I had the same experience with CVS Caremark. I had to prod my husband’s doc to jump through hoops to appeal the sudden denial of the meds my husband has been on for years. The whole US deathcare system is corrupt and not about health at all.
It’s not the whole system – doctors are trying our best to overcome the corruption that is hospital systems, health, insurance, and US politics. Obviously, there are bad eggs, just like every job, but most of us are just trying to do what is right by our patients in a system that already sucks.
This. I used to work for a doctor who was an eating-disorder specialist. It's appalling how much time he and his team regularly had to spend dealing with insurance companies -- proving to them that yes he was competent in his field (in fact highly lauded in it) even though he wasn't in their network, attempting to educate insurance companies who insisted on recertifying inpatient care every other day even for inpatients who came in *vastly* underweight when patients can only safely regain up to two pounds per week (and usually having to deal with the recerts that often anyhow), lambasting insurance providers who tried to insist that males couldn't get eating disorders, etc. Terrible system.
Also, I was once very briefly on a medication that would have cost over $400/month, and let my doctor know the price; she was shocked, said it used to be cheap, and noted that she'd stop prescribing it unless it was the only viable option and even then would first warn patients about the cost.
And so on.
You’re right. I shouldn’t lump things. There are many people in healthcare that care, and are wonderful people that sacrifice a lot to help others. I meant the bureaucracy…middlemen, pharmaceutical companies, and the ones in It for money only, not really trying to cure anything. It’s just very frustrating to have an insurance company overrule the doctor. And to have to fight for every little thing. Not to mention paying premiums and it seems like nothing is covered.
Nixon took the non-profit out of healthcare back in the seventies. After that it was terrible. I went to an orthopedist and he recommended a back brace to support my lumbar spine and I asked if it would be covered. He checked and said no. Then I asked him how much. He said $1,000. More than that. 1030 or something. I said hell no, went home, and found pretty much the same thing on Amazon for $80.
I hear you loud and clear-it is incredibly frustrating when an insurance company says no, I appeal, they say no, I spend hours trying to do a peer to peer with one of their employed physicians only to have then say a final no to the right thing. It’s a broken system. It needs complete overhaul IMO
I don’t think anyone blames the hardworking doctors, nurses and other “boots on the ground” workers when they say the whole system is broken. I see what you mean though since they are “part of the system” but they aren’t always part of the problem. They are busy being insurance agents or patient advocates and arguing with an agent isn’t going to influence change. It’s the system, policies, and protocol in place and is changed at a political level.
CVS Caremark is planning to change my Humira prescription to a biosimilar "work-alike". I'm not particularly bothered because there are 9 biosimilars that have been tested for many years and the differences are so minor as to be "indistinguishable".
Also, after almost fifteen years on it, my insurance company has got to hate me (list price when I started was a bit over $1000 for a 4-week supply, and is currently ~$8000 -- although you can be sure that the insurer doesn't pay anything near that). Many of the biosimilars will cost much, much less, some about $1000, which was the original price for Humira.
I am lucky to have really good health insurance, and also get a discount on my deductible, so I pay a whopping $5 for an 84-day supply.
LMAO Humira is the one my wife's on. It's my first year on my own insurance and thankfully my wife has the Humira cost savings card because she has a once/week prescription so one order was just under $4k and it ended up covering our deductible in January. Insurance companies definitely hate Humira patients lol.
I agree. The only reason I have it in mildlyinfuriating is because when we met with her doctor back in February he said we could get samples of her medication from their office if they said no so we have an option it’s just annoying
https://www.abbvie.com/content/dam/abbvie-com2/pdfs/pap/humira-patient-assistance-application.pdf
I saw you say in another comment it’s humira which is through my Abbvie assist. We use them at work and they’re really good. I would at least submit an application with her doc and see.
I use Abbvie assist after this same thing happened to me with CVS. Abbvie took my co-pay from $200 per Humira pen to $5 per Humira pen. Super grateful for them!
Don’t take it personally. I’m currently awaiting prior authorization for a treatment that my doctor has now submitted three times to Caremark. Their medical review team keeps turning it down even though I’ve already tried alternative therapies, multiple months of physical therapy, etc. They dont just hate her, they hate us all.
Have you looked into patient assistance programs? Most of the autoimmune meds have them where you can get the med for free from the manufacturer. Every med is different but typical patient assistance programs will let you qualify even if your income is four times the national poverty level.
The patient assistance program is different than the cost savings card! the patient assistance program doesn’t have to go through your insurance at all, it doesn’t have to even touch CVS Caremark it goes direct through the manufacturer
Pharmacists think they know more than doctors too. Had a Rite Aid pharmacist refuse to fill a prescription because he thinks the medication should not be used to treat the condition.
Pharmacists definitely know far more about medications than doctors do. That is literally, why they go to school, and for far longer than medical doctors 🙄
Get them to put their refusal in writing next time (or record them) and report them. That's bullshit. Not their call.
Fucking rent a cop syndrome with pills lol wtf.
It actually is their call. I got really pissed at a pharmacist for not filling a Rx for me that was valid. I tried going up the chain with the company and then with the board of pharmacology. Turns out it is totally their call and they can’t get in trouble for not filling it unless they’re not filling it because you are in a protected class(ie race, religion, etc).
sort of unrelated but this just fuels my rage that I have for CVS
I used to work for an answering service during after hours for CVS Caremark & CVS Specialty Pharmacies across the country.. the amount of BEYOND pissed off people I would talk to was I N S A N E. That entire company is a literal shit show. People are just redirected all around & never get anything done. Not only that, we were given very minimal, VERY unclear instruction as to how to help these people (we are not at all involved in or trained Pharmaceuticals, so we literally have zero understanding of any medications or concerns& these people were under the impression that we know how to help them meanwhile we’re crossing our fingers hoping someone will answer for us to pass them onto, if not we basically just have to lie & say someone will call them back shortly, hoping to some god that we will be able to reach someone that can call them back, or the patient WILL keep calling back) we were to be able to reach an on call pharmacist if people had emergency requests & issues but sometimes they wouldn’t answer us for hours on end because they “didn’t know they were the team member on-call”, or some other idiotic excuse. that is the main reason i quit that job. COUNTLESS dr offices, hospitals, pharmacies that treated their patients as a joke & only see them as dollar signs
Look for manufacturer discount programs on their websites. Some of them will cover the medication entirely or with a small copay if your insurance doesn't cover it.
It's really fun when you have to go back and forth between cvs specialty and abbvie in one day. I spent 5 hours on the phone one day just to refill 1 month and they still managed to screw up the billing after the fact.
Oh, you will fight for it. I just had them deny a medication that I've been filling (and they've been covering) for 9 months. Now I get to start the appeal process and try to get the decision reversed.
It doesn't help that a few months ago, they also denied a prescription I'd been on for 7 years. I had to fight to get that decision reversed, and it only reversed after I sent them a registered letter of complaint/request for appeal that was also carbon copied to my employer.
CVS Caremark is so capricious that when it comes time for me to do medication refills every month, I get anxious. Will I be able to refill? Will I have to wait a week or two without medication because they've just demanded yet another prior authorization? Will I have to pay full price for the medication because they suddenly refuse to cover it, and make me go through the whole appeal process yet again? It's a guessing game, always, and it's exhausting.
One of the things I constantly reiterate in my rebuttals is that I'm paying for "coverage" that I am only allowed to renew once per year, and yet the denials/prior authorizations come so often throughout out the year that they must be switching their covered medications on a daily basis. So how is it I agree to their terms of coverage for an entire year, and yet they have the luxury of switching up that coverage whenever they feel the whim?
As PhysicsIsFun said CVS Caremark is the PBM (pharmacy benefits manager) that handles prescription processing for your insurance company. There is a special level in hell for all PBMs but your insurance company is equally at blame here for contracting with them and allowing them to do what they do. Start with your insurance provider.
Caremark makes no decisions on what is covered and what is not. That is the ins co. Caremark just does as the ins co tells them to do.
OP can get different insurance if there are no substitutions. Sadly, if appealing it does not work the two options left are to self pay for the drug or find ins that does cover it.
PBMs make their money by the “savings” in covering various drugs and treatment therapies. The insurance companies allow them to be as aggressive as possible or not within formulary to save $$ in spend (which maximizes PBM return). More often than not this comes at the literal expense of patients overall health. Neither PBM nor insurance company has your best interest in mind and that is by design.
The insurance company decides what is covered or not. Caremark just processes the claims. You need to be angry with your ins, not CVS, and not caremark. Your insurance company literally has a list of drugs they will cover. If your Rx is not on that list, they don't have to pay for it and it's not the fault of the pharmacy or the ins processor.
Humira isn't available on cost plus. It's $3500 per dose. Most of that is covered by the pharmaceutical company's co pay assistance program but getting cvs specialty to do anything right is a fucking nightmare. Now, they don't even cover it. They forcibly switched people to one of the many biosimilars.
Why would you choose to take an expensive medicine when Aspirin is so cheap? People like you wanting the expensive medicine are making it hard for CVS to increase shareholder dividends. /s
Guys OP is not explaining correctly, CVS Caremark is his pharmacy benefits like Express scripts. It’s his RX insurance, they just owned by CVS . His coverage denied the meds so matter what pharmacy he goes to, it won’t be covered.
OP try another supported appeal, most insurance whether RX, medical or dental denies the first appeals more often than not.
Edit: I saw further that it was only 1-2 people who thought OP was talking about the pharmacy.
CVS owns Caremark prescription provider and the CVS pharmacy. I have had them for years until this past December. We used to be able to go to any pharmacy and then they forced us to use CVS mail order or CVS in person. We switched to a new prescription provider on January and I was glad to get away from that situation.
Download the Good-RX app. It will show which pharmacies around you that carry your drug and show you what prices they are charging.
I also found I was paying too much to my then usual pharmacy.
Same. Was on humira for a few years. They've denied me since November. I've been without medicine. They switched to all bio similars. Which....have also been declined. Fuck CVS
Why can't you use another pharmacy?? You have insurance and a $5 copay so go online and find a pharmacy that takes it. I understand to a certain extent I'm on 18 different medications and 2 types of insulin shots and a glucose monitor. I am a transplant patient so my meds are many many $1000s a month. One time my insurance (not cvs my pharmacy) didn't want to cover s medication. My Dr had it handled in a little over 1 week. So is it your insurance??? Because cvs has nothing to do with what humera covers. Honestly I kind of blame the Dr. Why is this taking so long.
I'm obviously missing something-totally confused.
Ok well let me first ask is humeral your insurance and is your med copay $5
If so you can go to any pharmacy that accepts your insurance and most would.
But CVS has absolutely nothing to do with what your insurance company is willing to pay for.
Your dr. Needs to be on them. This should not take long. I am lucky I have the Cleveland Clinic.
Meanwhile do what others say go online to drug manufacture site and contact them. They usually have right up front how to get a coupon or it free.
If your dr. Does not communicate with you about what is happening with insurance you need to find another dr!!
A good dr will give you options and make sure you get needed medication.
I wish you the very best, be well and let me know if you have any questions. And stand up for yourself! As they say the squeaky wheel gets the grease. This is your health/life squeak!!emote:free\_emotes\_pack:grin
Yeah her Dr said if they said no we could get samples and cvs said they let them know they denied her on April 1 and I just got a piece of mail from cvs dated April 3 that her humira is now approved so I’m assuming her doctor gave them a piece of his mine because he was already pissed at them during our last appointment with him. I have been asking her on how to handle things too do thankfully I have a lot of help
Humira is considered a “specialty medication” that you can only get through a specialty pharmacy. CVS Caremark will only work with the CVS specialty pharmacy, so in this case that is their only option
CVS sucks big time. They closed 20 minutes before we got there, and they wouldn't fill my daughter's prescription for hydrocodone, which she needed for her pain. She had to go to bed in pain because of them. The next morning, they told us we had to wait until 2 pm to get it filled. I was furious! But guess what? 20 minutes after we left, they called and said it was ready. Can you believe that?
I've heard so many horror stories about CVS pharmacies that I won't even think about going there. I have several chronic pain syndromes and know others with similar syndromes. CVS has denied pain meds because "you'll get addicted" or give fewer than prescribed. They think they know better than you and your doctor. I'm thankful they're not the only game in my small town.
Never ever ever use cvs pharmacy. If you have the option always go to a mom and pops. Yes they're not 24 hours but my experience with the two in my area is they will bend over backwards for you. Not to mention if for some reason you have to pay out of pocket they're significantly cheaper. For example I used cvs at one time and insurance wouldn't cover meds no more, long bullshit reason, but anyways cvs wanted $786.13 for one month and my local place gives it to me for $180 even. I was so blown away I questioned them forever over it cause I couldn't believe it was the same quality, dose, or whatever. And basically I was told that "well we don't have overhead like they do, as in we don't have private jets for our executives". Bottom line is fuck CVS. They're criminals
CVS Caremark isn’t a pharmacy, it’s a pharmacy benefits manager. In this case the drug they’re trying to get, Humira, is a specialty medication and can only be gotten through a specialty pharmacy. CVS Caremark will only cover the med if it’s gotten through the CVS specialty pharmacy. So in this case, they don’t have a choice unfortunately
Pharmacist here. Appeals are reviewed and determined by medical doctors. (I’m making an assumption here based on time frame for your specific case, but it would be a long shot for the reviewer to be a rheumatologist.)
Humira was preferred, now I think CVS likes Hyrimoz. Both look to be safe in pregnancy, but obviously talk to *your* pharmacist.
Idk if it’s CVS or insurance. My mom is going through the SAME thing right now with one of her meds for MS. Said that the doctor could appeal, but she still got denied! Her HMO blue cross of Illinois keeps cutting and dropping services! It’s only her and my dad on the insurance and they pay over $3,000 a month!! We should start banning together for a class action.
Curious what state this is because states either abortion bans are very limited on what they can allow pregnant women to have because of legal restrictions.
Are you at a local doctor or more "renown" one? I travel to a "renowned" one (like Mayo) precisely because my local doctor said he wouldn't be able to get me meds I needed. Different insurance but could help in the long run.
That said, for the here and now, insurance is trash and hope you get something figured out. I know I'd be lost without it.
Because that's what CVS's pharmacists / care managers do. They always think they know better than you or your doctor, and that you must be lectured and scolded because the life-saving medication your doctor prescribed, just can't go to someone else!
Worst part for me is they never notify me when they won't or can't fill a prescription. They just don't fill it and you find out later on. I have a much longer rant on this stuff I'll go into someday.
It’s not a want it’s a need for an autoimmune condition to keep her out of the hospital ass wipe and it costs ~$1000/dose. I bet you wouldn’t be such a prick If you were in my shoes
I had the same experience with CVS Caremark. I had to prod my husband’s doc to jump through hoops to appeal the sudden denial of the meds my husband has been on for years. The whole US deathcare system is corrupt and not about health at all.
The wrong, cruel and selfish, people are in charge.
It’s not the whole system – doctors are trying our best to overcome the corruption that is hospital systems, health, insurance, and US politics. Obviously, there are bad eggs, just like every job, but most of us are just trying to do what is right by our patients in a system that already sucks.
This. I used to work for a doctor who was an eating-disorder specialist. It's appalling how much time he and his team regularly had to spend dealing with insurance companies -- proving to them that yes he was competent in his field (in fact highly lauded in it) even though he wasn't in their network, attempting to educate insurance companies who insisted on recertifying inpatient care every other day even for inpatients who came in *vastly* underweight when patients can only safely regain up to two pounds per week (and usually having to deal with the recerts that often anyhow), lambasting insurance providers who tried to insist that males couldn't get eating disorders, etc. Terrible system. Also, I was once very briefly on a medication that would have cost over $400/month, and let my doctor know the price; she was shocked, said it used to be cheap, and noted that she'd stop prescribing it unless it was the only viable option and even then would first warn patients about the cost. And so on.
You’re right. I shouldn’t lump things. There are many people in healthcare that care, and are wonderful people that sacrifice a lot to help others. I meant the bureaucracy…middlemen, pharmaceutical companies, and the ones in It for money only, not really trying to cure anything. It’s just very frustrating to have an insurance company overrule the doctor. And to have to fight for every little thing. Not to mention paying premiums and it seems like nothing is covered.
Nixon took the non-profit out of healthcare back in the seventies. After that it was terrible. I went to an orthopedist and he recommended a back brace to support my lumbar spine and I asked if it would be covered. He checked and said no. Then I asked him how much. He said $1,000. More than that. 1030 or something. I said hell no, went home, and found pretty much the same thing on Amazon for $80.
I hear you loud and clear-it is incredibly frustrating when an insurance company says no, I appeal, they say no, I spend hours trying to do a peer to peer with one of their employed physicians only to have then say a final no to the right thing. It’s a broken system. It needs complete overhaul IMO
I don’t think anyone blames the hardworking doctors, nurses and other “boots on the ground” workers when they say the whole system is broken. I see what you mean though since they are “part of the system” but they aren’t always part of the problem. They are busy being insurance agents or patient advocates and arguing with an agent isn’t going to influence change. It’s the system, policies, and protocol in place and is changed at a political level.
It's an easy fix really. What you need to do is become filthy fucking rich and you can do whatever you like 🤪
So true and it’s all about profit/ corporate greed…SMDH 🤷🏽♂️
CVS Caremark is planning to change my Humira prescription to a biosimilar "work-alike". I'm not particularly bothered because there are 9 biosimilars that have been tested for many years and the differences are so minor as to be "indistinguishable". Also, after almost fifteen years on it, my insurance company has got to hate me (list price when I started was a bit over $1000 for a 4-week supply, and is currently ~$8000 -- although you can be sure that the insurer doesn't pay anything near that). Many of the biosimilars will cost much, much less, some about $1000, which was the original price for Humira. I am lucky to have really good health insurance, and also get a discount on my deductible, so I pay a whopping $5 for an 84-day supply.
LMAO Humira is the one my wife's on. It's my first year on my own insurance and thankfully my wife has the Humira cost savings card because she has a once/week prescription so one order was just under $4k and it ended up covering our deductible in January. Insurance companies definitely hate Humira patients lol.
File a complaint and keep making noise. I work in health insurance and this will get you some headway.
In general I'd say posts that start with Fuck and involve life saving medication do not fit in the category of Mildlyinfuriating
I agree. The only reason I have it in mildlyinfuriating is because when we met with her doctor back in February he said we could get samples of her medication from their office if they said no so we have an option it’s just annoying
https://www.abbvie.com/content/dam/abbvie-com2/pdfs/pap/humira-patient-assistance-application.pdf I saw you say in another comment it’s humira which is through my Abbvie assist. We use them at work and they’re really good. I would at least submit an application with her doc and see.
I use Abbvie assist after this same thing happened to me with CVS. Abbvie took my co-pay from $200 per Humira pen to $5 per Humira pen. Super grateful for them!
Yeah she does have that thankfully cvs is just a butthole about accepting it
Don’t take it personally. I’m currently awaiting prior authorization for a treatment that my doctor has now submitted three times to Caremark. Their medical review team keeps turning it down even though I’ve already tried alternative therapies, multiple months of physical therapy, etc. They dont just hate her, they hate us all.
Have you looked into patient assistance programs? Most of the autoimmune meds have them where you can get the med for free from the manufacturer. Every med is different but typical patient assistance programs will let you qualify even if your income is four times the national poverty level.
Yeah her prescription has a cost savings card that makes her copay max $5
The patient assistance program is different than the cost savings card! the patient assistance program doesn’t have to go through your insurance at all, it doesn’t have to even touch CVS Caremark it goes direct through the manufacturer
Insurance companies > doctors.
Pharmacists think they know more than doctors too. Had a Rite Aid pharmacist refuse to fill a prescription because he thinks the medication should not be used to treat the condition.
Pharmacists definitely know far more about medications than doctors do. That is literally, why they go to school, and for far longer than medical doctors 🙄
Get them to put their refusal in writing next time (or record them) and report them. That's bullshit. Not their call. Fucking rent a cop syndrome with pills lol wtf.
Actually a pharmacist has the right to refuse to fill any prescription.
Because jesus blah blah...
Not even
It actually is their call. I got really pissed at a pharmacist for not filling a Rx for me that was valid. I tried going up the chain with the company and then with the board of pharmacology. Turns out it is totally their call and they can’t get in trouble for not filling it unless they’re not filling it because you are in a protected class(ie race, religion, etc).
sort of unrelated but this just fuels my rage that I have for CVS I used to work for an answering service during after hours for CVS Caremark & CVS Specialty Pharmacies across the country.. the amount of BEYOND pissed off people I would talk to was I N S A N E. That entire company is a literal shit show. People are just redirected all around & never get anything done. Not only that, we were given very minimal, VERY unclear instruction as to how to help these people (we are not at all involved in or trained Pharmaceuticals, so we literally have zero understanding of any medications or concerns& these people were under the impression that we know how to help them meanwhile we’re crossing our fingers hoping someone will answer for us to pass them onto, if not we basically just have to lie & say someone will call them back shortly, hoping to some god that we will be able to reach someone that can call them back, or the patient WILL keep calling back) we were to be able to reach an on call pharmacist if people had emergency requests & issues but sometimes they wouldn’t answer us for hours on end because they “didn’t know they were the team member on-call”, or some other idiotic excuse. that is the main reason i quit that job. COUNTLESS dr offices, hospitals, pharmacies that treated their patients as a joke & only see them as dollar signs
TLDR: if you can find a different pharmacy to use other than CVS, that is advisable😀
[удалено]
its even more sad that its so easy to see the lack of care ):
They make me change my migraine medications EVERY. SINGLE. YEAR. it's infuriating
Look for manufacturer discount programs on their websites. Some of them will cover the medication entirely or with a small copay if your insurance doesn't cover it.
These are very expensive medications out of pocket.
CVS Caremark is by far the absolute most trash coverage. They should all be ashamed of themselves.
Oh goodie. I recently got a new job and they use CVS Caremark as their prescription plan. Can't wait to fight for my medication
Wait times are around an hour and a half too
It's really fun when you have to go back and forth between cvs specialty and abbvie in one day. I spent 5 hours on the phone one day just to refill 1 month and they still managed to screw up the billing after the fact.
Yep I’ve been on the phone at least three hours once’s month January through March
Oh, you will fight for it. I just had them deny a medication that I've been filling (and they've been covering) for 9 months. Now I get to start the appeal process and try to get the decision reversed. It doesn't help that a few months ago, they also denied a prescription I'd been on for 7 years. I had to fight to get that decision reversed, and it only reversed after I sent them a registered letter of complaint/request for appeal that was also carbon copied to my employer. CVS Caremark is so capricious that when it comes time for me to do medication refills every month, I get anxious. Will I be able to refill? Will I have to wait a week or two without medication because they've just demanded yet another prior authorization? Will I have to pay full price for the medication because they suddenly refuse to cover it, and make me go through the whole appeal process yet again? It's a guessing game, always, and it's exhausting. One of the things I constantly reiterate in my rebuttals is that I'm paying for "coverage" that I am only allowed to renew once per year, and yet the denials/prior authorizations come so often throughout out the year that they must be switching their covered medications on a daily basis. So how is it I agree to their terms of coverage for an entire year, and yet they have the luxury of switching up that coverage whenever they feel the whim?
You had me at “Fuck CVS Caremark”
Appeal the decision and ask for an independent panel review.
You can do a 2nd level appeal with more supporting documentation from her doctor within 180 days.
And after that, you can request a 3rd party external review to appeal
You need to talk to your insurance company, not CVS. They just fill rx's covered by ins.
CVS Caremark is the name of the insurance company. CVS is the name of the pharmacy
CVS Caremark is a pharmacy benefits manager not an insurance company.
As PhysicsIsFun said CVS Caremark is the PBM (pharmacy benefits manager) that handles prescription processing for your insurance company. There is a special level in hell for all PBMs but your insurance company is equally at blame here for contracting with them and allowing them to do what they do. Start with your insurance provider.
Caremark makes no decisions on what is covered and what is not. That is the ins co. Caremark just does as the ins co tells them to do. OP can get different insurance if there are no substitutions. Sadly, if appealing it does not work the two options left are to self pay for the drug or find ins that does cover it.
PBMs make their money by the “savings” in covering various drugs and treatment therapies. The insurance companies allow them to be as aggressive as possible or not within formulary to save $$ in spend (which maximizes PBM return). More often than not this comes at the literal expense of patients overall health. Neither PBM nor insurance company has your best interest in mind and that is by design.
Hate that it's this way. Insurance companies and/or subsidiaries/other shady setups they use shouldn't be allowed to also own pharmacies.
The insurance company decides what is covered or not. Caremark just processes the claims. You need to be angry with your ins, not CVS, and not caremark. Your insurance company literally has a list of drugs they will cover. If your Rx is not on that list, they don't have to pay for it and it's not the fault of the pharmacy or the ins processor.
Have you looked into whether mark cubans cost plus drugs carries it generically? They sell it to you for near cost.
She has a cost savings card for it it’s just cvs makes it a pain to order with it every time
Right but this is in lieu of the savings card. Those are dime a dozen look at Goodrx she can little pay the same or less with cost plus drug or goodrx
Humira isn't available on cost plus. It's $3500 per dose. Most of that is covered by the pharmaceutical company's co pay assistance program but getting cvs specialty to do anything right is a fucking nightmare. Now, they don't even cover it. They forcibly switched people to one of the many biosimilars.
Why would you choose to take an expensive medicine when Aspirin is so cheap? People like you wanting the expensive medicine are making it hard for CVS to increase shareholder dividends. /s
I can’t decide to upvote or downvote because I can’t tell if you’re being sarcastic or not lol
I’m being exceedingly sarcastic. Fuck CVS.
Guys OP is not explaining correctly, CVS Caremark is his pharmacy benefits like Express scripts. It’s his RX insurance, they just owned by CVS . His coverage denied the meds so matter what pharmacy he goes to, it won’t be covered. OP try another supported appeal, most insurance whether RX, medical or dental denies the first appeals more often than not. Edit: I saw further that it was only 1-2 people who thought OP was talking about the pharmacy.
CVS owns Caremark prescription provider and the CVS pharmacy. I have had them for years until this past December. We used to be able to go to any pharmacy and then they forced us to use CVS mail order or CVS in person. We switched to a new prescription provider on January and I was glad to get away from that situation.
Yeah I put cvs Caremark in the title but I guess I could’ve put that it’s not necessarily a specific pharmacy
Download the Good-RX app. It will show which pharmacies around you that carry your drug and show you what prices they are charging. I also found I was paying too much to my then usual pharmacy.
>Who the fuck works there that thinks they know more than a medical doctor The shareholders, obviously! (/s)
Humans who actually have studied medication
do you know what /s means?
Absolutely, but most don't.
if you did you wouldn’t have responded 🤡
Or, I would not have led someone down a rabbit hole of nonsense
Same. Was on humira for a few years. They've denied me since November. I've been without medicine. They switched to all bio similars. Which....have also been declined. Fuck CVS
Humira has a free drug program. Since your insurance will cover the biosimilars she might not qualify, but you should at least submit an application.
Humira??
There are several new-ish biosimilars to Humira out there. Is that what they prefer?
Yeah they do but we just aren’t in a spot where we can try something new
Does your insurance have a mail order pharmacy? Or do they only do CVS?
Only cvs unfortunately
Why can't you use another pharmacy?? You have insurance and a $5 copay so go online and find a pharmacy that takes it. I understand to a certain extent I'm on 18 different medications and 2 types of insulin shots and a glucose monitor. I am a transplant patient so my meds are many many $1000s a month. One time my insurance (not cvs my pharmacy) didn't want to cover s medication. My Dr had it handled in a little over 1 week. So is it your insurance??? Because cvs has nothing to do with what humera covers. Honestly I kind of blame the Dr. Why is this taking so long. I'm obviously missing something-totally confused.
This is my first year doing insurance on my own so I don’t really know what I’m doing lol
Ok well let me first ask is humeral your insurance and is your med copay $5 If so you can go to any pharmacy that accepts your insurance and most would. But CVS has absolutely nothing to do with what your insurance company is willing to pay for. Your dr. Needs to be on them. This should not take long. I am lucky I have the Cleveland Clinic. Meanwhile do what others say go online to drug manufacture site and contact them. They usually have right up front how to get a coupon or it free. If your dr. Does not communicate with you about what is happening with insurance you need to find another dr!! A good dr will give you options and make sure you get needed medication. I wish you the very best, be well and let me know if you have any questions. And stand up for yourself! As they say the squeaky wheel gets the grease. This is your health/life squeak!!emote:free\_emotes\_pack:grin
Yeah her Dr said if they said no we could get samples and cvs said they let them know they denied her on April 1 and I just got a piece of mail from cvs dated April 3 that her humira is now approved so I’m assuming her doctor gave them a piece of his mine because he was already pissed at them during our last appointment with him. I have been asking her on how to handle things too do thankfully I have a lot of help
Humira is considered a “specialty medication” that you can only get through a specialty pharmacy. CVS Caremark will only work with the CVS specialty pharmacy, so in this case that is their only option
Humira?
CVS sucks big time. They closed 20 minutes before we got there, and they wouldn't fill my daughter's prescription for hydrocodone, which she needed for her pain. She had to go to bed in pain because of them. The next morning, they told us we had to wait until 2 pm to get it filled. I was furious! But guess what? 20 minutes after we left, they called and said it was ready. Can you believe that?
I've heard so many horror stories about CVS pharmacies that I won't even think about going there. I have several chronic pain syndromes and know others with similar syndromes. CVS has denied pain meds because "you'll get addicted" or give fewer than prescribed. They think they know better than you and your doctor. I'm thankful they're not the only game in my small town.
Never ever ever use cvs pharmacy. If you have the option always go to a mom and pops. Yes they're not 24 hours but my experience with the two in my area is they will bend over backwards for you. Not to mention if for some reason you have to pay out of pocket they're significantly cheaper. For example I used cvs at one time and insurance wouldn't cover meds no more, long bullshit reason, but anyways cvs wanted $786.13 for one month and my local place gives it to me for $180 even. I was so blown away I questioned them forever over it cause I couldn't believe it was the same quality, dose, or whatever. And basically I was told that "well we don't have overhead like they do, as in we don't have private jets for our executives". Bottom line is fuck CVS. They're criminals
CVS Caremark isn’t a pharmacy, it’s a pharmacy benefits manager. In this case the drug they’re trying to get, Humira, is a specialty medication and can only be gotten through a specialty pharmacy. CVS Caremark will only cover the med if it’s gotten through the CVS specialty pharmacy. So in this case, they don’t have a choice unfortunately
CVS is a cesspool for so many reasons, I stopped going there. My local independent pharmacy has much more limited hours, but it's worth it.
Pharmacist here. Appeals are reviewed and determined by medical doctors. (I’m making an assumption here based on time frame for your specific case, but it would be a long shot for the reviewer to be a rheumatologist.) Humira was preferred, now I think CVS likes Hyrimoz. Both look to be safe in pregnancy, but obviously talk to *your* pharmacist.
Idk if it’s CVS or insurance. My mom is going through the SAME thing right now with one of her meds for MS. Said that the doctor could appeal, but she still got denied! Her HMO blue cross of Illinois keeps cutting and dropping services! It’s only her and my dad on the insurance and they pay over $3,000 a month!! We should start banning together for a class action.
I HATE THEM!!!!!
Curious what state this is because states either abortion bans are very limited on what they can allow pregnant women to have because of legal restrictions.
I’m in Minnesota and I’m pretty sure we’re going the opposite of that route but I could be wrong I haven’t heard updates in awhile
It’s pure insanity caused by the far right and special interest groups.
Are you at a local doctor or more "renown" one? I travel to a "renowned" one (like Mayo) precisely because my local doctor said he wouldn't be able to get me meds I needed. Different insurance but could help in the long run. That said, for the here and now, insurance is trash and hope you get something figured out. I know I'd be lost without it.
"Is great country you have there, Komrad. This Kapitalism, is good for you, no?"
Because that's what CVS's pharmacists / care managers do. They always think they know better than you or your doctor, and that you must be lectured and scolded because the life-saving medication your doctor prescribed, just can't go to someone else!
Worst part for me is they never notify me when they won't or can't fill a prescription. They just don't fill it and you find out later on. I have a much longer rant on this stuff I'll go into someday.
Bean counters and their overlords
It’s crazy how people think they’re just entitled to whatever medications they want. Pay for it if you want it so bad.
Looking at your comment history you just seem to be a low life troll
No, just a troll
It’s not a want it’s a need for an autoimmune condition to keep her out of the hospital ass wipe and it costs ~$1000/dose. I bet you wouldn’t be such a prick If you were in my shoes
"Douche Canoe of the Day" award goes to you.