Anyone have experience with Makena?

niknak1208

I receive makena injections weekly to prevent pre-term labor. The first three shots I had to have at a different hospital because the company would not ship to my current OB's office.  Because that was tier II .. I have $882.79 balance PER injection!!  That's right ladies.. $2648.37 in injection co-insurance!  Soo.. Makena Care Connection does copay assistance and approved me yesterday for December through June.  They will pay all but $75 per injection for me.  Sweet right.  But I have no idea how to process this. They told me to call billing and give them the account number but billing says they can't do that and has no clue what I'm talking about. Anyone deal with this before?  I'm wondering if I should be calling my health plan instead? 

CEOorbust

I am following this. I am supposed to receive the makena shots too but insurance has taken 3 weeks (I have UHC) and they are still "processing" it.

niknak1208

CEOorbust  Ugh. tell me about it.  It was a major pain in my arse too.  I had them with my daughter in 2012 and at the time I was treating with a different hospital.  I never ever had to deal with this crap when I was there. They just handled it. I never got billed. I never had calls from pharmacies or makena or anyone. It was just taken care of from the get go.  This time around I have a different health plan.. treating at a different hospital and it has been like pulling teeth!!  It makes me mad that I even have a balance at all from those first two shots because the only reason I had to go there is because the stupid pharmacy would NOT ship the medication to this hospital!  I mean literally I was on the phone non stop with the dispensing pharmacy.  Non-stop with the doctor's office. Non stop with makena.  I work in HR on the benefits side and finally I went to my manager and said umm we need to do something about this because patients should not have to deal with this crap! 

If your insurance doesn't cover the entire injection, I highly recommend calling Makena Care Connection!! They were actually very helpful and they are covering almost all of my expenses which is a huge weight off my shoulders. I think I finally got them to do the billing correctly. We'll see!!

Also-  one thing I had issues with when they were 'processing' my medication was that they were billing it wrong.  They were trying to bill it under pharmacy but it should have been billed under medical.  That was one hurdle.  The 2nd was that they were holding up shipment because I hadn't paid the $100 deductible that no one told me about or billed me for! Each vial has 5 shots in it and even before they would ship the 2nd vial.. they had to call me and 'authorize'  Just ridiculous!!  

I have about 12 shots left to do.  I started them at almost 18 weeks and I'm 25 weeks tomorrow. 

Good luck!! 

CEOorbust

@niknak1208 thank you for the info! I guess my pharmacy sent 5 vials to my Dr. Office. I had a $250 copay to the pharmacy for the meds. I will get my shot Thursday!! Have you had any side effects from the shots?

niknak1208

CEOorbust Both in 2012 and this time through.. the only side effect I've had is that I get a little bit of a skin reaction at the injection site.  sort of a red bump that itches.  It usually goes away in a couple of days.  it's a really thick medication.  They have to push it in slow so I think it's just the texture of the medication. .or so I've heard!  Other than that.. I haven't had any side effects.  In 2012 with my DD.. my high risk doc did say to expect delivery a week or two early because typically once the shots stop.. your body starts going into labor.  That's exactly what happened with my DD.  My last shot was at 37 weeks.  Almost 38 weeks exactly.. contractions started.  I don't know if that will happen this time or not but I'm expecting it will.  

Makena Care Connection finally called me back yesterday.  They paid $807.79 toward each of my copay amounts!!  All I have to pay is $150 as opposed to $1765.58!!!  How awesome is that?!