PrEPpedForCum Posted January 25, 2015 Report Share Posted January 25, 2015 Anyone else have this medical + pharmacy insurance combination? Especially if you are on PrEP or taking any HIV meds. Company I work for switched everyone's health insurance carrier from Humana to UnitedHealthcare as of Jan. 1. Our prescription drugs are administered by OptumRx, which is a subsidiary. OptumRx has refused to cover refills for 3 prescription medications (all generics) I was on. Two of them I have been on for more than a year, and they want me to take something else. Both were covered when I was put on them without question by Cigna, which was our health insurer until Dec. 31, 2013. When we switched to Humana a year ago, a "prior authorization" paperwork from the doctor was required, then Humana covered them. Third one I've been on for several months, and OptumRx wants prior authorization because the off-label dosage was high, which Humana hadn't questioned. The worker at the doctor's office who handles prescription refills tells me the doctor signing off on the medications I've been on won't be enough this time, that I will need to try the medications the insurer approves first. So I want to get on Truvada soon, and now I'm worried that this insurer will not cover it because condoms are available. Anyone else run into this problem? Link to comment Share on other sites More sharing options...
JDD Posted January 25, 2015 Report Share Posted January 25, 2015 I HAD THIS HAPPEN WITH MY 3 MEDS. FOR SUGER. THE DR TRY TO GET THEM OK'D BUT NO LUCK. I WAS TOLD THAT SHOTS WAS CHEAPER AND THAT WAS WHAT I NEED TO DO EVEN IF I HAD TO GO TO A NEW DR. Link to comment Share on other sites More sharing options...
SIReast Posted January 25, 2015 Report Share Posted January 25, 2015 Optumrx is the pits. it;s useless sending 'prior-authorization' for rx's, it's never granted. just a waste of time. Link to comment Share on other sites More sharing options...
fillmyholeftl Posted January 25, 2015 Report Share Posted January 25, 2015 There have been class action lawsuits against UnitedHealthCare and their forcing Mail Order on "customers". I know specifically in California. I know people who have brought this up, while talking to Customer Service and had some success. Link to comment Share on other sites More sharing options...
lower_bucks_bottom Posted January 25, 2015 Report Share Posted January 25, 2015 (edited) The class action suit was successful. You just have to call them and use the magic word, "privacy" and they will authorize them through the pharmacy you specify. I have had similar problems with United for my cholesteral and allergy meds. At one point it suddenly dawned on them that I was taking Truvada and they sent me a letter saying they wanted my Dr to call them. I assume this was about PREP, but ehn they sent me another letter saying "never mind" when, I guess, they realized a was taking it as part of a cocktail for HIV rather then PREP. It also took them 6 months to decide to approve Triumeq. The only thing I can suggest is that you complain to HR everytime they give you a problem. To me they are just a bunch of scum sucking toads Edited January 25, 2015 by lower_bucks_bottom 1 Link to comment Share on other sites More sharing options...
pigpozdad Posted January 25, 2015 Report Share Posted January 25, 2015 This may be the problem: http://blogs.wsj.com/pharmalot/tag/express-scripts-optum-rx/ Optumrx doesnt fulfill 1 of my chemo prescriptions because ExpressScripts has to do it and with prior authorization. I believe Optumrx may be a division of Expresscripts, or have the same parent. Link to comment Share on other sites More sharing options...
Guest kazore Posted January 27, 2015 Report Share Posted January 27, 2015 I 've been on prep since september. I have United Healthcare and also have to go through Optumrx. It is ok, they usually send me the refill fedex UPS next day where I work. They accept the Gilead copay card. The only thing that annoys me is those letters they keeps sending me. It's written truvada HIV/AIDS everywhre. I'm just afraid one day they are going to send one of those letters to my my work address. Two times they sent me a letter to let me know that if I didn't feel confident to received my HIV medication through the mail I could choose a pharmacy of my choice. This to respect my privacy. The letter was 3 or 4 pages, with HIV/AIDS, TRUVADA, in bold capital letters written at least 15 times, everywhere!!! I won't be surprised if on the envelope next time they write in big letters " IMPORTANT NEWS ABOUT YOUR HIV/AIDS MEDICATION". They haven't it but I feel almost as if they've done it! Link to comment Share on other sites More sharing options...
NastyRigPig Posted January 27, 2015 Report Share Posted January 27, 2015 I have UHC/Optim RX combo as well. I haven't had a problem, but we just switched to a HSA (health savings account) where I will have to pay the complete cost of my HIV meds for the first scripts, but the total cost counts towards my deductible. Overall, it'll be cheaper than what I paid last year, it's just that I never had to cough up $2300 for one script. Fortunately, I'm able to afford this, but yeah, the prescription thing is a complete racket. Link to comment Share on other sites More sharing options...
NastyRigPig Posted January 27, 2015 Report Share Posted January 27, 2015 So I just went on my United Health Care site, and I can still get 90 days supply for $225, or a one month supply at my local pharmacy for...wait for it...$2551.99. Gee, think I'll be using the mail order? Link to comment Share on other sites More sharing options...
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