There is a special place in hell for the specialty pharmacy

Zoe’s dad’s RX insurance provider, Express Scripts, requires us to use their mail-order specialty pharmacy, Accredo. I hate them. I can’t stress that enough. Previously we used Briova and I can’t say enough nice things about them. They worked tirelessly to get Zoe medication on a holiday weekend when I messed up and forgot to order it (that is the one and only time this has ever happened). Since switching to Accredo in 2014, medication refills have been a nightmare. The latest debacle is blog worthy.

Zoe has 2 insurances. The secondary picks up the co-pays for her medications. Since switching to Accredo, I’ve been told on multiple occasions, by different people, that Accredo does NOT bill to secondary. I called bullshit, but when they refuse to take the information what am I gonna do? Pay the damn co-pay, that’s what. Her Prograff carries a $10 co-pay every month ($120 a year) while the CellCept did carry a $10 co-pay every 3 months ($40 a year), but jumped to $25 at the beginning of 2016 (now $100 a year).  Zoe’s dad and I split the cost of all non-covered expenses. When the CellCept jumped up $15, we got behind and have thus accrued a $120 balance which is 90 days past due resulting in a hold on the account. I generally send the co-pay in between refills so it always appears that there is a balance on the account. I’ve been told by numerous people on different occasions that Zoe’s meds are “NO HOLD” medications, meaning that her meds would never be held for holds on the account or past due balances. Sounds legit since these are LIFE-SUSTAINING ANTI-REJECTION drugs. Knowing that there is a balance and that they refuse to bill to secondary (which would take care of that balance), I’ve asked, on multiple occasions, for an itemized bill to be sent to me so I can file the claim with her secondary. I keep being told that they can’t do that. They can only send bills to the insurance holder. Awesome. If he’s getting them, he’s not telling me.

Fast forward to last Wednesday, September 14th: I call to refill her Prograff. I’m reminded about the hold and the past due balance. I remind her that they won’t bill to her secondary or send me a bill to submit the claim myself. She sets up the refill, scheduled delivery for Friday, September 16th (one day before Zoe is due to be out of medication). She then tells me that I should apply for co-pay assistance through the drug manufacturers. She proceeds to give me websites and phone numbers and tells me that they’ll give Zoe an id number, rx group number and rxbin number that they will use to bill the co-pay too thereby alleviating the problem of paying the co-pay. She has 2 insurances. I don’t need co-pay assistance so I thanked her and didn’t write down a damn thing she said.

Thursday, September 15th: I get a phone call from Accredo accounts receivable regarding Zoe’s “pending” order. I explain Accredo’s refusal to bill to Zoe’s secondary and the refusal to send ME a bill so I can submit the claim myself. She transfers me to billing. I explain this AGAIN to the gal from billing. **This is where it gets good** This gal tells me that they DO bill to secondary AND they’ll send a bill to whomever is willing to pay them. EXCUSE ME?! COME AGAIN?! I’ve been given incorrect information for OVER A YEAR by people who are most likely just too lazy to properly do their jobs?! Awesome. She takes the secondary information from me and says that it will take 4-6 WEEKS to verify. That’s right, weeks not days. Until the secondary is verified, the hold will remain on the account. I ask her if that hold is going to affect the refill order we are due to receive the following day. She puts me on hold to check. She comes back and tells me that no, the hold will not affect the shipment and it will arrive tomorrow as scheduled.

Friday, September 16th: It’s 6:30 pm and usually Zoe’s medications have arrived by this time, but there’s no box on my doorstep. I have a very bad feeling about this so I call them to make sure it shipped. Keep in mind that after her morning dose tomorrow, she’s out of meds and it’s a weekend. I’m informed by the Accredo agent that the shipment was cancelled due to the hold on the account. I very nearly lost my mind at this point. I demanded to be transferred to a supervisor. I get the same story from the supervisor. I explained the secondary insurance issue and that the balance will be rectified in 4-6 weeks when the insurance is verified. I also told her that I was under the impression the Zoe’s medications were “NO HOLD” meds being that are anti-rejections drugs. I also told her that Zoe has 2 doses left of her medication and missing doses will result in hospitalization where hopefully she won’t die. The supervisor was completely unimpressed by my urgency. She said there is no such thing as “NO HOLD” medications. If an account is more than 90 days past due, no meds will ship until the balance is paid. NO MEDS. Period. She said that she was very sorry and that she understands my frustration, but if I want Zoe’s medication I need to pay the balance. I argued with her for 30 minutes. I finally agreed to pay the $120 if that guaranteed Zoe’s medication would be here Saturday afternoon. **This is when I completely lost my mind** She told me nope, not gonna happen because there are no flights coming this way. At this point I told her to get in her car and drive it to my house herself. I then requested someone higher up than her; a nurse, a pharmacist, the damn CEO, ANYONE. She told me that there was no there at that time higher up than her. I told her she better give me some home phone numbers then. I asked where Accredo is located and it’s at this point that I threatened to drive there and burn the place to the ground. If you know me, you know that I’m not exaggerating this. I said it and I’m fairly certain they have it recorded. I proceeded to scream at her for 5 more minutes before she put me on hold. I sat on hold for 20 minutes before I finally hung up. It was now 7:30pm on a Friday and Zoe had 2 doses of medication left. I needed to make something happen RIGHT NOW so I called and had Dr. Boyle paged. He called in a 3 days supply (18 pills) to Walgreens and told me to call Monday and have Colleen (transplant coordinator) or the team’s social worker handle Accredo. Before going to bed that night, I called Walgreens to see if the prescription had been received, what the cost of medication would be and if there was any way to get Zoe’s secondary to pick up the tab since the primary won’t let me fill at a retail pharmacy (hence my nightmare with the mail-order pharmacy). The good news was yes, the script was there and they were getting it ready. The bad news is that since she has a primary, the secondary will automatically deny for submit to primary and the 18 pills was $105. I tried to get the insurance company on the phone to ask about a retail override, but they were closed (of course).

Saturday, September 17th: After a very sleepless night, I get up at 9 am and get Express Scripts on the phone. I’m told that since it’s a specialty medication handled by Accredo that they need to do the retail authorization. I don’t have high hopes at this point. I asked if the hold and past due balance will affect it and I was told no. I get Accredo on the phone and initially I’m told, nope, no override for you because there’s a hold on the account. At this point, I’m exhausted and running out of time. I told her that this is completely unacceptable and I need to be put through to someone, anyone, who can make this happen for me RIGHT NOW. I have a young lady who is due to be out of her life-sustaining medication and I’m done dicking around. She puts me on hold while she gets someone from the retail authorization department. That person initially says nope, but after digging a little deeper into the account and the medication, they agree to authorize it. The reason they agreed despite the hold? THIS IS A NO HOLD MEDICATION AND THE SHIPMENT SHOULD NEVER HAVE BEEN CANCELLED. Duh. I spend an hour on the phone between Accredo and Walgreens getting this override done. Turns out, with the pending refill in the system, the denial code Walgreens was getting was “fill too soon” so Accredo had to void the script they had on file so the one from Walgreens would appear as a new one and allow the override. I was guaranteed a call back in 30 minutes when it was complete. I did indeed receive a call back within 30 minutes from a “Senior Prescriptions Analyst” who informed me that it was all taken care of. She also confirmed what I already knew, Accredo screwed up when they cancelled her refill shipment. That never should have happened and she was putting the script back in the system for Monday morning to be filled and shipped. She said I should call Monday to set up delivery. HALLELUJAH! I pick up the 18 pills from Walgreens and when I added them to Zoe’s pill case, I got a pleasant surprise. I was wrong. She had medication through Sunday morning not Saturday so we now have enough medication to get her through Wednesday.

Monday, September 19th: I do as instructed and call first thing Monday morning to schedule that refill. I’m told no refill due to the hold on the account. I actually laughed at the agent on the phone and asked for a supervisor. I relayed the story of my weekend to the supervisor. She says that I need a new prescription since the other one was voided so I could pick-up at Walgreens. Also, I would need to fill this month at Walgreens (so 2 prescriptions) since they have a paid claim. She also said that until the balance is paid, I’m going to have the same problem I had last week when I request her refills. I thanked her for her time and hung up. I immediately called Colleen and asked her to pretty please handle this for me as I was at the end of my rope. Colleen has a lot experience dealing with Accredo since by her own admission, she’s on the phone with them for these kind of problems at least once a week. She says a large part of her day is spent on the phone with people like this fighting unnecessary battles. She also hates Accredo. A couple hours later, I get a call back from her. She insulted the pharmacist and threatened to hold a supervisor personally responsible for anything that may happen to Zoe as a result of going without her medication, but the problem is solved. No refill at Walgreens. No 4-6 weeks to verify the secondary insurance. No account hold and no balance. I was to call by 2 pm to schedule delivery. I don’t have the medication in my hand so I’m not breathing a sigh of relief just yet. I call at 2 pm as instructed and am told they’re still working on it. I am to expect a call back by the end of the day. Just before 4:30 I receive a phone call from Ruth Ann at Accredo. Ruth Ann is on a team that handles transplant patient accounts. She is now my own personal Accredo person. All refills and issues go straight to her. If anyone else from Accredo calls me, I’m to direct them to Ruth Ann. I even have her direct phone number. The secondary insurance is verified. All balance amounts have been credited back to the account and she said she cringed reading all the notes in Zoe’s account. The only bad news she had for me was that the insurance wouldn’t let them fill the medication until Tuesday morning. She said I would receive a call first thing in the morning to set up overnight delivery of Zoe’s medicine.

Today: I did receive that phone call. The refill went off without a hitch. There was no mention of holds, or balances. We should have medication on our doorstep tomorrow afternoon. So help me…..if I don’t see a UPS box from Accredo when I get home from work tomorrow, I WILL drive there and I WILL burn the place to the ground.