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Why can’t I obtain my meds?

Why at the start of a new year is it difficult to get your specialty medication filled? Those of us diagnosed with MS know this issue all to well, as I express my insult to injury experiences that occur daily as an MS patient. The start of a new year and I have new medical insurance, thanks to the Obamacare program. The insurance I had last year pulls out of the State of Florida because it isn’t financially sound for them to stay in the program. I’ve picked a new plan in November, paid my premium, made sure it was done before December. Hoping my I.D. Cards would make it before the first of the year. Why you may ask? Because I worry about not getting my meds on time and going off my therapy. It’s now the end of January, I still don’t have my meds, call the insurance, they refer me to the specialty pharmacy, they in turn tell me my doctor hasn’t sent the prior authorization. I was just at my doctors yesterday and the staff said they sent it two days ago. I call my insurance back again, after three transfers and three very long holds, no promising answer to my two month process to obtain my drugs to treat my life long disease. Who knows if this will ever get resolved, but I can assure you my MS has began to exacerbate thanks to the stress and hours spent on the phone, in the car and visits to my doctors office one (1) hour away. How do we control these issues that end up controlling our lives and making us sicker by the day? Join me for the continuation of my story in the not to distant future. Good luck my MS warriors!

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Comments

  • Ms.Diva
    2 years ago

    I had the same issue! I was able to get the prior authorization number from my doctor’s office. To give to specialty pharmacy. And it is very stressful having to go back and forth with the insurance company and doctor’s office. I too, feel it stresses us out and make our condition worst.

  • ReeRee author
    2 years ago

    Thank for your reply, I’ve done that too! The problem with an MS specialty drug and certain insurance carriers they must be sent from their specialty pharmacy. You can’t hand carry it, you can’t pick it up and you must rely on the agent on the other end of the phone to be competent to get the right forms to the doctors office. I feel the problem is with the agents who work for the insurance carriers not knowing how harmful it can be if an MS patient doesn’t get their meds on time or gets off their protocol. Not only is it an MS medication, I take several drugs for depression and cognitive issues. These are considered narcotics and they can only be filled for 30 days, when you script isn’t filled and you go off your protocol it’s like a junky coming off a high, sweats, shivers, crying, headache and the list goes on. I don’t wish this on anyone………….

  • Meagan Heidelberg moderator
    2 years ago

    Hi ReeRee!
    A few days after the first of the year I actually had the same problem with trying to get a medication from the pharmacy! So crazy that although your doctor prescribes you something, you may or may not be able to get it due to it needing an authorization from the same doctor that prescribed it. I feel your pain. We are surely hoping that you get your medication as soon as possible!
    I know you said your doctor is an hour away, but I wonder if they can physically give it to you and you bring it to the pharmacy? Please let us know how your journey goes getting your medications you need.
    Hoping you can find some ways to decrease the stress that this has brought on. Here are some ways from our site; https://multiplesclerosis.net/living-with-ms/how-do-you-manage-ms-stress/. Hope you find this helpful!

    Best – Meagan, MultipleSclerosis.net Team Member

  • ReeRee author
    2 years ago

    Thanks Meagan, it finally came after my journey started in mid November to buy my new insurance plan in the marketplace, to obtaining my cards after the first of the year, to getting samples to hold me over. January 30, it arrived. This was a process that no one individual should have to deal with. Especially someone who has MS, because as we all know the stress can make the monster attack.
    Also, the doctor has already given a prior authorization for medication why do they need them every time?

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