nrp
08-31-2011, 01:31 PM
I have been in a battle with my pharmacy coverage. For my first two pregnancies (also with Caremark, but a different employer), I was instructed by my OB to go downstairs to the pharmacy in the building (Walgreens) to pick up the Rhogam shot, then I took it back upstairs and they administered it. I did that this last time, although Walgreens said that there was an issue and that I would need to file a paper claim (but didn't suggest that I wouldn't ultimately be reimbursed, although of course, I guess how would they know). Anyway, I filed the paper claim and it was denied. After endless calls, the answer I get is that Rhogam is only filled through their "specialty pharmacy", which meant that I would have had to pre-order it four days before the appointment and have it mailed to me, refrigerated, then I would have had to take a cooler to my OB with the shot to have them give it. This seems crazy to me.
To add to the crazy, when I asked what would happen when/if I needed it after my delivery, the woman at Caremark said the same process. So, to clarify, I said "so... I am supposed to call you four days before I go into labor to order this syringe and then remember to take it to the hospital with me and somehow keep it refrigerated until after I give birth and then have them administer it??" She said that was right. I told her I'd be glad to do so when they sent me a crystal ball and some ice packs, and she didn't find it funny. Ultimately, I spoke to someone else who said that when I'm admitted to the hospital my regular medical coverage kicks in and that it shouldn't be a problem. I hope that guy was right.
Honestly, at this point I'm ready to eat my $128, but this seems a very strange process to me, for a very standard drug. Anyone else have the same experience?
To add to the crazy, when I asked what would happen when/if I needed it after my delivery, the woman at Caremark said the same process. So, to clarify, I said "so... I am supposed to call you four days before I go into labor to order this syringe and then remember to take it to the hospital with me and somehow keep it refrigerated until after I give birth and then have them administer it??" She said that was right. I told her I'd be glad to do so when they sent me a crystal ball and some ice packs, and she didn't find it funny. Ultimately, I spoke to someone else who said that when I'm admitted to the hospital my regular medical coverage kicks in and that it shouldn't be a problem. I hope that guy was right.
Honestly, at this point I'm ready to eat my $128, but this seems a very strange process to me, for a very standard drug. Anyone else have the same experience?