It’s getting worst though. A lot worst. They keep adding more and more layers to make it so difficult and convoluted you give up. Last year my insurance started using an external pharmacy for my meds. Fine. But my meds to need to be administered by a nurse in a hospital. So I need to get prior authorization from my doctor to my insurance who then approves the pharmacy to do the meds. But there are 30% copays now so I use a third party company that works with the company that makes the meds to comp the 30%. Then I need to get the hospital to call the pharmacy to order meds on my behalf and send it to the hospital, not me. Then I can finally schedule my appointment to actually get the shot in the hospital. I do this circus once a year, every year because they change one layer every year and so I have to figure out the new rules. It’s pure madness.
This is exactly me trying to get ahold of immunosuppressants to treat my Crohn’s Disease. I have to go through a specialty pharmacy owned by the insurance company. They bill to SaveOn, an assistance program, because my 30% copay works out to over $8K. They additionally bill against a discount/coupon program. If anything gets screwed up between the five systems of record I have to keep my data in (via phone calls, of course, because the self-service web portals are designed to give you incorrect data and accomplish nothing), then I spend weeks trying to correct everything and wind up getting my meds late.
It’s getting worst though. A lot worst. They keep adding more and more layers to make it so difficult and convoluted you give up. Last year my insurance started using an external pharmacy for my meds. Fine. But my meds to need to be administered by a nurse in a hospital. So I need to get prior authorization from my doctor to my insurance who then approves the pharmacy to do the meds. But there are 30% copays now so I use a third party company that works with the company that makes the meds to comp the 30%. Then I need to get the hospital to call the pharmacy to order meds on my behalf and send it to the hospital, not me. Then I can finally schedule my appointment to actually get the shot in the hospital. I do this circus once a year, every year because they change one layer every year and so I have to figure out the new rules. It’s pure madness.
This is exactly me trying to get ahold of immunosuppressants to treat my Crohn’s Disease. I have to go through a specialty pharmacy owned by the insurance company. They bill to SaveOn, an assistance program, because my 30% copay works out to over $8K. They additionally bill against a discount/coupon program. If anything gets screwed up between the five systems of record I have to keep my data in (via phone calls, of course, because the self-service web portals are designed to give you incorrect data and accomplish nothing), then I spend weeks trying to correct everything and wind up getting my meds late.