BlueCross Forces Us to Use Precision RX for Enbrel | Arthritis Information

We were told by Bluecross to try Precision RX specialty solutions for our enbrel and they did a terrible job and were unprofessional when we tried to fix their mistakes. Now, Bluecross will not allow us to get our enbrel from anywhere else. We cannot go to any of our local stores. They threatened us with not covering the enbrel unless we purchased from precision RX. This should be illegal. Beware. Do not let your insurance company switch you over to them. I have BlueCross and I chose my own specialty pharmacy for enbrel. Wonder why the difference.I can't pick and chose what specialty pharmcy I use. I am required to use Caremark because of my insurance plan. I didn't realize that other plans offered a choice.BlueCross told us to use them because we could get three month supplies ordered at one time and that it would come mail order and be much easier for us. After multiple mistakes with our prescriptions and a very unprofessional and unhelpful attitude, we wanted to go back to our local pharmacy and Bluecross told us we could not do that and they would not cover enbrel at all for us. They threatened us and were quite rude about it. Good luck with what you have. Two factors come into play. The first being BC/BS coverage differs from state to state and second is what your group plan includes, if you're covered by insurance through work.

*Gentle Hugs *
I filled my first month of Enbrel at the local CVS. When I called for my 2nd refill, it was denied. I was like, "WHAT?" The pharmacist couldn't give me any details. Upon calling Anthem, I was informed that I couldn't use CVS for Enbrel, I had to use PrecisionRX. I was really upset. I said, "Then why didn't you tell me that BEFORE I filled the first prescription?" They agreed to let me fill it one more time because obviously I didn't have time to get a new script from my RD. I was really upset.

I got a three month supply from PrecisionRX and am getting ready for a refill in about a week. So far, I haven't had any problems with PrecisionRX, just Anthem.

kweenb2008-05-05 08:34:52Have you reported the mistakes to Enbrel? I would think they would be concerned about mistakes with their med. Maybe they could help straighten things out with the pharmacy, so you could still use them and get what you need. Hope everything works out. The problem is that we have always been able to chose a pharmacy for the last eight years. Now, they decide to change on us with no reason or warning. We would have never tried PrecisionRX if it were not for Bluecross wanting us to. Now, we get no help and half our orders have been wrong and we can't go anywhere else. I'm getting frustrarted reading this thread, and t's not even my problem. Where's the "free enterprise" in this? [QUOTE=Lynn49]I can't pick and chose what specialty pharmcy I use. I am required to use Caremark because of my insurance plan. I didn't realize that other plans offered a choice.[/QUOTE]

Lynn, how has your experience been with Caremark? I've been using ExpressScripts for delivery of my Humira and have been VERY happy with their service, but I have to switch to Caremark in June.
Hubby uses Caremark for his meds (all pills), no problems in the three years so far. [QUOTE=Suzanne]Hubby uses Caremark for his meds (all pills), no problems in the three years so far. [/QUOTE]

Great!! I'll probably still be on pins and needles until I actually get my first shipment from them. It's such a pain having to switch pharmacies ... I wish I could just pick up my Humira locally.
I use Caremark too and they are great. Very easy to get my scripts refilled. Usually I just fax them the dr.'s scrip and then I just stick it in the mail as well. They will ask me what day I want to recieve my shipment. They are very professional, caring and have not had even the slightest of problems with them. Actually, my credit card expired and they still sent me my shipment but included a letter to remind me to give them my updated credit card info for the shipping charge. That was a surprise! To get my shipment before I paid for it. [QUOTE=treefrog001] I wish I could just pick up my Humira locally.
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I have a question about that. Hubby could get his meds locally, it just costs more. I think it works out we save a month's copay - he gets a three month supply directly from Caremark for what it would cost for two months from the pharmacy.

Could you get your Humira locally, for more money? For example, if my daughter started it, I don't want three months worth until we know she could tolerate it.
As the cost of prescription drugs increases for insurance companies, they do various things to control costs. I think most have "formularies" list of drugs they cover, and the copays may vary depending if its a generic, preferred brand, nonpreferred brand, etc.

I use to be able to get my biologic at a walk-in pharmacy. I then was informed I could only fill it at a mail in pharmacy, Caremark. I didn't have any problems w/them, and it did keep my copay affordable. Then my insurer switched to Medco. I had one problem w/them when I received 2 boxes of enbrel w/broken seals that they would not replace. I contacted Enbrel and they replaced them.

Recently I was informed by Medco that my osteoporosis drug will no longer be covered. However, if my doctor can make a case as to why I need to use this particular drug, then it will be covered. So I'm concerned. What's next? Making enbrel a Tier 4 drug and charging me 20-30% of its cost? A trend now for expensive speciality drugs.

I understand the need to control costs, but insurance companies, pharmaceutical companies and pharmacy benefit managers (PBMs) (Medco, Caremark, etc) are for profit businesses, and that makes me a little nervous. Will their priority to make a profit be at the expense of us consumers? There have been lawsuits involving drug companies and PBM's and criticism of their practices. There's a need for transparency and disclosure of these practices, and perhaps better oversight, regulation or complete reform of our health care system.

In Germany, Switzerland, Japan, Taiwan, prescription drugs are cheaper than in the US, they have universal health care and negotiate w/drug companies over price. These countries are democratic, capitalistic nations, they pay less than we do on health care, cover all their citizens, and have heathier people. In the US, our health care system is heading for a crisis, and we need to start addressing how to fix it.

The link below is to an NYT article about PBMs, their exclusive distribution arrangements and rebates they receive from drug companies for drugs they put on their formularies:

http://www.nytimes.com/2008/04/19/business/19specialty.html?ex=1366344000&en=c734174973cb1055&ei=5088&partner=rssnyt&emc=rss

This link is to a reprint of a NYT article about the new pricing system of expensive specialty drugs, Tier 4 drugs, which for some insurance plans could include biologics in the future.

http://www.truthout.org/issues_06/041408HA.shtml

Joie2008-05-05 11:48:41I love Caremark. They have done a wondeful job for me and I wouldn't hesitate to recommend them to anyone.... [QUOTE=birdlanguage]We were told by Bluecross to try Precision RX specialty solutions for our enbrel and they did a terrible job and were unprofessional when we tried to fix their mistakes. Now, Bluecross will not allow us to get our enbrel from anywhere else. We cannot go to any of our local stores. They threatened us with not covering the enbrel unless we purchased from precision RX. This should be illegal. Beware. Do not let your insurance company switch you over to them. [/QUOTE]

If PrecisionRX is making mistakes, contact the state board of pharmacy (both in your state and whatever state they are based in).

[QUOTE=birdlanguage]Beware. Do not let your insurance company switch you over to them. [/QUOTE]

I don't think a consumer has any control over this. An insurance company contracts with a pharmacy benefits manager (PBM) like Precision Rx, The insurance company may contract with a different PBM in the future, but until then you're stuck w/ Precision Rx. You should make your complaints and problems known, cuz if customer service is poor, and the insurance company receives a lot of complaints they may switch to another PBM. If they don't, the next time you have open enrollment you could change to another insurance plan with a different PBM, that is if you have employer-based coverage with a choice of plans. Good luck, I hope you have fewer problems in the future.

[QUOTE=Honey]I use Caremark too and they are great.[/QUOTE]

That's good to know. The phone reps at Curascript (ExpressScript's specialty pharmacy) were all really nice. They actually contacted my doctor for me to get my initial Humira prescription, and to get new prescriptions whenever I was on my last re-fill. Hopefully the reps at Caremark will be as nice ... sounds like they are.
[QUOTE=Suzanne]Could you get your Humira locally, for more money?[/QUOTE]
That's not an option for me with my insurance. They let me fill my first prescription at my local pharmacy, but they made me use their mail-order pharmacy after that. I don't really mind getting my Humira through the mail. However, it's just kind of a pain having to track it & go home from work in the middle of the day to bring it inside once it's delivered. I don't like leaving it on my doorstep any longer than necessary.
We switched in January to a specialty network and have the choice of 4 pharmacies nationwide. So far so good, they call about a week before I'm due for my next delivery - deliver to my home or work and if it's time to have my RD renew the script, they will contact their office. Downside is that it's no longer available as a 90day with 2 copays, so I have a monthly copay. But, knowing the cost of Enbrel, I'm willing to pay a copay each month. Now, if they could just figure out how we can recycle the little styrofoam coolers.

Any chance that your insurance has more than one pharmacy option in the specialty network? If you weren't satisfied, definitely contact your insurance company and complain - as Joy said if there are enough complaints, at renewal time maybe they'll contract with someone else. Hope your next order goes more smoothly.

[QUOTE=treefrog001] [QUOTE=Suzanne]Could you get your Humira locally, for more money?[/QUOTE]
That's not an option for me with my insurance. They let me fill my first prescription at my local pharmacy, but they made me use their mail-order pharmacy after that. I don't really mind getting my Humira through the mail. However, it's just kind of a pain having to track it & go home from work in the middle of the day to bring it inside once it's delivered. I don't like leaving it on my doorstep any longer than necessary.
[/QUOTE]

Get it shipped to your place of employment if possible. Even if your company has a policy against getting personal packages at work, they almost always make an exception for medications - especially when they realize they will have a more productive employee if he/she isn't spending half the day worrying about their meds sitting on the front doorstep. If that's not an option, have it held for pickup at the local office (FedEx, UPS, USPS). They are generally open later in the evening. When I purchase computer parts, I have the package held for pickup at the local UPS office and I pick it up on my way home from work.
I think someone else asked this question but I did not see an answer or I missed it. Your Blue Cross - Is it insurance that either you and/or your husband receive through work or have you contracted with Blue Cross on your own? If you receive your insurance through your job, then you need to make known the problems your experiencing to your Human Resources or Employee Benefits coordinator. These are the people who pick and choose what your insurance will cover.

Caremark and Caremark Specialty Pharmacies are the ones my insurance requires me to use. So far I have had no serious problems receiving my regular prescription through Caremark or my Enbrel through the Specialty Pharmacy.

Marianne
I use Pharmacare Specialty and they are fabulous. I have my meds delivered to my office and they call me the week I'm due for a delivery. I'd forget to order it half the time if they didn't call. They are really nice and I'm on a first name basis with the represenative that calls to set up my delivery. They also offer a hot line service; although I've never had to use it. Their connected to CVS. Here in our town their located near the hospital (Although I'm 40 miles away and they deliever).

I also have BCBS; and they've been really great. Never any problems.