****sliz***

pria2004

this ordering of depot lupron is being such a pain. did your drs office take care of it for you or did you have to step in....my nurse had called ten different numbers and finally was told she needs to fax it to walgreens specialty,,which i dont belive will work again cos of the same " injectibles not covered" ***. I dont know what thsi whoe "for medical" and "fro prescription" stuff is about

 

sliz

I had a horrible experience getting this sorted out. First I got the runaround with my insurance (BCBS TX)....My prescriptions are covered through Caremark is what they first told me. I tried to go through Caremark, spent a week with them on the phone screaming and crying (was told the whole time it was RE's office's fault.). The RE I was using at the time had terrible office staff who marked that I was doing ART on the forms (I was doing clomid/ovidrel/TI)....etc. All in all that was a cluster-F***.

After talking at length with BCBS, someone finally mentioned the specialty pharmacy.

I directly called the specialty pharmacy (it is Triessent and it may be related to Walgreen's). They helped a lot in figuring this out - so for me here is the process. The infertility drugs for me are billed as procedures and need prior approval from insurance:

RE phones/faxes prescription to Triessent. Triessent sends RE pre-approval paperwork to fillout and send to BCBS. BCBS take a long-a$$ time to review (they say up to 2 wks) - but if something is wrong, they won't call you so you have to stay on top of them. Make sure that when your RE sends insurance the pre-approval paperwork that they include that you are going to use the drug for a covered purpose (i.e. for me they specified TI cycles only cause we have no IUI/IVF coverage) AND the "national drug code" for the drug (you can google this).

Insurance finally pre-approved the drug and alerted Triessent. Triessent called me to set up delivery of the drug. For ovidrel this took 2-3 weeks.

For follistim this time, the process took 2 days - my nurse already knew what to do. She had the pre-approval paperwork from the last drug and filled it out with the same info and the drug code for follistim and faxed it to insurance. The same day she put in the order at Triessent. They just called me today to tell me that they are going to mail it out to me next week.

I had to intervene a lot and play middle man - it still wouldn't have worked if my doctor's nurses weren't so patient and persistent 

 Sorry this sucks so bad....page me again if I can help.