[Gabyunbound]

I've been trying to get Vraylar (my pdoc says it's an antipsychotic, but a study says it helps with depression) for weeks now. I'm very depressed and I just can't get my hands on it.

First, CVS was sending the paperwork for the pre-authorization to the wrong fax number, then it took a while for my pdocs' medical assistant to fill it out, and then, yesterday, CVS said that my insurance says I have to get the med from a special mail order pharmacy, that it's my insurance's preferred pharmacy (even though I've always gotten my meds at CVS).

So I called the mail order pharmacy (Acaria Health) and they had my name and address but not my insurance details. Gave that to them and they said they would submit the paperwork for approval (seriously??) and then send it to me by mail if it's approved.

Meanwhile, I got a call from my pdoc's assistant saying that it had been approved and could be picked up (obviously not).

Has anyone's insurance plan forced them to use a particular pharmacy, mail order or otherwise, and do you know why?

I'm done with this. On my days off, I just take lots of Seroquel to make the day end and then sleep for some 15 hours. One day melts into another, but at least I'm not awake with this deep dread of depression.

Thanks.

[rwwff]

For something as expensive as Vraylar, I think that's pretty common. They want to keep their thumb on something that runs a grand+ a month.

[Rjaye]

The reason insurance companies require people to use certain pharmacies is because they have a contract with them to get the drugs cheaper. They've negotiated a payment deal. It's the same reason insurance companies have in plan docs and medical services-a contract to get services cheaper.

Sometimes the online pharmacies work out well, but it's a pain. I'd call the CVS and see if somehow it was approved and it's sitting there, but if not, call your pdoc's office and explain your issue. See if they can get the approval to them right away. It's a hassle but once it's done, you don't have to deal with it.

It is a hassle. I've gone through this more times than I like. I just had to do it again in January, but I have done this enough that I know who to call. But, man, it's irritating.

[Gabyunbound]

Originally Posted by Rjaye

The reason insurance companies require people to use certain pharmacies is because they have a contract with them to get the drugs cheaper. They've negotiated a payment deal. It's the same reason insurance companies have in plan docs and medical services-a contract to get services cheaper.

Sometimes the online pharmacies work out well, but it's a pain. I'd call the CVS and see if somehow it was approved and it's sitting there, but if not, call your pdoc's office and explain your issue. See if they can get the approval to them right away. It's a hassle but once it's done, you don't have to deal with it.

It is a hassle. I've gone through this more times than I like. I just had to do it again in January, but I have done this enough that I know who to call. But, man, it's irritating.

I'll call CVS again just in case. Thanks for the information!

[scatterbrained04]

My insurance auto-enrolls me in a mail order pharmacy where I can only get 2 fills per year at another pharmacy. This is for regular meds. I was able to call my insurance company and opt out.

[~Christina]

My dermatologist and I had to jump through enormous hoops to get my Otezla approved, one told me the company would mail directly to me then a pharmacy kept calling , meanwhile my dermatologist was able to keep me in samples until everything got sorted. All in all I think it took almost 4 weeks.

I am sorry your having to go through all this , can your Pdoc give you samples to get you started ?

[*Laurie*]

Yes, I have been with a certain provider in the past that forced me to use only a certain pharmacy. Like others have posted, it's about contracts...money.

I've got no choice but to use CVS...so...I do.

Skipping the vulgar part...

We are the hoop hoppers. Joy...

[ComicWisdom]

Your pharmacy vendor is probably Caremark. They own CVS. Just guessing, but you medical insurance only processes medical (doctor, hospital, physical therapy, etc.) claims. They have a company like Caremark to process the pharmacy claims.

RJaye is correct, the insurance company works a contractual deal with Caremark/CVS to pay less for a major portion of your prescriptions. The idea being if the insurance company saves money, they don't have to increase your premiums.

There's also a cost savings when the vendor (Caremark) just happens to own the pharmacy where you need do business.

It's my understanding that you may be able to use a pharmacy other than CVS, but you may pay more out of pocket.

[Naynay99]

Hey. My insurance requires me to do mail order thru an online specialty pharmacy for 2 of my rarer and costlier non-psych meds. I used to use cvs Caremark and now use Walgreens specialty. It can be convenient until they fxck up and u don't get ur meds on time and can't just go to a 24 hr rx and pick them up.
My advice is to always refill 2+ weeks early, so if they screw up u don't run out of meds. Good luck

This is not unusual. It was mentioned above how insurance companies enter into contracts with pharmacies.

Another reason is that some pharmacies will prescribe enough medication to last for longer periods of time. For example I was stuck using a pharmacy I hated because they filled prescriptions for 90days at a time instead of refilling it 3 times at 30 day increments. By doing it this way the insurance company is paying for only one filling fee instead of three.

[Gabyunbound]

Originally Posted by ~Christina

My dermatologist and I had to jump through enormous hoops to get my Otezla approved, one told me the company would mail directly to me then a pharmacy kept calling , meanwhile my dermatologist was able to keep me in samples until everything got sorted. All in all I think it took almost 4 weeks.

I am sorry your having to go through all this , can your Pdoc give you samples to get you started ?

That's a good idea, though I don't see her for a couple of weeks. If I still don't have it by then I'll definitely ask her for samples.

[Gabyunbound]

Originally Posted by ComicWisdom

Your pharmacy vendor is probably Caremark. They own CVS. Just guessing, but you medical insurance only processes medical (doctor, hospital, physical therapy, etc.) claims. They have a company like Caremark to process the pharmacy claims.

RJaye is correct, the insurance company works a contractual deal with Caremark/CVS to pay less for a major portion of your prescriptions. The idea being if the insurance company saves money, they don't have to increase your premiums.

There's also a cost savings when the vendor (Caremark) just happens to own the pharmacy where you need do business.

It's my understanding that you may be able to use a pharmacy other than CVS, but you may pay more out of pocket.

The weird thing is that I've always used CVS, but for this particular med -Vraylar- my insurance is saying I have to use a different one, the mail order pharmacy Acaria Health. Who knows though, maybe CVS owns it...