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Dr Trevor Marshall
Research Team
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Posted: Mon Jun 6th, 2005 11:15 |
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Roo,
Medco is under investigation by the Federal Dept of Justice. Recently a Judge criticized the way they do business. MP patients have been having a lot of trouble with Medco, I am afraid, and they seem to be totally ruthless with their decisions, refusing Benicar even for patients in wheelchairs, for example.
All you can do is complain to your insurer.
..Trevor..
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Rich
inactive member
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Posted: Fri Jun 10th, 2005 20:48 |
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The circus continues with Medco. I recently received a denial of my prescription for 3 months of benicar which was submitted by my Dr(see my post on page 2). I requested today that my Dr. write a new prescription for the 360 tablets and I would take it to Costco to have it filled. After getting the prescription filled and ready to give to me at the cashier(for a price of $520, I peeked) they asked me for my medical card which is Premera Blue Cross with Medco as the prescription drug provider.
They went back and spent about 45 min. trying to figure it all out and finally came out with 120 tablets. That was my original prescription with them. They also told me that Medco had denied coverage but when it came to paying it was $40 versus the $181 I had originally paid back in Jan. Go figure.
I didn't get 3 months worth of benicar,but I saved $140.
Today I received confirmation from Medco of the prescription denial and written on the slip "we will not fill prescriptions for the Marshall Protocol".
I will continue to work the system but there is definately something wrong in the accounting dept. at Medco.
____________________
Rich Sarcoidosis 3/03 "remission" 5/04 MP 12/05
12,5-D 50, 25-D 40. Benicar 4X40 mg/day. 100mg mino 3/9/05, Phase 2 3/26 05,25-D22,1-25D 53: 8/15/05 25-D 27,1-25D 45.Phase 3 2/1/06 25-D 15
1-25D,29 Under care of MP literate Dr. Benicar 3X40 mg/day
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Dr Trevor Marshall
Research Team
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Posted: Sat Jun 11th, 2005 02:07 |
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Rich,
I think you have a real complaint, as medco should not be second-guessing your Doc at the level of protocol.
Tomorrow we are going to issue another NIH action alert, for Tuesday. This is a question you should forward to Dr Zerhouni, and ask him why a health insurer could possibly give you a reply like this...
Keep your eyes peeled tomorrow, please 
..Trevor..
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Ray-Gun
Member
| Joined: | Mon Sep 19th, 2005 |
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Posted: Tue Sep 20th, 2005 00:59 |
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I have to ask, has Sankyo or its subsidiaries given any form of remuneration to Dr. Marshall, his foundation, or otherwise provided incentive to promulgate the usage of Benicar?
Sincerely,
Ray
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Dr Trevor Marshall
Research Team
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Posted: Tue Sep 20th, 2005 01:05 |
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No, not a penny
Why do you ask?
..Trevor..
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Tobi
Member
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Posted: Tue Sep 20th, 2005 06:27 |
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Ray's question is a sad reminder of how current scientific and medical research is perceived by those in the public domain. So much of such work is done with huge financial incentives by pharmaceutical companies who wield so much power.
Astounding, isn't it,that Dr. Marshall's work is totally uncontaminated by such factors?
The fact that no sponsorship is involved elevates this research to a level not often encountered in the scientific community.
Tobi
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CFS,Rickettsia Conoori-,HHV6,Ureaplasma(all 3 culture,PCR) 25D 16.4ng/ml,1.25D 26pg/ml.Ratio 1,3 Blood probably NOT frozen Benicar 9/18/04 Mino 100mg 10/18/04 Phase 2 01/26/05
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jrfoutin
Member Advocate
| Joined: | Tue Aug 9th, 2005 |
| Location: | Oregon USA |
| Posts: | 3846 |
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Posted: Tue Sep 20th, 2005 12:18 |
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My husband spoke to our insurance co. yesterday. I got it second hand but the main idea went something like this: Seems they've spent several weeks looking at my novel Benicar prescription (first Sarcie, first MP) and going back and forth with Medco. Insurer still seemed to side with my husband's point of view (they told him a Sarc dx is a death sentence in 8-22 years with traditional options, he replied, "then MP is her only hope").
They suggested that their perception of Dr. Marshall's program would improve if a large drug company would sponsor publishing more of his research in several internationally-respected peer-reviewed medical journals and so the journals would not just report some exuse remark along with the publication.
I thought it was an interesting perspective of how the world turns.
Last edited on Tue Sep 20th, 2005 12:34 by jrfoutin
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Sarcoidosis 125D61, MP10/05 ModP2 12/05 Ph2 6/06 Ph3 10/06, NoIRs limited outings covered, 2/08 25D6.2
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Tam
Member
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Posted: Tue Sep 20th, 2005 15:22 |
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Yikes! they said 8-22 years... That is very scary! Didn't think they would be aware of a timeline like that... didn't think there was one!
Thanks for the info,
Tam.
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Sarcoidosis Diag. July 22, 2005. Lung and Erythsum Nodosum. Stage 2. No meds. Researching MP
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Dr Trevor Marshall
Research Team
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Posted: Tue Sep 20th, 2005 17:14 |
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Tam,
This is what I wrote earlier today about the prognosis of Sarcoidosis:
Until quite recently Sarcoidosis was thought to spontaneously remit in a majority of cases, but the 6-year (1995 to 2001) ACCESS study, funded by the National Institutes of Health (NIH), found that during the 2-year period subsequent to diagnosis only 22% of patients showed a measurable improvement, and that 13% got worse [see Table.3 of ref.5].
Further, it was noted that “most patients with persistent disease at 2 years were unlikely to have resolution of sarcoidosis” and “end-stage pulmonary sarcoidosis usually develops over one or two decades.”
ref 5 can be found at http://autoimmunityresearch.org/access-2yr.htm
..Trevor..
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carol
Advocate
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Posted: Sun Oct 30th, 2005 20:05 |
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Can anyone tell me what the status is with Medco covering Benicar at 40mg q 6hrs? I am considering changing to a United Health Care plan that uses Medco for Rx drugs.
I currently have insurance with Humana (Rx drugs coovered thru Caremark). After I filed an appeal, including a letter of medical necessity, I have had no problem with getting my Benicar covered.
This issue will determine which plan I go with. Any help is much appreciated.
Carol
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rheumatoid arthritis dx '96...started MP 8/11/04...initial D tests (7/11/04): 25-D=32; 1,25-D=65...phase 2 started 12/6/04...phase 3 started 2/26/06...vicodin & valium as needed for pain...last 25-D=9 (5/08)
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Robertrr
Member in Phase 3
| Joined: | Thu Jul 14th, 2005 |
| Location: | Austin, Texas USA |
| Posts: | 374 |
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Posted: Sun Oct 30th, 2005 20:27 |
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Carol,
I'd urge you to go another way than Medco if you can. I use Medco and they are not filling any Benicar scripts for me at this time. They're quite arrogant about it...to the extent they argued with my caregiver.
Anyway, I have no way to avoid them, but if you can, stay away from insurance that relegates you to Medco for perscriptions of Benicar if you're on the MP.
RobertLast edited on Sun Oct 30th, 2005 20:28 by Robertrr
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Sarcoidosis 125D44 25D28 Ph1Jul05 Ph2Sep05 Ph3May06 D25-8(Feb07) MP brk May08 NoIRs outside otherwise normal light exposure
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carol
Advocate
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Posted: Mon Oct 31st, 2005 22:33 |
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Thanks, Robert and thanks to those who replied via PM. I did have I person tell me that Medco was paying for full dose Benicar, but several others were having the same problem as Robert. Because I had successfully appealed and gotten coverage thru my current insurer, I decided to stick with them.
Carol
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rheumatoid arthritis dx '96...started MP 8/11/04...initial D tests (7/11/04): 25-D=32; 1,25-D=65...phase 2 started 12/6/04...phase 3 started 2/26/06...vicodin & valium as needed for pain...last 25-D=9 (5/08)
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Freddie Ash
Member in Phase 3
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Posted: Tue Nov 1st, 2005 15:46 |
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HI ALL
This is Fred in WV. I just got a call from my doctor's office and Medico said they were not going to pay for benicar. This is the second time in a year I have tried to get benicar thru the mail. The doctor's office told me that they were going to fill and the corperate head quarters stopped it.
I have been getting the benicar from Rite Aid and my insurance pays for some of it. But I never know what I am going to pay. I have paid as little as $33 or as much as $168, for 30 day supply 40mg at 6 hours.
Your friend in sarcoidosis
Freddie
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Freddie: dx-sarc 2/82 lymph; skin, eyes, joints, esophagus, intestines, spleen, heart,lungs-meds digitek, L-thyroxine, nexium, furosemide, nattokinase36mg,eat cinnamon w/meals,25D-7; 125-D43
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wytnez
Advocate
| Joined: | Mon Nov 29th, 2004 |
| Location: | Texas USA |
| Posts: | 596 |
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Posted: Tue Nov 1st, 2005 18:41 |
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Its time for open enrollment at my job and we will have Humana. I will know tomorrow who the prescription carrier will be. I hope it is Caremark that way I can get my Benicar covered. And since when can an insurance company tell your Doctor how to prescribe medication for you? The Doctor is the one who is following your care. You are paying premiums. The insurance companies really can be nasty when it comes to health care.
Saj
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sarc lymph nodes. ph1 1/05,125D 33,25D 10,ph2 5/05,ph3 12/05,125D 21, 25D less than 7
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Meg Mangin R.N.
Research Team
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Posted: Wed Nov 2nd, 2005 01:30 |
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Freddie,
Medco is getting away with denying your full insurance benefit for what your doctor ordered. Perhaps if you and your doctor do a lot of complaining, you will succeed in getting what is rightfully yours. Be sure not to mention the Marshall Protocol because it is a red flag for them and it is irrelevant to the fact that your doctor has ordered this dosage of Benicar for you. Just have our doctor keep calling and insisting that he is the one practicing medicine and he has the right to determine what amount of Benicar you should be taking and their contract with you provides for payment of Benicar.
I had my own little battle with Humana today but I learned something that might be valuable. In reordering my Benicar via Walgreen's mailorder, I found via a followup phone call that the order was not being processed because the claim had been denied by Humana. A Human rep told me they had no record of an "override" that was done in April and allowed the prescription to be filled at q6h as ordered by my doctor who had called them at that time. The override is usually good for one year but this rep told me that the doctor or her office staff should call and ask for an "indefinite override" since the prescription was not likely to change. Then, he said, the doctor would never have to call in again. My doctor's nurse said she'd never heard of this but would try it. I'll let you know, eventually, if this surprisingly forthright fella is right.
Best,
Meg
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Memoking
inactive member
| Joined: | Wed Apr 6th, 2005 |
| Location: | Illinois USA |
| Posts: | 314 |
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Posted: Wed Nov 2nd, 2005 01:38 |
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I have been able to get the Benicar filled at the prescribed dosage, with Medco as the insurance company, thru the state, but I didn't tell the pharmacist that it was for the Marshall PRotocol...
However, they just order it the way that the Dr prescribed it.
That has worked for me, I don't tell them it is for the Marshall Protocol since I have seen on here that Medco is wary of that. . but they should be following the Dr's orders for the prescription.. and so far they have done that.
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Mary..Sarcoidosis. 1,25D=56..25D=6..Began Benicar 20mg q3hrs..9/4/05. Granulomas in arms, hips,legs. Painful lymph nodes hips, armpits. Pain in chest,back,head. Avoiding sun/bright lights/Vit D. Using NoIRs
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wytnez
Advocate
| Joined: | Mon Nov 29th, 2004 |
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Posted: Wed Nov 2nd, 2005 19:12 |
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Hello all,
I just found out that PPO that my job offers is Humana and Caremark is the prescription rider. I am hoping that I don't have any problems with them. The deductable is only $50 for prescriptions. I hope that I don't have to go to battle with them.
Saj
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sarc lymph nodes. ph1 1/05,125D 33,25D 10,ph2 5/05,ph3 12/05,125D 21, 25D less than 7
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debbie
inactive member
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Posted: Wed Nov 2nd, 2005 21:47 |
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| i have bluecross ppo with wellpoint pharmacy . my appeal thru wellpoint and blue cross have been denied, now i an doing an independent evaluation. i have sent so many copies of the things on the mp web site that have been suggested plus my letters with no change in their denials, deb
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deb.premp.3/05.pcrlyme+.d125-71.d25-31.mp4/16/05
benicar,celexa.4/23mino.5/5quer5/30 z+m,lithium
6/29d125-41,d25-26,11/05modph2,12/05125-29,25-30
1/06 ph3,4/06 125-35,25-19;8/06d25-18
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Meg Mangin R.N.
Research Team
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Posted: Wed Nov 2nd, 2005 23:21 |
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debbie,
You will not change an insurer's decision by trying to educate them about the Marshall Protocol. They do not practice the art of medicine. That is your doctor's job. Your insurer's responsibility is to pay for medications on their formulary that your doctor orders. If the dosage exceeds the standard, your doctor should simply call and insist that they override that standard dosage because s/he has determined, based on your individual case and his/her expertise that that is the dosage you require. No further explanation is needed nor should one be offered.
This is done for other medications and Benicar should not be an exception.
Best,
Meg
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Rich
inactive member
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Posted: Wed Nov 2nd, 2005 23:24 |
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Hi all
I have had a battle with Medco covering Benicar which everyone can read through my posts over the last year. Medco is currently covering my Benicar through Premera Blue Cross at the price of $40/120 tablets. I buy them at the COSTCO pharmacy. They will not give me more than 120 tablets at a time(120@4/day even though I am taking 3/day). My doctor wrote to Medco directly requesting that this prescription be filled and that seemed to help. One thing that everyone might try is to get only 1 months supply at a time. I have presented prescriptions twice for a 3 months supply(360 tablets) and it has been changed by Medco to 120 tablets. This is a small price to pay for a reduction in price from approx $200/120 tablets to $40/ 120 tablets.
____________________
Rich Sarcoidosis 3/03 "remission" 5/04 MP 12/05
12,5-D 50, 25-D 40. Benicar 4X40 mg/day. 100mg mino 3/9/05, Phase 2 3/26 05,25-D22,1-25D 53: 8/15/05 25-D 27,1-25D 45.Phase 3 2/1/06 25-D 15
1-25D,29 Under care of MP literate Dr. Benicar 3X40 mg/day
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