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Mail order prescriptions
Apr 3, 2012

Hi Doc,

So here is my story. I am currently on complera. I have insurance that is telling me that I can no longer get long-term medications from a retail pharmacy because it will not be covered. I spoke with a social worker and we called the insurance company and they stated that it will be covered as long as the prescription is for 90 days or 100 units, whichever is greater and enough refills for a year. So my doctor called in the prescription for 100 and enough refills for the year. When I first filled the prescription, the pharmacy only gave me 30 because they said that is all the insurance allows at once, even though the prescription is for 100. I have only 6 pills left and I called in for the refill and the pharmacy called me back saying the insurance is not covering it and I have to go through mail-order. This is so frustrating. I have been doing great. My cd4 is up from 420 27% to 612 33% and VL down from 38,000 to 275 as of jan 26. I am scared. What happens if I run out of medicine and do not have a refill? This is absolutely crazy. I feel like I'm just being taken for a ride from hell and its never-ending. I cannot have the medicine sent to my house because parents are nosy and do not know of my diagnosis. Do you have any suggestions?


Response from Mr. Chambers

You definitely should get back in touch with the insurance company, hopefully you have the name of whom you originally spoke with.

Some carriers are trying to force people on medications indefinitely, to get them through mail order as it is much cheaper for them. However, many will make exceptions as it appears yours may have done. It's entirely possible that the exception you were offered didn't make it into your file, or it could be possible the pharmacist knows the company's general policy and didn't confirm your exception.

Talk to the insurance company and take notes. Explain the situation and get help in resolving this.

By the way, if you are on an ADAP program that's an even stronger argument of why you need to use an in-state pharmacy rather than some national distributor.

Good luck, Jacques

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