Steve,
It’s a weird situation, Employer got on the phone with Caremark yesterday and verified I can fill that prescription and they would cover it. They even called the pharmacy and were told all they were waiting for was my Dr to verify the prescriptions. They claimed their phones were down for 24 hours.
Now today the Drs office let me know that CVS would not under any circumstances accept me as a customer because of my high dose.
So the insurance carrier Caremark will cover the dose but CVS will not fill it.
Now I have to pharmacy shop to find one that will fill my prescriptions. In the mean time I can’t go to work because of the pain and getting sick from withdrawals.
I have been exchanging emails with this pts for months and has been put thru the ringer by various healthcare providers. This pt needs a high dose of opiates due to a accident 2-3 decades ago and taking this high dose enabled this pt to engage in a highly technical job on a full time basis and generating a income way above the average.
This pt has seems be entangled in the new CDC guidelines and pain specialists who are exempt from such guidelines but are still functioning under the premise that they are not and targeting this pt to being weaned down to the 90 MME’s limits.
It will be interesting if this pt is forced to go on disability, if an attorney will be able to see the “substantial financial damage” that is being caused and willing to take on a case on a contingency basis ?
Filed under: General Problems
Jan,per your note of !-23-19,is the agent you are referring to with Optum?May or may not know the person you are speaking of,but PLEASE allow me to have a way to contact.My mail is aalligood204@gmail.com or privately phone 407 701 0565/.That’s about all I feel safe w/sharing online,no offense.Thank you in advance!May the Lord give you and all who suffer His Grace and Peace!
Yes,OptumRX has come thru for me,but mostly I believe they see the arsenal of money headed their way due to the moronic dead end deals of the other’pharmacies'[those guys should be called cosmetics and hair color outlets since thats about all theyll sell to you w/o a life history]I am terrified Optum may be blackballed by the feds someday,even tho they have followed the new laws to the letter.God help this country if that day ever comes!!!I believe the public will snap back so fiercely it will make the riots in Watts.CA.look like a Sunday picnic.Not to mentionholdups,suicides and the like.I opt for the latter…..Passing note-perhaps Jay Sekalow of the ACLJ]American Ctr.Law Justice[can bring it in the spotlite.He doesnt care if its “p.correct”or not.And remember,publicity is the best justice for revenge!!!With all the problems,Optum’s performance level is extremelyGOOD right now![Thank you Optum,for preventing at least one suicide-my own!!]As far as the ‘bottom of the toilet bowl’I have attempted legit business at EVERY SINGLE of the lg.ones[Wall’ys,CVS,W-martevery mom and pop shop on the map.This covers ENTIRELY Orange,Lake,and Marion Counties in Fla.Homeless people get better treatment!!With all due respect,many Publix stores tried desperately to help,even calling their other locales searching.At least,when I looked in their eyes,I knew they werent lying,they just simply are on an allowance.I’m sure that wasnt their idea!Big Kudos to Optum RX and Publix!Let’s keep praying until compassion prevails.And to the ‘stiff -necked fools’that passed these ruthless laws,may you and your children inherit incurable cancers and 3rd degree burns.JESUS,forgive me that vindictive emotion in advance.AMEN
This is why I use a small pharmacy with people who know me and understand what’s happening federally. It’s why I got away from the big box pharmacies. I’d been with Sam’s Club for several years and when I transferred my prescriptions to a small pharmacy, the pharmacist from Sam’s called and wanted to know what was wrong, why I was leaving, begged me to come back, blah blah blah, etc. This was ~3-4 years ago when I could see the writing on the wall, and I could foresee these problems coming. That, and the fact that the small pharmacy delivers too. That helps a lot because after my pain dr cut my dose by 50% (even though he didn’t want to), I’m often in too much pain to even drive to the pharmacy (ironic how some idiots think anyone taking opioids for pain is a danger on the road, yet don’t understand severe pain is far more impairing). I recommend everybody get away from these big box pharmacies, especially chronic pain patients. Even if you know and like the pharmacist(s) at your local large corporate pharmacy, they’re still going to be constrained by the insanity of the rules and corporate thinking of the place they work for. I like it when people can actually see my face and can see me as a real person rather than just some number.
I have taken all my medications away from the big chains. Walmart denied my chronic pain medication prescriptions so they get none from me and my family anymore. These box store pharmacies think they are doing good, but they are just making sick people manage even more hurdles. It’s bad enough we are required to get ourselves to a pain management doctor once a month, provide urine samples whenever asked, not allowed to change pharmacies without asking, let alone the pharmacies refusing to fill a prescription we obviously need. Even when you have a good pharmacy, the insurance requires a prior authorization from the doctor in order to pay for it. The script signed by your doctor isn’t enough anymore. It’s completely ridiculous and assinine the hoops we have to jump through all the while being sick and hurting. Something needs to change.
I also got denied by my local CVS! It’s ridiculous how they treat us, the chronic pts!! These chains are telling us we’re a one size fits all category! I guess they’ve never been in excruciating pain,, Daily!
This is outrageous! I left CVS many years ago for how they treated me! I am now with a small pharmacy in my medical complex and have never had a problem. thanks
This is exactly what my husband went thru with Caremark..he has worked as a craftsman at a well known food manufacturing company for 18yrs.he had been on same high dose for 10yrs.i finally called his employer and they stopped Caremark from putting any limits on his meds.thank God his pharmacy rite aid that he has been with for 10yrs have never given him any problems filling.its was a 3 month battle with forced tapers and time off work, had to give a car back and more.i pray that attorneys will step up in these cases cause this is huge injustice
I can’t give advice, but Andrew made an interesting point. I’m on Medicare and have United Healthcare who use Optum RX. Andrew is correct when he says these agents give all kinds of conflicting answers. Most of them are new, don’t read, are lazy and have given me grief every time I call. My Dr. says ” It’s a whirling wheel of confusion and despair!”
However,. God gave me an agent who knows EVERYTHING THERE IS TO KNOW about their rules and regulations esp. if you are taking Opioids. She should run the company! She told me that when I called to tell the agent answering to email her along with my member ID number and tell her it’s urgent for her to call back.” She’s faithful to do this every time, and now she monitors me, and whenever I have a problem, like my opioid script is being rejected, etc.shes the only one who can fix it! She knows more than the Supervisors!
Steve, if you think this patient, needs her name for help, I would be happy to give it to them, or anyone else who might need her.
Maybe you or she can advise me. I’m am intractable pain pt and palliative care. My doctor of 11Yrs is in CA and I am now in north GA. IMPOSSIBLE to find a doctor locally. Until last year my high dose pain meds were shipped that pharmacy will no longer ship I have been flying to CA every month to pick up meds and it’s become too hard as I stay in a pain flare from the travel and can’t do it anymore financially or physically I tried optima rx was refused.. Reason I live to far from my doctor. For that reason I switched to humana and vetted them thoroughly about my ability to get meds shipped even spoke to their pharmacist who assured me I wouldn’t have a problem. Yesterday humana mail order refused me and gave me no reason. I asked for a reason in writing that refused. They don’t refuse payment or deny need just refuse to provide mail order svc to me. They wouldn’t even contact my doctor to see if the meds were needed just arbitrarily refuse to fill them even though they do feel the same meds for other people. I told them it was discrimination of course that didn’t get me anywhere. I am at my wit’s end. I am going to go into withdrawal without my meds and will be in severe pain. I’ve already lost to 98 lb from severe pain withdrawal and medical complications while trying to get scripts filled last year. I do have a pharmacy in California but as I said I have to fly 2000 miles and a 12-hour trip to pick up meds. Can you help or does anyone have any suggestions. God bless you all!
I’m addition I’ve been on these meds for 23 hrs following spinal cord injury plus have complex multiple medical issues and have a unblemished medical legal and pharmacy record. Always completely compliant. Thanks a million. 1415travis@gmail.com pharmacies I’ve tried on GA tell me they can’t fill out of state schedule 2 but I’ve checked with pharmacy boards and know that’s not true and also that CA and Putney pharmacies CAN legally ship. They refuse out of fear I believe.
Huh cvs owns Caremark something stinks
dont know who the person is,but I have had similiar problem.Only helpful advice to be offered is try mail order[OPTUM RX]these people give all kinds of conflicting answers,but it is only due to the hype and new laws.They have been mostly ok and will expidite for you[$12.50 extra]but worth it if you are sick!!almost always in 3-4 days.Maybe they can try that?
$#@!^%$ @@$