Wednesday, May 8, 2013

I Don't Even Know Why I Am Surprised

Yesterday morning, while I was feeding OZL breakfast, I decided to call Aetna Specialty Pharmacy to order a refill of my Enbrel. After spending so much time getting things sorted out with them last time, I assumed this would be a quick call. (Can you see where this is going? Foreshadowing!!!!)

It started out pretty well. I picked my way through their menus and eventually got in touch with a human, who proceeded to review all of my information with me. I told him I needed a refill and he said he could have it to me tomorrow. I said great! 

Then he said: that will be $250.

No! No it will not. I already spent an absurd amount of time trying to get enrolled in co-pay assistance and the last person I spoke to assured me that the cost to me would be $0. He put me on hold.

Eventually, he came back and mumbled something about me not being properly enrolled. (Who is in charge of this stuff anyhow?!?!) I asked if he could properly enroll me. He said he could. And so I waited on the phone with him for fifteen minutes or so while OZL screamed and he theoretically "properly" enrolled me this time. 

Eventually he said my Enbrel would arrive tomorrow and it would cost me $0, which was exactly what I wanted to hear!

But then he said next time the co-pay assistance would only cover a percentage of the cost, so it wouldn't be free anymore. What?!? Of course, he was unable to tell me what percentage would be covered or what I would have to pay for my next refill. Awesome.

I don't even know why I am surprised.

Although, to be fair, at least the Enbrel actually arrived.


Skye said...

I think it's no more then 10$ after the 0$ period. I'm pretty sure thats what it says in the enbrel program and thats what It was for me after I reached that period!

Leslie said...

Your specialty pharmacy sounds like a pain in the butt! I have CuraScript - my insurance requires it and I'm sure that your insurance requires that you use the one that you do. I did have a really hard time finding out what my copay would be and I enrolled in the Humira copay assisitance program myself. I hard a rough time just getting in contact with CuraScript now they call me. Since that somewhat rocky start, everything has been smooth. Hope things smooth out for you!

Unknown said...

It was great to find your blog. I have been dealing with RA for 13 years now. It is reassuring in a way to find someone else who had a horrible time with Aetna Specialty Pharmacy. I thought at times that I was just an unreasonable person, but it made ordering the medication such a painful process. My first order from them took 8 weeks to sort out all the problems on their end, and I ended up having a flare up after not experiencing one for 2 years due to not getting my Enbrel. They always made me feel like the dumbest person in the world by the time I got off the phone with them. At some points, I just wanted to give up even trying to get my medicine. It was a sad mess.

I still consider myself lucky that I have always had reasonably good health coverage. I don't think people without a chronic condition understand how devastating the costs can be.

I was probably the most excited person in my company when we changed insurance companies last year to United Healthcare. Now, I use OptumRX, and it has been a pleasant experience so far. My orders always go through without a hitch. They go out of their way to offer help. I found out about the Enbrel support program through them. Walgreens was also a great specialty pharmacy program. Both companies are friendly and professional.

Glad you are sharing your experience with others and hope you do well in the future.

~Mariah~ said...

COURTNEY: I agree - Walgreens Specialty Pharmacy was great! Too bad I don't have a choice anymore ::sigh:: And nice to "meet" you!!