PharmCountry

Sarafem is the biggest rip-off I’ve ever seen. We had a patient bring in a script for Sarafem 20mg, 1 capsule daily, for a 3 month supply. Of course, we didn’t have it, so I told here we would have to order it.

What I knew about Sarafem was limited; I knew it was for postpartum depression, and that it was essentially an antidepressant. What I didn’t know was that it’s the exact same thing as Prozac (fluoxetine), which is available as a generic for literally 1/10 the copay (for this patient anyway.) The patient’s copay for 3 months of Sarafem is $120 whereas her copay on 3 months of fluoxetine is $12.

On the other side of things, we got a promotional fax (which I usually throw away) for Neupro, the new Parkinson’s patch. We have one patient (Mrs. Nicelady, if you’ve been reading this blog for a while) who can only afford her Parkinson’s meds during the catastrophic coverage of her medicare plan, which is usually just the last 2 months or so of the year. So, I priced Neupro for her, and even during the coverage gap, it’s under $100 a month for the lowest strength, which is much less than her normal $600 a month. Plus, since it’s new, her doctor can get a ton of samples to give her when she can’t afford it.

It’s nice to see a new drug that doesn’t cost an arm and a leg (relatively speaking, of course.)

I usually love processing claims for Caremark. (About 20-25% of our claims are processed through them, thanks to the number of Federal government employees and State Medicaid beneficiaries we serve.)

They have easy to remember override codes for Vacation and Dosage Increase rejections, and if that doesn’t resolve the issue, they have a very easy to use voice activated IVR system.

I don’t love them so much when their computers go down. I was working a rare Saturday today, but nearly 20% of our prescriptions could not be processed because Caremark was down. About 12:30 I called and was told that they expected their systems to be up in about 2 hours.

At 2:30, I tried again and still no go. At 4:00, I called again and was told that they didn’t expect the systems to come back up until at least tomorrow (my emphasis on “at least”). I can only hope they come up by Monday, or we’re going to be in trouble.

I already hate UHC because they manage my insurance (which is why my Advair script is $140 a month, and why I don’t take it anymore). Now, I have a new reason to hate them:

Last week on Thursday, we had a patient, (call her Ms. Goodman) call in her prescription for zonisamide #150 capsules. Of course, we didn’t have enough, so I asked her if she’d be willing to wait until Friday to pick it up. She was fine with it, so I processed the script and placed it on order.

When it came in, though, our supplier had switched us to a different manufacturer, so I had to back out the script, and rebill it for the corrected NDC.

A week rolls by, and we get a call from a frantic Ms. Goodman because she got a letter from UHC stating that we had billed them twice for the same medication, and if she actually got two fills, she owed them $139.

So, I called Medco, the company that processes prescriptions for UHC, where the nice Indian lady, after saying “Thank you for patiently waiting,” confirmed that the first claim was reversed.

So, I called UHC itself to see what was going on, and all they could tell me was that I had to call Medco.

So I hung up and called the patient to tell her what was going on. She told me she had called UHC and they told her that their system showed two claims.

Well, I called UHC again, and finally got someone to confirm that, but they told me I had to call Medco to have them retransmit the reversal. At this point I was ready to pull my hair out.

So, I called Medco again, and all I could get them to do was “document” the situation in their system, because “UHC should be able to see it in their system if I can see it in mine.” But he told me he would see if he could get someone to fix it.

I was at least able to get the rep’s name (Richard, if I were to actually believe him) and ID number, which I then gave to Ms. Goodman. She thanked me for everything I did, but I’m afraid it wasn’t enough.