor my doctor was explained this when we initiated my first fill on 2/3/14.

Wednesday 2/26/2014 - My specialty pharmacy called Express Scripts to get more info on the above and was told the same. They said I would pay more for the fills to keep them where they were or move them to Express Scripts' specialty pharm for the same price. They would not tell my specialty pharm what it would cost to keep them where they were but said I (the patient) could call in for that info. My specialty pharm went ahead and filled the 2nd fill which was allowed at the discounted rate despite being a "Retail Pharmacy".

Friday 2/28/2014 - I called Express Scripts to discuss and find out the difference in cost. I was told there was no restriction on the Sovaldi, only the Riba but she couldn't tell me the cost either way despite them telling my pharmacy they could tell me personally the cost. Per my request I was transferred to a supervisor who said she couldn't tell me anything about the Sovaldi as that required pre-approval. After explaining that it had already been approved with an approval expiration of 4/28/14 and two fills already completed which had to be on her screen, she said I would have to speak with THEIR specialty pharmacy about that. She said my plan "allowed" for appeals to the 2 fill rule and provided that appeals info. I then called the appeals line and was told that I would pay 100% of both Rx's if I kept them where they were, not just a higher co-pay. They said I can submit a "Retail Refill Override Request" via fax to ask for the 3rd and final fill be kept at the local specialty pharmacy.

Sunday 3/9/2014 - I faxed a written "Retail Refill Override Request" for both Sovaldi and Riba to the appeals number.

Wednesday 3/12/2014 - I called the appeals line to check the status of the appeal and was advised both appeals were denied. I could either pay 100% of both Rx's or move them to their Pharmacy. They said while they understood it may appear like a hassel they assured me that it would be "seamless" and they would handle everything. They said through them, the Sovaldi would be $135.00 and the Riba $80.00. I explained I had only paid $5 and $8 respectively through my own pharmacy and asked why it was so much more through them (my riba rage was increasing steadily at this point). The guy put me on hold and said he would find out. I was then cold transferred to their specialty pharmacy where the poor unsuspecting girl had no idea why I was calling (and I had no idea I had been transferred out of Express Scripts). After realizing she was as clueless as I, we started over from the beginning. She set up an account and confirmed she could see my pre-auth in the system until 4/28/14. I gave her my Sovaldi coupon info. She said that my current specialty pharm could not transfer the Rx's, instead I would have to call my doc and ask him to call in new Rx's. (not seamless so far). She gave me the phone number my doc should call. She said I would hear back from them in 24-48 hours from receiving my doctor's Rx.

Thursday 3/13/2014 - I emailed my specialty pharmacist who got a message to my doctor who had his nurse call it in right away. Of course the number I was given was wrong and the nurse got bounced around until she finally got to call in the Rx and got names and such. She emailed me and confirmed it was done and they told her they would be in touch with me in 24-48 business hours.

Saturday 3/22/2014 - (NINE DAYS LATER) ... I called the number for CuraScripts which was on my letter from Express Scripts. That number directed me to Acrido Pharmacy. I explained the entire situation and that it's been much longer than 48 hours and I still hadn't heard from anyone. He confirmed receipt of the Rx from my doc on 3/13/14 however admitted they did not enter it into their system until Monday 3/17/14. It was approved in their system on 3/18/14 and sent to a pharmacist for review and that I should hear from someone by next Tuesday or Wednesday (two weeks from my doctor's call). He said my Sovaldi would be $135 and Riba $80. I told him that all of what he just said was unacceptable and that he needed to look further into this. He confirmed the Sovaldi coupon was not applied and I had to give that info to him all over again. He kept telling me $80 on the Riba until I made him look at the last two fills and he confirmed they cost only $8.00. He said he would note the system and they would honor that. (Honor that? It's YOUR system that charged me $8 to begin with). Then he said there were three separate accounts set up under my name. One with CuraScripts who only handles 5% of Express Scripts RX's; and two with Acrido, one set up by my doc and one set up by me. He was honest and said; the way this is set up, there's no way you're getting your prescriptions by next Saturday. I was on the phone with him for about an hour, he "integrated" all my accounts and assured me that he would get a supervisor involved. I explained that in no uncertain terms they MUST have my medication here by next Saturday 3/29/14. He said that he couldn't guarantee that and per their system I had enough pills to get me through Monday 3/31 and that if I haven't received my medication by 3/29, (two days of meds left) that I could call in then and they would get a supervisor involved again as they consider that an emergency. He said that I should give them until Tuesday or Wednesday and then if I do not hear back from them to call back in and check the status and that if "the pharmacist has had time to look at your account, they may be able to get it filled by Thursday 3/27" ... If he has time? They MAY be able to get it filled THREE WEEKS AFTER MY DOCTOR CALLED?!?!!

I will give them until Noon on Tuesday before I call again. The riba is finally starting to affect my sleep and the riba rage has definitely been increasing. I am really in no mood to be dealing with these idiots. The moral of the story is - GIVE YOURSELF PLENTY OF TIME TO MAKE SURE YOUR REFILLS ARE DONE ON TIME!!!!

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