The Unending Saga of Specialty Medication Continues

[rowyn]

Saturday: No news.
Monday: No news.
Tuesday afternoon, Accredo calls.
Lacey: "This is Lacey from co-pay assistance. We want you to apply for a grant from the Leukemia & Lymphoma Society to cover the co-pay."
Me: "I thought Medicaid was covering that?"
Lacey: "Who told you that?"
Me: "Accredo. On Friday."
Lacey: "Well, I don't have any notes about that. Do you want to apply for the grant or not?"
Me: "Why can't he get the grant from Celgene?"
Lacey: "Because he has Medicaid, he's not eligible."
Me: "If Medicaid won't cover the copay, why does the grant specifically exclude Medicaid patients? This makes no sense."
Lacey: "I know nothing."
Me: applies for the same grant that turned Lut down when they applied for it in 2019, and that historically opened in November and ran out of money for new grants in December
Lacey: "So the status is 'pending' until the doctor confirms the diagnosis."
Me: "He had a grant from them in 2018. The diagnosis hasn't changed."
Lacey: "Oh. Well, maybe 48-72 business hours until we get a response?"

Two hours later, Sarah Cannon Cancer Center called.
Aisha: "So, our rep with Accredo said -- and, um, this didn't make sense to me so I'm not sure I followed it -- but he said that the insurer didn't have Revlimid and Ninlaro in their pharmacology so they have to add them first."
Me: "That is consistent with exactly nothing that any other person has said about this."
Aisha: "I KNOW RIGHT???"
Me: "I picked Cigna because the health insurance exchange said that they covered Revlimid and Ninlaro. Cigna sent us a pre-auth for Revlimid and Ninlaro on July 13. They know what Revlimid and Ninlaro are. Their website even showed the Ninlaro script. Is he talking about Medicaid not knowing what the drugs are?"
Aisha: "But how could Medicaid not know? I didn't ask, though. I'll send him an email to ask. I'm off tomorrow but I'll call on Thursday with whatever I find out. Did you hear anything from Accredo?"
Me: explains
Aisha: "Funding in since COVID has been weird, so the LLS might have more money in the grant fund than they used to? I guess we'll see."

Hope levels: none.

Comments

[tuftears]

Good gravy. o.o *hugs* You are a saint for being so patient with all these people!

[otterb]

I am so sorry Lut's care is being delayed and you are being driven bananas by this nonsense.

Is there an insurance ombudsman or health care ombudsman available to you? Getting someone at the regulatory level involved can sometimes magically untie knots.