Today medco called to tell us "Medco doesnt believe in long term antibiotoc therapy for Lyme"
I had a long talk with that pharmacist. I asked her how it is that people with long term viral infections like HIV can get antivirals, but people with long term bacterial or protozoal infections cannot get treatment for more than a month.
She of course blamed IDSA and their treatment guidelines, saying there is no research to support long term treatment, blah blah blah. I even quoted some research about the persistence of Lyme in animals
Boy, i did really fuss at her. It was sort of empowering to be able to argue back at her!
She did in the end tell me that if medco didnt fill the antibiotics prescriptions, we could try at our local pharmacy "if your local pharmacist is comfortable with the treatment plan"
Im just afraid a red flag is now raised by our names bc of this.
What do people do when insurance decides to stop covering the meds? Get a bunch of credit cards? Go the herbals route?
Posted by poppy (Member # 5355) on :
This has been going on for several years now. So, you are just one of many lyme people who have been stiffed by Medco. How they are getting away with this I don't know.
Do what their pharmacist suggested: go to your local pharmacy and fill the prescription. It will probably cost you more, but still just the copay. Of course for really expensive drugs, that could amount to a lot. And don't ask the local pharmacist what he thinks about the treatment plan!
Posted by nru (Member # 35247) on :
I did not know that a pharmacist could overrule a physician's judgement - might do to ask why they think that way.
Posted by Rene (Member # 4870) on :
Appeal!! You have the right to appeal any rejections by your insurance company. Unfortunately, someone will have to take the time to do this. We never lost when we appealed non payment from our insurance company, however, my husband spent many hours preparing.
Your insurance booklet should tell you how to start the appeal process. Good luck.
Posted by poppy (Member # 5355) on :
The problem is that this is a pharmacist, not the insurance company. Of course, it might be the insurer that is behind it. That affects the appeal right.
Use the Lymnenet search function wih keyword medco and read the posts in the archives.
I have personally wondered if it would be worthwhile for everyone who had this happen to file a complaint against the head pharmacist of Medco. Their HQ is in NJ, and the state medical board also oversees pharmacists. But there aren't many friendly medical boards, so this might not do anything useful.
The other possibility, or in addition to, if you feel like making gestures, is to file a complaint with the insurance commissioner in NJ. This assumes that the pharmacy benefits company is acting as an agent of the insurance company. Might not fly either, but sometimes it helps to make gestures anyway, as a way of coping. That is, after you make other arrangements to get your meds.
Don't name any lyme docs in any complaints or give out this info. Maybe run the complaint idea past your doc beforehand, in case he/she does not want the water agitated.
[ 02-21-2012, 01:15 PM: Message edited by: poppy ]
Posted by aperture (Member # 34822) on :
How did they know you had Lyme?
Posted by Tincup (Member # 5829) on :
Kick back!!! We have been dealing with the Medco idiots for a while now. You can fight and should.
Also mention the IDSA guidelines "expired" and have not been re-written to reflect new science. There are over 70 persistence articles- PROVING persistence.
You may also mention you have CHRONIC Lyme disease, not the IDSA version. The IDSA guidelines do not address treatment for CHRONIC Lyme, so in your case they are not a valid document.
Plus, the PATIENT has a choice on their treatment and you are following Dr. Burrxxx recommendations, not IDSA.
I would contact the insurance commissioner and the Attorney General also. They don't budget for handling complaints or do anything about them if they don't get LOTS of complaints.
Good luck!!!
It might even be fun to protest your pharmacy to call attention to it, especially in an area like NJ where Lyme is rampant.
Posted by kelmo (Member # 8797) on :
My daughter was just called by MEDCO and grilled for the reasons she has been taking medication for such a long time.
The matter will be brought before the MEDCO specialist and the board to decide if all the medication my daughter takes is needed.
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