Friday, May 16, 2014

Mail-order prescriptions: Update #1 on Cellcept

A few weeks ago, I blogged about the incredible savings I was going to see by ordering my Cellcept prescription in a 3-month supply. The numbers were astounding to me - $400/month if I filled it monthly, vs. $100 total for a 3-month supply. Too good to be true, right?

Unfortunately, it WAS too good to be true!

I am sorry to say that I was misquoted. Not once, not twice, but three times by my drug prescription provider (aka the part of my insurance company that handles my prescription benefit). Turns out that Cellcept (generic name mycophenolate) is categorized incorrectly in their computers. It doesn't come up as a specialty drug - so the numbers I was being quoted applied to a regular run-of-the-mill drug, not Cellcept. In fact, once we figured out the glitch, the fourth person I talked to explained that when a drug comes up as "specialty", they aren't even allowed to run test claims to determine pricing, because the cost varies so much.

Here's how I found out:

When I went to pick up my cellcept prescription at my pharmacy (having confirmed not once but twice with my insurance company weeks before that the total should be about $100 for the three month supply), my beloved pharmacist, whom I know well, pulled me aside and asked if I was sure I wanted to fill the 3-month's supply. She said she was asking because the co-pay came to a whopping $1900! Eeek! Actually double Eeek!

I called the insurance company, and they told me that I could still get the $100 for the three month supply, but I had to mail it in to them. (Which, in the end, turned out to be incorrect also...but I'll get to that.) The problem with mailing it in, however, was that because I'd been told I could fill it with my local pharmacy, I only had a day or two until my prescription ran out. So allowing for the two weeks it takes for mail order wasn't going to be possible.

Thankfully, my local pharmacy said they'd do what they could to get me by until the medicine arrived, and the mail order company said they would rush it (of course, all for a fee.) I counted down the days until the mail-order company called to get approval on the co-pay and arrange shipping instructions. But when they did, I had another surprise. The co-pay wasn't the $100 I'd been quoted...it was even MORE than my retail pharmacy. It came to $2100. Agggghhh!!

So now - I had actually increased the cost of the medicine by mailing it off, and I'd lost almost a week. What a nightmare! It doesn't get much better - because the insurance company simply said that, indeed, I had been misquoted (three times!), and they were sorry, but asked how I wanted to pay for the prescription. Seriously?

I weighed my options - and I chose to transfer the prescription back to my local pharmacy, pay for a one month's supply (still a whopping $650), and work on options for the future. I couldn't go one more day without the medicine, and I was catching a plane for Indiana the next day, and I couldn't leave without my pills. Plus, I'd had enough. I'd spent way too much time and energy over the past few weeks on the logistics of the whole thing, and I just needed a break.

Now - the promising news (I won't called it "good" because it's still unconfirmed), but my oh-so-helpful sister recommended I try Costco, and it looks like it may be the ticket. Online, the costs for 100 pills of mycophenolate appear to be $80. (I need 120 pills a month, but even double that dollar amount would be an improvement!) I called two different Costco pharmacies just to make sure what I was seeing online was correct, and I received two quotes - one for $80, and the other for $160. While the conflicting quotes are a bit disconcerting, it does indicate that there are savings to be had. And a good thing, too, as my local pharmacist warned me:  the cost through them this month was $650, but next month, it would increase to $750, based upon the way my benefit works. Fingers crossed that Costco comes through!

I'll definitely keep you posted. Look for an update #2 in the coming weeks. In the meantime, I'll work on releasing the negative energy I feel toward my insurance company. :)

6 comments:

Aymie said...

You know, reading things like this make me glad we've got the NHS over here and don't have to worry about paying for our meds. I looked up the cost of some of mine at one stage and it would have cost me around £250 a day. A day! It's crazy, and respect to you guys who have to shop around for the best deals.

The Patient Doc said...

As a physician and patient with lupus, I have come to find the insurance companies are my worst enemies.

Sara Gorman said...

It is crazy how quickly the costs add up. We lupus patients aren't cheap dates, are we? :) thanks, as always,for commenting!

Sara Gorman said...

Agreed! And it takes so much time to manage the process - on both sides, I'd imagine. But, that said, there's not one day that goes by that I'm not thankful for coverage. I just wish it were easier!

Melissa M Martinez said...

I get mine through CanadaDrugs. 90 day supply for way less than I get it here in USA.

Sara Gorman said...

Thanks for sharing!