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Living with Psoriatic Arthritis (PsA)

Awful Accredo


#1

Davita lost specialty pharmacy to Diplomat who said now mandated Accredo be used for Humira. No such luck getting delivery scheduled. Only long wait times and idiotic delays.

Latest supervisor says it is denied and will not be filled. Actually waited on the line to have a pharmacist tell me to call Humira manufacturer and ask for a replacement. Second person to suggest I get the medicine from the manufacturer! These people. Now I’ve been told I will have to go through the Appeals process and they will not send anything out or work any further. How dare I expect to receive Humira that I’ve been taking for 2 1/2 years.

Since Wednesday I have been trying to work with Accredo. Countless phone calls, hours waiting on hold only to be directed to call the insurance, doctors office and pharmacy so that new forms, telling my birthday and zip code over and over and they never could figure out once a week or twice a month. Was supposed to dose yesterday. Making sure my frustration and pain did not translate to their recording our conversations or notes for the next person asked to look at my file for status.

Strangest stories and suggestions. But no one saying that yes, the doctor’s orders are going to be followed and we will get your medicine to you promptly.


#2

I’ve switched specialty providers twice. Each time there’s been a hold up in getting Enbrel (and that’s once a week). Each time my delay was by a few days. It got to the point where if I have to delay an injection, I lie when asked when I inject and how many I have left in order to have an extra, just in case.


#3

I’m having similar difficulties but I don’t know if they’re with Accredo or the prior auth specialist at my rheumy who no longer works there. My rheumy offers samples when there are insurance/delivery delays. It might be an idea to see if you can grab one to avoid an injection delay. And I’m with @Stoney on grossly underestimating my supply to get faster delivery.


#4

Thanks. Still on hold for more than 20 days trying to get this approved by Anthem’s appeal process. Apparently Accredo was only the start of the problem? The insurance has so many layers of people who seem to cycle the scripts? “Someone keyed in the urgent appeal incorrectly” but I will have a phone call with the decision before the end of the day. The theme seems to be get me off the phone without me triggering a bad survey? Usually they hang up which cancels the survey if I get close to being exasperated or anything other than grateful they came back to the phone after half an hour again. In pain I have to measure my words so that my frustration does not ‘get coded’ incorrectly as anything but a person in need of Humira as directed by my physician for these past 2 1/2 years. I remember the first year every-other-week dose schedule was like walking uphill backwards carrying a gallon of water in each hand and wearing rain boots filled with sand.


#5

In desperation and lots of pain I pled with Abbvie to put me in their patient assistance foundation and have received Humira to return to once a week. They graciously granted me inclusion. My eyes/eyelids are nearly cleared up. My pain reduced. It was difficult to shake the flu and I am still easily fatigued. I marvel at biologics and all it took to make it available. Grateful but still sad the insurance put me in jeopardy in favor of their profits. It is not like 20 years of premiums should cover their costs and it is not like they pay full price. Swelling has gone down but the joint damage that occurs, a little or a lot at a time is irreversible and there does not exist any advocate for patients when it comes to such a giant.


#6

I feel your pain. I am in the process of starting a new specialty pharmacy and no one can find my script. Have a call into the doctor to see whom they faxed it to and still waiting for the phone call. And I have to take a shot on Monday and this is Thursday so it is not looking good! Cried all morning and have to be all happy when I see my daughter after school.


#7

My sympathies. Out of sheer desperation I went to my Dr.'s office and asked to see the prior auth staff to talk through why I had been denied a biologic medication for 6 months. My insurance denied having denied the script (you dig?) and the pharma (accredo) said the script had been denied and it must have been the insurance (nice passive voice usage). After 3 hours on the phone and after I yelled at my INSURANCE provider for failing to be my advocate and not assisting to get treatment which they had APPROVED we got to the bottom of it. Two different departments in accredo were involved. The first communicated perfectly with my doctor. The second department who handles the appeal after prior auth is demonstrated and automatically denied had the WRONG FAX NUMBER and the only reason they kept denying the claim was they they never received anything from the Dr.'s office. Because the Dr.'s office never received the forms to complete. THREE HOURS of phone calls after 6 months. Now I have a great relationship with the staff and my employer switched to CVS Specialty this year so the process was repeated. This time they sent the first script in on January 9th and I took delivery of my meds on January 23rd. MIRACLES HAPPEN. But seriously, though, who has time for this??


#8

Well we found the script. I too went to the dr office and paitiently had me walk through the process and WE found the error together! Just a simple typo. If i had not been assertive and my own advocate who knows how long i would have had to wait.

I am also convienced my 16 year could work at the insurance call center. All they do is read from a screen!


#9

Like I said…who had time for this cr@p??

So glad this was resolved for you, too.


#10

No one has time for this. It adds undo stress which we do not need!


#11

@Rebel_mom: I got home last night to a letter from CVS Specialty pharmacy which–I assume at the behest of our insurance–is changing its formulary for PSA biologics. There are now only 4 approved bios for PsA: Humira, Enbrel, Otezla and Cosentyx. I’ve taken and failed 3/4 and am currently taking the 4th. Jeeeeeez. So perhaps I’ll also take CVS and Anthem in addition to Accredo off my holiday card list!