Insurance Problem - Enbrel Coverage
I have been on Enbrel about one month with wonderful clearing. Shortly after Christmas I called to reorder the Enbrel and was told by Advanced Care Specialty (Name just changed to Caremark) that I would have to wait till 12/28 to order. On 12/28 I was told I had to wait till 1/3 to order. On 1/3 I was told to wait till 1/4. On my first call on 1/4 (today) I was told that my percription was with the pharmacist and he was trying to get it for 3 months supply! Wonderful - I was so excited. They said call back in 2 hours. I did and then I was told it was still with pharmacist and to call again in 2 hours. I did and then I was told that there was a mistake and that my plan would only cover 12 injections in 84 days. Did I have any to return to them because they sent me too much! I said no and my script was written for 4 months of 50 mg 2 X a week. They said no - call your dr. I did and of course he was out. The insurance secretary said she would call and see what she could do. She called back and said they want to speak to dr. He will call tomorrow. OK whats one more day. 10 mins later she called back and said Caremark changed their mind and I should call this new phone number to arrange shipping. I called the new special number and the same lady answered and told me I was not approved - but while I was debating this with her - I was all of a sudden approved on her computer. Anyway I should have Enbrel tomorrow (depending on the snow storm) and have only missed 2 shots. Does this crap happen every month? No wonder I'm itching tonight. How does it work with most people on Enbrel? I have Empire Blue Cross - Blue Shield but when I call the number on the back of the card - Wha la - the same lady at Caremark answers! She's tired of hearing from me.
Thanks for any info. I don't what to have this again Feb. 1st!
Debbie

Answers:
I use Caremark too, and get Enbrel from them. They just screwed up my script which I'll fix soon enough (they have me set up for 25mg 2x a week instead of 50 2x a week).
Do you call the NJ location for your refills? If so, they should be giving you a specific contact and # to call for your refills. I'll pm you the person's info that I talk to (I had it in here but probably shouldn't be listing her info for all to see). She is a pharmacist at their specialty pharmacy for stuff like Enbrel.
The best thing to do with Caremark that I've found is to get a script and mail it in. Make sure it specifies 50mg, 2x a week and have your doctor write down the total # of packages that they should be sending you for a 90 day supply, ie. Enbrel, 50mg, 2x a week, for 90 days = 6 boxes. Otherwise they misinterpret the script and send you something else. I had the same type of problem with cyclosporine. The script read 100mg, 4x a day and they send me 25mg, taken 4x a day to EQUAL 100mg. Must be nice to be able to freely interpret scripts to whatever makes sense to you!
Hope this babbling helps.
-Steve

Answers:
Wow that is crazy, but I guess all is well that ends well.
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