Who's Right? Doctor's office vs Express Scripts/Accredo re: preauthorization

[Hopefulone]

I am new to this site, and I am so thankful and impressed with all the information those of us with Hep C can use and obtain from here.  I was diagnosed with Hep C, geno type 1a five years ago.   After having a liver biopsy showing that my liver showed no damage, my doctor and I decided to put treatment off as I had just returned to college and I was in the process of completing my electives in order to become a nurse, a second career.  My doctor also said that better treatments were in the pipeline.

Last fall I decided to seek treatment (my energy levels are low) and was so happy to hear of the new treatments that are available!  The last time I saw my nurse practitioner was January 30th in which case blood was drawn to get the latest viral load and I was told all the necessary paperwork would be submitted to my insurance co. for pre authorization.   My insurance is BCBS of Michigan thru General Motors.  She warned me that it might take several months for the medication (Harvoni) to be approved as it was a new drug.  I knew I was going to be very busy with school at least until the second week of March and it was fine with me. 

After completing my class in March and not hearing from my N. P. I decided to call my insurance co. to check on the status of my pre authorization.  I was surprised to find out that Express Scripts or Accredo Specialty Pharmacy did not require any preauthorization for Harvoni based on my prescription plan thru General Motors!  According to Express Scripts and Accredo Specialty Pharmacy all my doctor had to do was call or fax the prescription over so they could start the processing.  I was really happy to hear that news, and I immediately rushed over to my N. P’s office to speak with her Medical Assistant who is in charge of the processing.  I informed her of what I was told by Express Scripts and Accredo Specialty Pharmacy not needing authorization[/i], and told her she could just fax the prescription over.  She asked if I was sure that I had gotten the right information, because a preauthorization was required for this type of drug.  She also told me that the coupon that Harvoni issues to pick up the co-pay for a patient did not work and this patient was burdened with a very high balance to pay.  I thought back to a previous experience with a different insurance co.  and how the representative had misinformed me pertaining to a different issue…..she assured me they had not forgotten me, the paperwork was submitted and should not be too much longer. 
 I left the office dismayed.  The next day I decided to call Express Scripts and Accredo and spoke with a different representative, who also informed me that no pre authorization was required according to my prescription plan, she also was familiar with the coupon that Harvoni offers toward help with your co-pay and informed me Accredo honors them.  I even called the billing department which informed me they also honor Harvoni’s coupon.  I called my N. P.’s office left a voicemail message for this M. A. to call me, and she never returned my call. 
I am now perplexed as to what my next step should be.  I believe the information that I received from   the people I have talked to at Express Scripts and Accredo is true.  I was able to go to their web site and see exactly how much will be covered by my prescription plan as well. To add to this, my husband came home the other night and informed me they are making cutbacks in his department and he fears the worst.  I really need to approach my N. A.’s office again, but I do not want to cause any waves.    I am hoping someone may be able to give me some input as to the best way to re-approach them in order to get them to take action regarding my treatment. 

[Lynn K]

Have you doctor send in the prescription. I have express scripts accredo as well through my employer BCBS.

In my experience the get the prescription and then it goes into an approval process your situation may be different. For me after the received the prescription that was when they denied my prescription so after I got my denial I sent them additional info I also found an inside email address and appealed that way and everything went much better after I contacted that email. It seems the call takers are not very knowledgeable and I spent a lot of time listing to recorder music and getting a phone tree run around.

If you do Face Book check out Express Scripts Face Book page many angry customers there.

https://www.facebook.com/ExpressScripts?fref=ts

Donna Hoffman
you should be spending ALL your time fixing the mess you have made of delivering medicine that people need.
Like · Reply · 1 · May 4 at 3:32pm

Amber Brister
Still failing to get that January prescription filled like the emails you sent saying it was shipping

Express Scripts
Hello Kevin, We're sorry you feel this way. Please send your contact information along with your ID# to ExpressRxHelp@express-scripts.com for help with an Rx. Thanks- Melanie

Kevin Baker
Fortunately, Express Scripts protects me from adverse interactions...by not actually filling my prescriptions. So I just live with the misery of untreated chronic illness instead. It's like being uninsured, but with premiums and copays!


Not to scare you just to let you know it may or may not be smooth sailing. Also the email address above was what got me the meds ExpressRxHelp@express-scripts.com

Good Luck