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    Quarterly Review

    Got a voicemail from my Specialty Pharmacy that my plan requires a quarterly review of my medication. Never got a message regarding a quarterly review nor have I changed plans or medications. Looks like my plan has changed requirements.
    Anyone else received a call like this? What questions do they ask? I suspect they want me to change to a generic.... (Been on Copaxone for over a decade - had increase in lesions when I went off it for a few months as I was unable to afford it a few years back.)
    Why do they need a quarterly review - once every three months??? Seems crazy to me!

    #2
    Originally posted by its2much View Post
    Got a voicemail from my Specialty Pharmacy that my plan requires a quarterly review of my medication. Never got a message regarding a quarterly review nor have I changed plans or medications. Looks like my plan has changed requirements.
    Anyone else received a call like this? What questions do they ask? I suspect they want me to change to a generic.... (Been on Copaxone for over a decade - had increase in lesions when I went off it for a few months as I was unable to afford it a few years back.)
    Why do they need a quarterly review - once every three months??? Seems crazy to me!
    I'm also on Copaxone, and have been since 2008. I have not had a quarterly review. I wouldn't be happy with switching to generic. I hope that's not what will happen to you.

    Please keep us up to date on what happens with this.
    ~ Faith
    MSWorld Volunteer -- Moderator since JUN2012
    (now a Mimibug)

    Symptoms began in JAN02
    - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
    - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
    .

    - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
    - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

    Comment


      #3
      Here's What They Asked

      1- For what disease am I taking Copaxone?

      2- Have I missed any dosages the first quarter of 2019?

      3- How many days of work or school have you missed the first quarter of 2019?

      4- How many days have you felt sad, lacked energy during the past three months?

      5- Have you been depressed during the past three months?

      6- Have you taken any medications the first quarter for Lyme Disease?

      I don't know what to think about the questions. They said they were checking for the effectiveness of the drug.

      I tried to order a refill for my Copaxone but they wouldn't put it through. I was transferred to another department for my "Quarterly Review".....

      Comment


        #4
        Originally posted by its2much View Post
        I tried to order a refill for my Copaxone but they wouldn't put it through. I was transferred to another department for my "Quarterly Review".....
        After you completed your quarterly review, did they allow you to refill your copaxone?
        ~ Faith
        MSWorld Volunteer -- Moderator since JUN2012
        (now a Mimibug)

        Symptoms began in JAN02
        - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
        - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
        .

        - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
        - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

        Comment


          #5
          Yes

          but I had to ask them to put it through. Can't wait for the next Quarterly Review. Still wondering what exactly they're looking for. I might ask the next time why/what they're doing these reviews.

          Comment


            #6
            I am always interested in the sorts of things that MSers, other than myself, experience. Your story smacks of intimidation. This is a tactic that insurance companies employ, regularly !
            I, myself, have been filling out 'continuation of disability' forms, every year for several years . And this form includes a 'physician statement' form, which must be filled out and signed by my 'attending physician' ! That form costs me $40.00 ! As if I am the very first guy in history that found himself 'cured' of MS ! And there is a question that asks 'when will I return to work' ? ! It's a kick in the shorts !

            Comment


              #7
              Dear its2much,
              Your story raises suspicions in me. Have you called your usual Specialty Pharmacy to be sure the "Quarterly Review" is really a requirement FROM THEM? Unsolicited calls always make me think someone somewhere is fishing for my information for their own purposes. Many of these questions could be about marketing additional medications. I don't mean to meddle, but I think we all need to be careful.

              Stay lifted,
              Mermaid Susan
              "Life is short, and we have but little time to gladden the hearts of those who travel with us; so let us be swift to love, and make haste to be kind."
-Henri Amiel

              Comment

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