So you may or may not know that I’ve been in specialty pharmacy pre-authorization hell for the last few days trying to get my Ampyra refilled longer term. It’s not gone well. I’m down to five days worth of pills. Still no approval.
I have a business trip next week for which it would be most helpful to be able to walk. It’s longer than 5 days away. I’m kind of in a bind.
One of my smart friends suggested I reach out to the Ampyra people directly to see if they had any way of sending me samples (or something) while I try to wade through insurance hell. So after being on hold today with CVS/Caremark (aka the seventh pit of hell) for exactly 58 minutes, I decided it was worth a shot.
Guess what? They can’t help me with samples. I couldn’t be that lucky. But the very helpful woman from Ampyra wanted to know why I wasn’t in their system. This confused me. I explained I wasn’t aware that I was supposed to be in their “system.”
She then very clearly and helpfully explained to me that when a new patient starts Ampyra the doctor’s office is supposed to send a form to the company to enroll me in their program.
The program gives new patients a free 60 day supply (which makes a ton of sense since this drug doesn’t work for everyone). While you’re enjoying your free 60 day trial, the drug company handles setting you up with a long term script with your specialty pharmacy. In other words, they do the work. You try the drug. If it works, at the end of 60 days you’re all set with a year long refill system on their patient assistance program.
“Oh!” I say. “Well that probably explains it then. I probably make too much money to qualify for any patient assistance programs. I pay $250 out of pocket for the 30 day supply.”
Ampyra Rep says,”Do you have private insurance through your employer?”
“Yes I do, which is why I’m currently stuck in CVS/Caremark pre-authorization hell,” I say.
“It doesn’t matter how much you make, honey. You qualify. We need your doctor’s office to fill out a form they can get on our web site. Once that’s done, we do the work. Your co-pay will be $40 for a 30 day supply. For as long as you take the drug.”
“I’m sorry, what?” I say.
“You qualify for patient assistance. Get them to fill out the form and get it to us. We’ll take it from there,” she says. She is super duper nice and very helpful.
“Wait. So you’re telling me I could have had 60 days for free? So $500 (to me) worth of medication and then YOU would have handled this whole mess for me? For the refill for the drug that I still DON’T HAVE?!” I’m trying at this point to modulate the tone of my voice. “Um, can I just get in that program now?”
“I’m so sorry. You’re not a new patient anymore. But you still qualify for the assistance program. Just have your doctor’s office send in the form today. It will take ten minutes tops, I promise,” the helpful Ampyra representative says to me.
So who do I have to call? Freaking Nurse Bane of My Existence Carol. She’s far too busy to help me. She will let me know when she has time to send in the form. It’s the end of her day after all.
Let me recap.
I could have had 60 days free (thus saving myself $500 dollars out of pocket) if Nurse Carol had done this the right way. I would have had no lapse in medication because I’d have pills to take for 60 days – while the company works out the details for the long term with the insurance and specialty pharmacy.
“Honey, that’s why we have this program. Your doctor should have told you about this. We know how hard it is to get your authorization approved so we give you 60 days free.”