Denied! Can't get Humira to see if it works. Sigh.

In the six months since I last posted, a lot has changed. I'll get to that in my next post.

But today I'm complaining about my insurance company's (Anthem Blue Cross) ineptitude at keeping its part of the deal after we've paid premiums non-stop.

I shouldn't be surprised, since Anthem Blue Cross is beholden to stockholders before patients. Private business, in my opinion, is NOT always the best way to get things done, especially when it comes to health issues.

Here's what happened:

In November, my new gastroenterologist (Yes, I switched to Kathy Peterson at the U.) started me on Humira. It's a biological medication to decrease inflammation that has been successful to treat some people's Crohn's disease.

I'm more than a month late taking it, though, because I can't get the medication, even though my policy says it's covered. By the way, Humira is so expensive that just the co-pay is $100.

After filling the prescription a couple of times at the University Medical Center pharmacy, I went again on Friday, December 13th, the day it was due, to get a refill. I was supposed to stay on schedule so we can tell if it helps or not. The chance of it causing problems, or simply not working, increases if I don't take it as prescribed.

I'd had no trouble filling the prescription the two or three times I'd bought it at the U, so I didn't realize there'd be a problem that day.

Boy was I wrong!

The insurance denied the claim when the the pharmacy tried to get payment, because after a couple of refills at a local pharmacy, it's only covered when it comes from a "specialty pharmacy," called Acredo. After three hours either talking with people at Acredo, the specialty pharmacy, or having my doctor's office or the University pharmacy techs talk with people at Acredo and the insurance company, I left without the medication.

So after the weekend, I called Acredo again to set up home delivery of the Humira.

The day it was supposed to come, instead I got a robo-call stating that I needed to call Acredo because there may be a delay in shipping my medication. So I called. The tech that answered couldn't tell me why it was cancelled, only that I needed to reschedule the delivery. So I did.

Guess what happened the day it was supposed to come?

Good guess! Another robo-call!

This has happened repeatedly since then. Nobody can tell me why it keeps getting cancelled, only that the pharmacist, or somebody involved with filling the prescription, is the one who keeps cancelling it. The person I spoke with yesterday guessed that maybe it's back-ordered.

Tomorrow, I'm calling my insurance company with my story to ask again if they'll approve coverage at a local pharmacy. And I'll contact Dr. Peterson to see what I should do next.

Sigh. I wish private enterprise wouldn't get between patients and treatment.