Specialty Pharmacy?????

patchen30 · August 2009

I just tried to fill my prescription for Crinone (progesterone) at a local pharmacy and was told that the insurance company said that they would only pay if it was filled through a "specialty pharmacy". Of course they didn't say what a specialty pharmacy was, the pharmacy I tried to fill with said they had no way to ask (this was done electronically) and now I can't get a hold of the insurance company b/c it's after hours.

I'm supposed to start taking the progesterone tonight, which would either be O day or 1dpo - so I hope it's not a big deal if I don't start taking it for a couple days.

Does anyone know what the H a specialty pharmacy is or how I order from them? I obviously plan on calling my insurance company to ask tomorrow but wanted to see if anyone knew in the meantime.

Thanks!

BostonTerrier · August 2009

That's exactly what happened to me when I tried to pick up my HCG trigger from the HOSPITAL pharmacy!!! I couldn't wait for it, so I just paid OOP for it! UGH! I don't know what to tell you, but if you figure it out, please post a new post about it--I'd really like to know!!!

RFBsbride · August 2009

Can you ask your RE or your nurse? When I started seeing my RE she sent us a packet with all sorts of information and one of the pamphlets lead us to a "specialty pharmacy" called Village Pharmacy that specializes in fertility medication (it's a mail order pharmacy, but they can overnight stuff if necessary). Perhaps your RE or nurse can give you a name?

Good luck! I hope you get an answer soon!

momma mimi · August 2009

What insurance company do you have? I have Aetna through my employer. The only way they will pay for any IF medicine is if the order is processed through Aetna Specialty Pharmacy. I had to call in to their IF hotline to get my case started. Once they got my info in the system, I gave my RE that account number and the RE's office called Aetna Specialty Pharmacy with my prescriptions. They charge my debit card the copay amount and then send out the items. Usually they can send it out the next day, but I have had them send it the same day once. The meds are delivered by UPS in a cooler box and I have to sign for them.

It would be best to contact your insurance company. If you have to start them tonight, then if possible, I would just pay the amount out of pocket. Just know if you do that, you more than likely won't be reimbursed for that from your insurance company, unless you have a FSA.

Hope that helps some. Good luck to you.

NantucketSunset · August 2009

I have BC/BS insurance (in MA) and they require that you use a specialty pharmacy. They provided a list of three - as pp said, one was Village Pharmacy. Village will fill your prescription tomorrow and overnight it to you for free. They can tell you if your insurance allows you to use them. Their 24/7 medline is (I think they can tell you if they take your insurance) 1-877-334-1610. If you really need tonight, perhaps you can get the local pharmacy to fill the smallest amount possible (my guess is 1 box) and pay oop. Good Luck!

Wish you were in Boston - I have 3 boxes of that stuff I won't need for a while!

Anasara · August 2009

When I met with my RE she said most of her patients use Village Pharmacy (mail order) & gave me info on it. I called the # in the packet & they took my insurance info over the phone. I'd ask your RE's office about them. GL!

BeccaLandes · August 2009

I also use Village, but I also have BC/BS of MA. I would call your insurance and ask which pharmacies they will reimburse for-- they should give you a list of the preferred ones. Your doctor might then have to fax or call in the prescription, but most places will overnight the meds to you. I have gotten one night's worth at a local pharmacy and paid OOP for it while waiting for my mail-order meds to come.

katieranck2202 · August 2009

My insurance specifically has a specialty on-call pharmacy. I learned that the hard way because my local one couldn't even attempt to fill my HCG injects. Mine is Caremark if that helps.

EMTTessie · August 2009

My RE's office called my order for injectables in for me. They used a company called Freedom Fertility Pharmacy...or something like that. I agree with pp that you should ask your RE's office who they usually go through or who they would recomend you using based on your insurance.

BTW-I have MVP and I called to check that they participated with Freedom and the woman I talked to had never heard of them, even though I was told Freedom participated with MedCo. So I called my doctor's office back because I was freaking out, but they took care of it all for me. GL!

Jaclyn278 · August 2009

i just had to deal with this for the Lupron.

A speciality pharmacy is a pharmacy through your health benefits, not your pharmacy benefits. Therefore, if you have Aetna, Aetna has a SP that you need to contact to fill your rx. most likely your RE office will need to call the rx in or fax it (although I highly recommend they call it in for you)

The SP will then ship your drugs out most like overnight, that's what they did for my Lupron (and even on a sat delivery!)

usually SP is for injectables, or expensive non-injectable medication. HTH!

patchen30 · August 2009

Thanks for the help ladies. I will call first thing in the a.m. I have BCBS Anthem. I did call Freedom Fertility Pharmacy and they said that they are a speciality pharmacy and could overnight meds but that I should call my insurance to make sure I can use Freedom. So looks like I won't be starting progesterone until 2 or 3dpo...I hope that's ok. To complicate things further, I'll be out of town Sat. so I'll have to have the meds delivered to the hotel!!!!!!

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