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» LymeNet Flash » Questions and Discussion » Medical Questions » Medco not covering Bicillin now!! HELP!!

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Author Topic: Medco not covering Bicillin now!! HELP!!
skrwolf
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I have been on Bicillin for over 3 months now. The first month - one 1.2 mu shot per week. The second month - two shots per week and then the third month, three shots per week. My insurance (Medco) has covered the shots except for my $80 co-pay until tonight. I went to pick up another month's supply and Walmart said that my co-pay was the full amount (which was over $500). They tried running it at different quantities - no go.

I came home and logged into my Medco account online and it says "not covered" under my coverage notes. What the heck??? On Sept 3rd, I had Walmart fill the prescription and it was the $80 copay. I didn't have the money for another 10 days, so they put it back on the shelf. Now when I had it filled again... Yikes!!

Anyone have any experience with Medco and Bicillin? My health insurance policy says it does cover injectables at 70%. Would it maybe be covered under this benefit now?

HELP!!! If I can't get the insurance to pay, I'll probably have to get it from Mexico. I'm an RN, so mixing and injecting is no big deal.

Thanks!

Posts: 292 | From UT | Registered: Aug 2001  |  IP: Logged | Report this post to a Moderator
Allie
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I have medco through United Health Care. You are correct, it is not covered to get at a pharmacy. Fortunately for me I also have BCBS with a different formulary, which covers it.

This is what I suggest. I think you can probably get it covered if you get it at a doctors office. You probably inject yourself (as most of us do) and can't handle the inconvenience of going to a MD each time you need a shot.

But, maybe your LLMD can get it shipped there and you can pick it up from him/her????

Call Medco (which is a horrific experience with their phone web) and see HOW it is covered. Something tells me that there might be a way.

Maybe others here have navigated the web. But don't despair yet.

The pharmacists probably can't help, because they probably don't see lists for other ways to get drugs.

Best of luck.

Don't give up yet.

Allie

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lou
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Medco acts as an agent for your insurance company. The ins co makes these decisions, not Medco. So, if there has been a change, the finger to point at is ins co. Check their formulary, which might be online.

I have been hearing that other ins cos are stopping meds used for lyme too. And when asked why, they point to the IDSA guidelines.

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skrwolf
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Thanks for the suggestions... Anyone else?
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Doomer
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Most injectable meds including IM Bicillin are covered under a MEDICAL BENEFIT not a pharmacy benefit.

Call Medco and speak to someone in specialty pharmacy regarding the Bicillin being covered under a medical benefit. You may have to talk with several people before you get someone who knows what is going on. Insist on them checking if it is covered under a medical benefit NOT a pharmacy benefit. You may also call the Medco mail order to check coverage status.

Call your plan and ask why it was covered and now it is not. If it is covered under a medical benefit you will get it shipped to you.

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skrwolf
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Well, I talked to Medco and they said that the decision not to cover came from my health insurance company. So I called them and they said that it's no longer covered. I told them that I just picked it up 6 weeks ago and it was... She said that it may have been a change in formulary. Hmmm... A little coincidental. I further questioned her and she said that she would talk to someone in internal pharmacy and call me back. Otherwise, I will have to submit an appeal w/medical records.

Crap - is it worth that? My sister is going down to Tijuana today to look for it for me. Has anyone gotten it from Mexico?

Shelly :-)

Posts: 292 | From UT | Registered: Aug 2001  |  IP: Logged | Report this post to a Moderator
   

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