Another Example of Express Scripts difficulty

[SIXFOOTFOUR]

Hi Everyone,

I wanted to share yet another example of why we all need to be persistent in demanding Harvoni and not give in to Viekia Pak if that is not the medication that you want, even though it is the medication they want to provide due to their discount.

As Ive posted before Im B/C member with Express Scripts as pharmacy provider.
I was denied 2 times for Harvoni but offered Viekira pak as their substitute due to their discount with Abbey. my doctor was persistent and with the addition of some extra test and being diagnosed at F3-F4 and VL >6 mil they gave in and I started Harvoni 3 weeks ago.

So the point of this post is I went to reorder my 1st refill (2nd bottle) on Monday only to be told it was denied and I should have been on Viekira so they would not send the refill of Harvoni and I have a 32,000 bill for the first bottle of Harvoni! Now 2 days later multiple calls to Express Scripts and then to their specialty provider Accredo and a long 24 hr wait for a call back from a manager. All the time worrying Ill run out of Harvoni and Ill be liable for the cost of the first bottle and then have to restart on Viekira Pak. 2 days later this am I get a computer call from Express Scripts that my medication is approved and to call to arrange delivery. Im relieved and make the call only to again hear that Im approved for Viekira not Harvoni...... !!!!!!!!!!!!!

More calls today and a couple threats to them that they sent the first bottle of Harvoni and Im mid treatment now and if I have to stop Ill hold them responsible for any setbacks to my health! I just got a call from a Patient Care Advocate (?) from Accredo and they approved the remaining 2 bottles (8weeks) of Harvoni and Ill have my 2nd bottle on Fri via UPS and they have covered the first bottle !

So I guess the point of this post besides venting my anxiety is that Express Scripts will approve Harvoni but you need to be your own advocate and dont take no for the answer , especially if you are F3 or more.

[sapphire101]

6'4" above sea level 


I am a B/C member with Express Scripts/Accredo 100% approved for Viekira Pak with Riba and still manage to have much pharmacy drama along the way. It is the Murphy Law approach to medication prescription and delivery. I have made it to the middle of my 12 weeks and I am relieved that there will only be one more shipment to deal with.

Thank you for sharing your post because I thought long and hard about my treatment choice and you validated my decision to go with the flow and take the 'V Pak' and not hassle with fighting them on Harvoni Rx. I didn't  have the energy or the time and when my research found the same efficacy, well that was that and I took my chances on the increase pill burden and potential riba side effects.

So far so good for me and let us know when your Friday delivery is complete and you get those pills in your hands!
BTW my first shipment of Viekira came with Harvoni instructions. The Pharma Gods are crazy for sure.

[Lynn K]

Had my share of problems with Accredo/ Express Scripts if you have something like this come up I have an e mail address it is kind of an open secret it is even on Express Scripts Facebook page you should see some of the comments they get we heppers are not alone in having problems with them.


If the going gets tough remember this address ExpressRxHelp@express-scripts.com

Sent them your problem like the one you had with your member number and contact information and get a phone call back from an Accredo/Express Scripts supervisor with the power to help. My friend on the inside is Lis I have a direct line to her she has made my express scripts experience almost bearable

[SIXFOOTFOUR]

Sapphire101, I would have done exactly what you did if my doctor had not told me to wait a little longer. I was happy to have an easier option with so much greater success than in the past with either Viekira or Harvoni. But my doctor was really pushing for Harvoni due to the 1 pill a day and less testing and possible side effects. But any longer and I would have gladly gone Viekira.

Lynn K, Thanks for the direct email. I think Ive got it finally worked out with Express Scripts. They agreeded to send the 1 st refill (2nd bottle) and Ill have it tomorrow and they said I wont have this problem in 3 weeks when I refill for the last bottle.

But again for all of the Express Scripts members Viekira is easily available and their first choice due to their cost but Harvoni can be approved if you are persistant and meet the additional criteria of F3 or greater based on my information and experience dealing with them.

[dogdave]

Hi SixFootFour,  glad you got Lynn's help with the Accredo's email address and especially that it worked for you!  I used that email address to finally get approved.  Start-date is today!  Good luck with your treatment!

[Else]

Congrats on standing your ground and sorting it out, 6'4"!!

Makes me hopeful though I'm still scared to death.  I hope to begin Harvoni as soon as possible.  Will be dealing with Express Scripts regarding ViekiraPak with riba (I'm genotype 1a)

Hoping well-documented, successful treatment of another disorder will establish that ribavirin is contraindicated for me. 

Saw some scary forms on my insurance website stating that to appeal it must be proven that patient could not tolerate first-line treatment.  Good god.     Pardon me if I don't agree to injure myself to satisfy some arbitrary approval guideline.

[dogdave]

Call BC/BS appeals menu option.  I explained everything that was contrary in their denial letters and everything else.  I wasn't rude, but more like exasperated and I got a decent human on the line.  She had all the denials right in front of her and she went and sent it through.  She said she'd do the appeal for me because I didn't know the process. It worked.  She went on vacation and told me her assistant would follow up and she did.  Keep at it and good luck!

Else, thanks for you good wishes.

David (use to be sixfoottwo, but now I am fivefooteleven) it seem to be settling down at my waist unfortunately.

[Lynn K]

I believe that means you need to provide documented proof why the riba is contraindicated. Rather than making you try it to prove you could not tolerate it.

[SIXFOOTFOUR]

Quick update.

I received the 2nd bottle of Harvoni via UPS from Express Scripts ! Started pill1 of the 2nd bottle today so Im in week 5 now, doing well min side effects.

Hope I dont run into the same run around for the last refill in 3 weeks, but I dont think so since I see Harvoni on my Express Scripts account now ($30,990 their cost, 5 copay)

Best of luck to all trying to negotiate insurance!

[Lynn K]

Congrats!

I am so glad I have my last bottle number 6 in hand and hopefully never have to deal with Express Scripts Accredo again.

I still get my Spironolactone through them but just some clicks on their web site and my 90 supply is on the way

[dragonslayer]

Lynn, youve so been through the ringer on this disease.  I really admire your fortitude  in dealing with all the issues youve had!  And a big congrats to you on finally arriving at your last bottle.  I sincerely join you in hoping this is the last youll have to face from this illness.

[Else]

Big kudos and congrats to all here who've stood their ground.  You're really an enormous inspiration to those that are just getting started.  It can be done!     It sucks and it's hard, but it can be done.

[Lynn K]

Thanks Paul

But really what other option is there? Just keep putting one foot in front of the other.

And I consider myself lucky really to still be here and relatively in good health when this long awaited cure for most has finally arrived.

So many others did not make it this far and succumbed to liver disease or liver cancer. We are all are only here because of those that came before and the scientists who worked tirelessly to find us a cure when for so long there was none.

Best to all