FRUSTRATED in North Carolina!!

[Sunshine]

I got a call from the speciality pharmacy (Care Mark? ). They got the prescription from my Neuro but good old BCBS of NC is requiring authorization and that the ball is now back in my docs court to provide more info to BCBS. I called the office and they said that that if BCBS denies it then we will have to go through the appeals process. We should know midweek if we go to battle. I did find out that my meds (if I get to get them) will come from Pennsylvania. But she could not give me any idea about the cost. Has anyone else out there facing this issue or had to go through the appeals process? Would like to know how long it might take..Pharmacy put it back on doc..the doc office puts it back on the insurance company...and I just get to hurry up and waitSo FRUSTRATED! !

[dcorbitt]

I went through similar issues with Ampyra when it first came out. It was quite frustrating getting the paperwork in place but it was worth it in the long run. hang in there and be your own advocate! You are the customer to all of them including the doc!

[durgastiger]

@Sunshine

Are you almost done your starter pack or is this what you are talking about?

I noticed my started pack was approved through claims with BCBS Pennsylvania but my tecfidera comes from a pharmacy in Florida "i-core".

BCBS declined my prescription refill also wanting pre-authorization from my neurologist. I'm getting blood work tomorrow so maybe my neuro wants to see the results also before prescribing me another month or 3.

I have 5 days left of tecfidera so hopefully I can get all of that to my neuro so she can approve me for another month or three of tecfidera.

You got your starter pack right? Did BCBS not cover the starter pack?

[Sunshine]

Hi Bill

Hi Bill...I got my "Starter Pack" through Tec/ Biogen..via US Bio Services. It came with 7 days of 120 and 30 days of 240 which I believe was not the standard starter pack. Biogen had sent the orignal script to Caremark which was Not the speciality pharmacy for my BCBS plan, mine is Medco Accedo pharmacy.

So after getting the run around I finally had to put my Southern Belle sugar aside and got down right ugly with the Biogen rep. And low and behold I get a call from Bio services on a Saturday ( ) telling me I would get my Tec that following Tuesday. When I asked them about the cost they said that they were there to assist while my insurance was being worked out.

I Friday after I got my Tec from Bio Service, I got a call from Medco Accredo to set up my delivery for Tec I told them that I had gotten my starter pack already so they sent me 30 day supply of 240 but said my Pre Authorization was good for 1 month, and that my neuro would have to get Preautherization again. My doc office sent me a letter showing were they tried to get Preautherization again, but now Medco said it wasn't necessary. It is now an approved drug. So we shall see if that really holds true.

As for cost, it would normally be $100 copay per month, but I am suppose to be on $10 assistant program. Accredo didn't require me to pay. They said that I'd get the bill in the mail...here's hoping that they get it right

Hope this long winded explanation answers your question.