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ShrnHml
Guest
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Posted: Fri Dec 21st, 2007 06:44 |
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Medicare Part D Benicar alert:
Unicare no longer provides Benicar at the doses needed. Try Aetna or call the Medicare 800 number to find companies that will provide. If computer savvy and not brain-fogged, try the Medicare website for companies that have no limitations on Benicar.
1-800-MEDICARE
http://www.medicare.gov
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Neuroborreliosis, MP 3/05, 1,25D 62; 3/06 25D<4, ModPh2 12/05, Premarin, Effexor, stopped Benicar 1/07....no longer in study
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rebeckah
Member in Phase 2
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Posted: Wed Jan 9th, 2008 21:21 |
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I had Community Care Rx and they require step therapy (trying different drugs first). I got sent a letter after they refused coverage of Beni saying I could "send a written appeal to the following address". So, I sent a rewrite of the letter found here signed by my DR, and a personal letter from me. I phoned a month later, they couldn't find my letters. I tried the whole scenario again in December but sent it delivery confirmation this time. They said since they took more than a week to decide my case, they forwarded it to Maximus who is an independant medicare insurance coverage reviewer thingey-do.
While on the phone, the CCRx agent said I had to fill out a form requesting a formulary exception. That's not what my denial letter said I had to do. HAD I known and filled out the forms, and got the other drugs filled (but not taken), I may have gotten coverage for Beni in the end. You really need to know what to do to get an exception from your provider. Call them. Talk to different reps to verify. But who needs the aggro? I'm switching carriers. I moved almost 2 years ago & only this month did CCRx send me an updated card (new numbers), yet they're still using my old address. I phoned my new address to them before I even moved here. I am unimpressed with them.
Maximus denied it because Benicar hasn't been "used for a medically accepted indication". IOW: it's not on the FDA books that Beni is used to treat sarc.
I've used the Medicare website ins. helper thing and found it very easy & helpfull. I also called medicare directly and went through the same process with them & asked more questions etc. Trying to double check things. I must've got a new hire, she didn't know what she was doing.
Also, if you're "dual eligible" meaning you have both medicare and medicaid, then you can change insurance providers at "any time". Yet, on some insurance websites I've seen dual eligibles may only switch from Nov-March 31st. So, check individual provider websites to be sure.
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Sarcoidosis/lungs dx 1991 aspergellis dx '07 125D39 25D8 Ph1 Jan08 Ph2 May08 oxygen 24/7 famotidine lo lux home NoIRs limited outings covered up
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ShrnHml
Guest
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Posted: Wed Jan 9th, 2008 22:00 |
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I went through the Maximus process too and was also denied. I do not believe they are "independent" of the drug companies, especially with the current administration favoring the drug companies.
Also, even if the Medicare website says there are no restrictions on Benicar for a certain company, that is no guarantee I found. I wonder if there is a way to call the company and get it in writing before joining or if that would just call attention to it.
Because I am dual eligible, I have been able to make changes at will and am now on my fourth company. Unicare was the only one that actually paid, but now they have cancelled the plan I was on. That's why I went to Aetna.
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Neuroborreliosis, MP 3/05, 1,25D 62; 3/06 25D<4, ModPh2 12/05, Premarin, Effexor, stopped Benicar 1/07....no longer in study
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rebeckah
Member in Phase 2
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Posted: Sat Jan 12th, 2008 00:23 |
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Twice I called the insurance company I want to switch to & got confirmation that there are no restrictions to Benicar coverage. I also checked through the medicare website as well as the insurance company's online formulary. All said no restrictions. So I should be ok now. It's good to be thorough.
I also found out that medicaid tells you what your copays will be per script. It's written on the medicaid acceptance letter. Mine was in very small print at the bottom. The insurance compnay has no idea what each persons copay is.
Switching companies was very quick and easy. The customer service of my new company (Silver Script) FAR exceeds what I was getting at CCRx too. & that matters to me as well. But wow. four times is alot to change companies. It's good to know you were able to do that without a penalty. I think the rep said we can only change providers once a month.
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Sarcoidosis/lungs dx 1991 aspergellis dx '07 125D39 25D8 Ph1 Jan08 Ph2 May08 oxygen 24/7 famotidine lo lux home NoIRs limited outings covered up
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ShrnHml
Guest
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Posted: Sun Jan 13th, 2008 03:11 |
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missrebeckah....keep us informed about how well SilverScript does. I used them two years ago, and here is what I posted about it on January 3, 2006:
...........I spent the whole day going back and forth between home (phoning company) and the pharmacy trying to get my Benicar script filled. The plan I chose is because they are a Caremark company, and I have read reports here that Ben was easier to obtain through them (in the quantity we need) than through Medco, United, and others.
I had done a thorough computer search and comparison of all the companies available to me and felt good about my choice. However, the script would not go through on the pharmacy computer. I came home, called Silverscript, and was told that Ben is not covered on the plain vanilla plan which I have.....just on Silverscript PLUS. However the computer formulary for Silverscrpt says that it is covered on BOTH plans.......
Sharon
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Neuroborreliosis, MP 3/05, 1,25D 62; 3/06 25D<4, ModPh2 12/05, Premarin, Effexor, stopped Benicar 1/07....no longer in study
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ShrnHml
Guest
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Posted: Thu Feb 14th, 2008 04:33 |
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My experience with Aetna has been disillusioning. This is the most intrusive company I have tried yet. I believe they have implemented a new "control" policy on every medication and are no longer operating as as before.
If you want to know more, please PM me. ........Sharon
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Neuroborreliosis, MP 3/05, 1,25D 62; 3/06 25D<4, ModPh2 12/05, Premarin, Effexor, stopped Benicar 1/07....no longer in study
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Meg Mangin R.N.
Research Team (on leave)
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Posted: Wed Oct 15th, 2008 20:28 |
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Jillian writes:
I must tell you that as much as I appreciate that Medicare now has drug coverage, I dread this time of year as I must double-check each year that the insurance company I choose has UNLIMITED coverage for Benicar. So far, my room-mate, also on the MP, and I have done okay and not had any problems. She is dual eligible (Medicare/Medicaid), I am not.
As Sharon posted on Oct 4th, go to Medicare.gov and do a personalized search. I've just gone there and although sign up doesn't begin until November 15th, you can start searching for a policy using the Formulary Finder. Once you've entered your drug infomration into the Formulary Finder, Medicare will give you a list of possible policies. You must go one by one through the list (by clicking on the name of the plan) to see if they offer unlimited Benicar. How do you know that?, see below. The policy I've had for the past two years is no longer available. Each year there are fewer and fewer policies with unlimited Benicar, and many of these have the higher premiums... This year, for me, there are ONLY 3 different companies offering 5 plans that initially come up with no limits on Benicar! I'm preparing that by next year none will be available and I'll have to fight for coverage, which I'm not sure my doc will do!
IMO, very important things to consider about the list the the Formulary Finder will give you:
- You most probably want a PDP Plan Type (Precription Drug Plan). The MAPD is a managed care plan that's like a HMO.
- You must be sure that the plan lists NO in any of the plan limitations/restrictions (Prior Authorization, Quantity Limits, Step Therapy).
- Then, once the information is available (not yet, too early), you'll need to dig more to find out what that specific policy covers, i.e., the cost of monthly premium, the deductible, the co-pay, how do they handle the coverage gap, etc. I've done that in the past by going to the insurance company's website and printing out their formulary to double-check the status of Benicar. I would imagine this earliest this information will be available is November 15th, when we can sign up for a policy.
'til later,
Jillian from North Dakota
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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