Pulmozyme and Wellmark BCBS of Iowa

2

2cfers

New member
Wellmark BCBS of Iowa has been covering my kids Pulmozyme since diagnosis for the last 2 years. For the last 6 months this has been paid as a prescription and not as part of our medical policy which means a difference of a 387 dollar copay vs a 159 dollar copay if it is submitted as a medical claim. Today I found out from BCBS that they have made a "Mistake" and Pulmozyme should have never been paid on my medical policy eventhough it is listed as a specialty med on their pharmacy information. I am absoluty livid.

We have patient access network to pick up what insurance does not pay but we will max out the $4500 assistance with the higher cost and Caremark which is our pharmacy provider just increased the cost to $1649 which means our copay will be $414 per kid per month. So I guess we will just not have pulmozyme for 2 months a year.

Sorry if this is complicated I am just mad and wonder if anyone else has problems? I am going to turn them into the Iowa insurance division since it has always been in their policy to cover the med as a part of the medical policy.

Thanks for your time,


Christy
 
2

2cfers

New member
Wellmark BCBS of Iowa has been covering my kids Pulmozyme since diagnosis for the last 2 years. For the last 6 months this has been paid as a prescription and not as part of our medical policy which means a difference of a 387 dollar copay vs a 159 dollar copay if it is submitted as a medical claim. Today I found out from BCBS that they have made a "Mistake" and Pulmozyme should have never been paid on my medical policy eventhough it is listed as a specialty med on their pharmacy information. I am absoluty livid.

We have patient access network to pick up what insurance does not pay but we will max out the $4500 assistance with the higher cost and Caremark which is our pharmacy provider just increased the cost to $1649 which means our copay will be $414 per kid per month. So I guess we will just not have pulmozyme for 2 months a year.

Sorry if this is complicated I am just mad and wonder if anyone else has problems? I am going to turn them into the Iowa insurance division since it has always been in their policy to cover the med as a part of the medical policy.

Thanks for your time,


Christy
 
2

2cfers

New member
Wellmark BCBS of Iowa has been covering my kids Pulmozyme since diagnosis for the last 2 years. For the last 6 months this has been paid as a prescription and not as part of our medical policy which means a difference of a 387 dollar copay vs a 159 dollar copay if it is submitted as a medical claim. Today I found out from BCBS that they have made a "Mistake" and Pulmozyme should have never been paid on my medical policy eventhough it is listed as a specialty med on their pharmacy information. I am absoluty livid.

We have patient access network to pick up what insurance does not pay but we will max out the $4500 assistance with the higher cost and Caremark which is our pharmacy provider just increased the cost to $1649 which means our copay will be $414 per kid per month. So I guess we will just not have pulmozyme for 2 months a year.

Sorry if this is complicated I am just mad and wonder if anyone else has problems? I am going to turn them into the Iowa insurance division since it has always been in their policy to cover the med as a part of the medical policy.

Thanks for your time,


Christy
 
2

2cfers

New member
Wellmark BCBS of Iowa has been covering my kids Pulmozyme since diagnosis for the last 2 years. For the last 6 months this has been paid as a prescription and not as part of our medical policy which means a difference of a 387 dollar copay vs a 159 dollar copay if it is submitted as a medical claim. Today I found out from BCBS that they have made a "Mistake" and Pulmozyme should have never been paid on my medical policy eventhough it is listed as a specialty med on their pharmacy information. I am absoluty livid.

We have patient access network to pick up what insurance does not pay but we will max out the $4500 assistance with the higher cost and Caremark which is our pharmacy provider just increased the cost to $1649 which means our copay will be $414 per kid per month. So I guess we will just not have pulmozyme for 2 months a year.

Sorry if this is complicated I am just mad and wonder if anyone else has problems? I am going to turn them into the Iowa insurance division since it has always been in their policy to cover the med as a part of the medical policy.

Thanks for your time,


Christy
 
2

2cfers

New member
Wellmark BCBS of Iowa has been covering my kids Pulmozyme since diagnosis for the last 2 years. For the last 6 months this has been paid as a prescription and not as part of our medical policy which means a difference of a 387 dollar copay vs a 159 dollar copay if it is submitted as a medical claim. Today I found out from BCBS that they have made a "Mistake" and Pulmozyme should have never been paid on my medical policy eventhough it is listed as a specialty med on their pharmacy information. I am absoluty livid.
<br />
<br />We have patient access network to pick up what insurance does not pay but we will max out the $4500 assistance with the higher cost and Caremark which is our pharmacy provider just increased the cost to $1649 which means our copay will be $414 per kid per month. So I guess we will just not have pulmozyme for 2 months a year.
<br />
<br />Sorry if this is complicated I am just mad and wonder if anyone else has problems? I am going to turn them into the Iowa insurance division since it has always been in their policy to cover the med as a part of the medical policy.
<br />
<br />Thanks for your time,
<br />
<br />
<br />Christy
 
2

2005CFmom

Super Moderator
Here is a link to the Pulmozyme <a target=_blank class=ftalternatingbarlinklarge href="http://https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp">Website</a>...

https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp

They have a phone number to call to get help with copays. It looks like they refer you to charitable orgs that will hopefully will be able to help you.

Good Luck!


Darn...I couldn't get the link to work...you will just have to copy and paste the website.
 
2

2005CFmom

Super Moderator
Here is a link to the Pulmozyme <a target=_blank class=ftalternatingbarlinklarge href="http://https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp">Website</a>...

https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp

They have a phone number to call to get help with copays. It looks like they refer you to charitable orgs that will hopefully will be able to help you.

Good Luck!


Darn...I couldn't get the link to work...you will just have to copy and paste the website.
 
2

2005CFmom

Super Moderator
Here is a link to the Pulmozyme <a target=_blank class=ftalternatingbarlinklarge href="http://https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp">Website</a>...

https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp

They have a phone number to call to get help with copays. It looks like they refer you to charitable orgs that will hopefully will be able to help you.

Good Luck!


Darn...I couldn't get the link to work...you will just have to copy and paste the website.
 
2

2005CFmom

Super Moderator
Here is a link to the Pulmozyme <a target=_blank class=ftalternatingbarlinklarge href="http://https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp">Website</a>...

https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp

They have a phone number to call to get help with copays. It looks like they refer you to charitable orgs that will hopefully will be able to help you.

Good Luck!


Darn...I couldn't get the link to work...you will just have to copy and paste the website.
 
2

2005CFmom

Super Moderator
Here is a link to the Pulmozyme <a target=_blank class=ftalternatingbarlinklarge href="http://https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp">Website</a>...
<br />
<br />https://www.genentechaccesssolutions.com/pulmozyme/patient/index.jsp
<br />
<br />They have a phone number to call to get help with copays. It looks like they refer you to charitable orgs that will hopefully will be able to help you.
<br />
<br />Good Luck!
<br />
<br />
<br />Darn...I couldn't get the link to work...you will just have to copy and paste the website.
 
N

NoExcuses

New member
i had problems in CA..... what a nightmare!

genentech is already struggling with people switching off of pulmozyme to HTS (wrongfully so... many are misinformed that they do the same thing when they DON'T). If genentech doesn't get their managed care reps to fix the situation with BCBS, more patients will drop off and revenue will fall.

but then again, warwick doesn't use pulmozyme but instead using mucomyst, so maybe it's not the end of the world for some patients not to use it....
 
N

NoExcuses

New member
i had problems in CA..... what a nightmare!

genentech is already struggling with people switching off of pulmozyme to HTS (wrongfully so... many are misinformed that they do the same thing when they DON'T). If genentech doesn't get their managed care reps to fix the situation with BCBS, more patients will drop off and revenue will fall.

but then again, warwick doesn't use pulmozyme but instead using mucomyst, so maybe it's not the end of the world for some patients not to use it....
 
N

NoExcuses

New member
i had problems in CA..... what a nightmare!

genentech is already struggling with people switching off of pulmozyme to HTS (wrongfully so... many are misinformed that they do the same thing when they DON'T). If genentech doesn't get their managed care reps to fix the situation with BCBS, more patients will drop off and revenue will fall.

but then again, warwick doesn't use pulmozyme but instead using mucomyst, so maybe it's not the end of the world for some patients not to use it....
 
N

NoExcuses

New member
i had problems in CA..... what a nightmare!

genentech is already struggling with people switching off of pulmozyme to HTS (wrongfully so... many are misinformed that they do the same thing when they DON'T). If genentech doesn't get their managed care reps to fix the situation with BCBS, more patients will drop off and revenue will fall.

but then again, warwick doesn't use pulmozyme but instead using mucomyst, so maybe it's not the end of the world for some patients not to use it....
 
N

NoExcuses

New member
i had problems in CA..... what a nightmare!
<br />
<br />genentech is already struggling with people switching off of pulmozyme to HTS (wrongfully so... many are misinformed that they do the same thing when they DON'T). If genentech doesn't get their managed care reps to fix the situation with BCBS, more patients will drop off and revenue will fall.
<br />
<br />but then again, warwick doesn't use pulmozyme but instead using mucomyst, so maybe it's not the end of the world for some patients not to use it....
 
J

jacksmom

New member
Hi Christy,

I would find the documentation stating that Pulmozyme is covered as a speciality med and go after BCBS to continue covering it.
Also check with the clinic and see if there is anything they can do to hlep you out.
-Carey
 
J

jacksmom

New member
Hi Christy,

I would find the documentation stating that Pulmozyme is covered as a speciality med and go after BCBS to continue covering it.
Also check with the clinic and see if there is anything they can do to hlep you out.
-Carey
 
J

jacksmom

New member
Hi Christy,

I would find the documentation stating that Pulmozyme is covered as a speciality med and go after BCBS to continue covering it.
Also check with the clinic and see if there is anything they can do to hlep you out.
-Carey
 
J

jacksmom

New member
Hi Christy,

I would find the documentation stating that Pulmozyme is covered as a speciality med and go after BCBS to continue covering it.
Also check with the clinic and see if there is anything they can do to hlep you out.
-Carey
 
J

jacksmom

New member
Hi Christy,
<br />
<br />I would find the documentation stating that Pulmozyme is covered as a speciality med and go after BCBS to continue covering it.
<br />Also check with the clinic and see if there is anything they can do to hlep you out.
<br />-Carey
 
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