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DianeC
Member in Phase 3
| Joined: | Sat Aug 20th, 2005 |
| Location: | New York, USA |
| Posts: | 617 |
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Posted: Thu Jan 26th, 2006 18:09 |
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Hello Trevor,
My husband Tom just mentioned to me that Merck and Medco are now separate companies and that Medco's only business is dispensing drugs. Would this mean that Merck would no longer have influence on Medco's decisions regarding what drugs they can dispence?
Thank you!
DianeC
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chronic fatigue/osteoporosis osteoarthritis, 9/05 25-D 40 1,25-D 52 1/06 Benicar 40mg Q6H Mino 28Jan @25mg q48h Mino 12Mar @50mg q72h Mino 15April @75mg q72h Mino 1May 100mg 5/06 Phase 2 D-25 18 10/06 Phase3 D-25 20 5/07 D-25 under 7
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Dr Trevor Marshall
Research Team
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Posted: Thu Jan 26th, 2006 18:40 |
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DianeC,
It all depends whether you feel that a single large shareholder has effective control of a widely held public corporation. My experience as a public CEO tells me that large shareholders call the tune. Additionally, many of the Medco professional staff transitioned from Merck during the spinoff, and some may have 401Ks and similar vested interests
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DianeC
Member in Phase 3
| Joined: | Sat Aug 20th, 2005 |
| Location: | New York, USA |
| Posts: | 617 |
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Posted: Thu Jan 26th, 2006 18:45 |
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Thank you Trevor, for the clarification!
DianeC
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chronic fatigue/osteoporosis osteoarthritis, 9/05 25-D 40 1,25-D 52 1/06 Benicar 40mg Q6H Mino 28Jan @25mg q48h Mino 12Mar @50mg q72h Mino 15April @75mg q72h Mino 1May 100mg 5/06 Phase 2 D-25 18 10/06 Phase3 D-25 20 5/07 D-25 under 7
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DianeC
Member in Phase 3
| Joined: | Sat Aug 20th, 2005 |
| Location: | New York, USA |
| Posts: | 617 |
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Posted: Thu Jan 26th, 2006 18:48 |
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Hello Alayne and Janet!
Thank you both for your prompt replies and for your advice!
Best to you both!
DianeC
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chronic fatigue/osteoporosis osteoarthritis, 9/05 25-D 40 1,25-D 52 1/06 Benicar 40mg Q6H Mino 28Jan @25mg q48h Mino 12Mar @50mg q72h Mino 15April @75mg q72h Mino 1May 100mg 5/06 Phase 2 D-25 18 10/06 Phase3 D-25 20 5/07 D-25 under 7
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DianeC
Member in Phase 3
| Joined: | Sat Aug 20th, 2005 |
| Location: | New York, USA |
| Posts: | 617 |
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Posted: Thu Jan 26th, 2006 19:38 |
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Hello Alayne,
Are you now able to get the Benicar now without a problem? The way our Medco insurance works is that they will allow you a prescription with 2 refills at the local pharmacy and then you must use the mail order for subsequent meds to be covered by the insurance. But the problem occurs when they see such a large amount for the 3 month prescription which includes the refills.
I am still waiting for a call from my doctor who received the message of denial today from medco and I just received a phone transcription as well from Medco stating that they will send me a letter with more information.
Hope you are doing well! All this just contributes to added stress at a point when we can handle it the least
Best wishes with your health!
DianeC
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chronic fatigue/osteoporosis osteoarthritis, 9/05 25-D 40 1,25-D 52 1/06 Benicar 40mg Q6H Mino 28Jan @25mg q48h Mino 12Mar @50mg q72h Mino 15April @75mg q72h Mino 1May 100mg 5/06 Phase 2 D-25 18 10/06 Phase3 D-25 20 5/07 D-25 under 7
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DianeC
Member in Phase 3
| Joined: | Sat Aug 20th, 2005 |
| Location: | New York, USA |
| Posts: | 617 |
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Posted: Thu Jan 26th, 2006 20:06 |
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Hello Janet,
Sounds like Costco is the buzzword from all that I have been reading; wish we had one here
I have printed out some of the information from the links you sent!
Did you have the same problems initially? How are you progressing along? I see that you are now in phase 2.....congratulations! We all have to perservere to assure that we all will obtain good health!
Best wishes!
DianeC
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chronic fatigue/osteoporosis osteoarthritis, 9/05 25-D 40 1,25-D 52 1/06 Benicar 40mg Q6H Mino 28Jan @25mg q48h Mino 12Mar @50mg q72h Mino 15April @75mg q72h Mino 1May 100mg 5/06 Phase 2 D-25 18 10/06 Phase3 D-25 20 5/07 D-25 under 7
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DNStog
Advocate
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Posted: Fri Jan 27th, 2006 03:47 |
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You can order prescriptions online from Costco's website and have them delivered via mail to your home. I don't know if Costco requires you to be a member when there's not a store near you or not. Turn around on vitamins took me about seven days to receive, including a weekend.
Donna
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Sarcoidosis/skin, joints, lungs, nerves, Raynauld's, uveitis, hypothyroid, sinus, wt. gain, Peradontal disease, GERD-hiatal hernia, breast ca 11/06, 25D7, Synthroid, Wellbutrin, eye vits, melatonin, Milk Thistle, Quercetin, Rx glacier, cover up, low lux h
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DianeC
Member in Phase 3
| Joined: | Sat Aug 20th, 2005 |
| Location: | New York, USA |
| Posts: | 617 |
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Posted: Fri Jan 27th, 2006 12:52 |
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Hello Donna,
Thank you for forwarding this information! I did check the website online and it appears that they will ship to N.Y. as our state is not listed as one of those that they will not ship to
It is reassuring to know that there are other options as the stress from not knowing if you will be able to get your medicine surely has a profound effect on the ability to get well.
Thanks again Donna and best wishes to you!
DianeC
Last edited on Fri Jan 27th, 2006 12:57 by DianeC
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chronic fatigue/osteoporosis osteoarthritis, 9/05 25-D 40 1,25-D 52 1/06 Benicar 40mg Q6H Mino 28Jan @25mg q48h Mino 12Mar @50mg q72h Mino 15April @75mg q72h Mino 1May 100mg 5/06 Phase 2 D-25 18 10/06 Phase3 D-25 20 5/07 D-25 under 7
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DNStog
Advocate
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Posted: Sun Jan 29th, 2006 02:23 |
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You're so welcome, Diane! Wishing you well, gently!
Donna
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Sarcoidosis/skin, joints, lungs, nerves, Raynauld's, uveitis, hypothyroid, sinus, wt. gain, Peradontal disease, GERD-hiatal hernia, breast ca 11/06, 25D7, Synthroid, Wellbutrin, eye vits, melatonin, Milk Thistle, Quercetin, Rx glacier, cover up, low lux h
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DianeC
Member in Phase 3
| Joined: | Sat Aug 20th, 2005 |
| Location: | New York, USA |
| Posts: | 617 |
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Posted: Sun Jan 29th, 2006 03:20 |
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You're so kind Donna! Thanks again!
DianeC
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chronic fatigue/osteoporosis osteoarthritis, 9/05 25-D 40 1,25-D 52 1/06 Benicar 40mg Q6H Mino 28Jan @25mg q48h Mino 12Mar @50mg q72h Mino 15April @75mg q72h Mino 1May 100mg 5/06 Phase 2 D-25 18 10/06 Phase3 D-25 20 5/07 D-25 under 7
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Knochen
Advocate
| Joined: | Thu Feb 23rd, 2006 |
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| Posts: | 281 |
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Posted: Thu Mar 9th, 2006 22:22 |
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Well, I seem to be in good company. Having searched the forum for insurance troubles, it looks like I'm in that happy group who are under the thumb of Medco. Some of the more recent posts don't seem to hold out much hope, either. I was told that they would not cover for Benicar except for high blood pressure - no exceptions. (I have HMO Blue, so I assume they are using Medco, as has been suggested elsewhere.)
I have been making many pungent comments about them under my breath for the past couple of days while figuring out what my next move should be. It sounds like they have circled the wagons against the MP, and have flags looking for the typical prescriptions associated with it even if you don't say anything specifically about it. So is there any hope? I've seen the suggested letters and approaches, but my impression is that Medco is clamping down and these may not do any good. I don't see how they can get away with interfering with my MD's ability to freely practice medicine like this. What's the current legal situation? Anything on the horizon?
I'd be happy to go through the motions of the appeal, but my doctor's office was pretty snooty with me when I told them I wanted to fight this. They don't appear too willing to go the extra mile. Do I stand a chance without them on my side? And if by some miracle I get the benicar, what will happen with the various abx's down the road?
I knew this was going too smoothly! 
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Reiter's Syndrome 25+ yrs, fatigue, joints, muscles, migraine, brainfog| 25D 6 ng/ml |Benicar May06|Ph1 June06|Ph 2 Sept06|Ph 3 Jan 07|NoIRs K-Cream Zinc Oxide cream - Always covered!
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Meg Mangin R.N.
Research Team
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Posted: Thu Mar 9th, 2006 23:36 |
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Knochen,
I would suggest that you continue to 'badger' Medco as much as your time and energy allow. And let them know that you are contacting your state's insurance commissioner and then do that.
Also ask to see, in writing, the statement in your policy that verifies their right to deny your doctor's order for Benicar used off-label and at higher doses.
I don't think whether or not your doctor wants to join you in this fight is relevant. As long as he stands by his original order that indicates Benicar only and by his request for a dosage override.
If the policy specifically denies payment of Benicar for off-label use and/or a dosage override, then you will, unfortunately, have to pay out of pocket.
Good luck,
Meg
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Knochen
Advocate
| Joined: | Thu Feb 23rd, 2006 |
| Location: | USA |
| Posts: | 281 |
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Posted: Fri Mar 10th, 2006 06:53 |
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Meg,
Sound advice (as always!)
I wasn't sure how much of the fight had to come through my provider, and how much I could argue on my own behalf. I'll dig up the contacts and start ASAP. Maybe registered mail will give it that little bit of emphasis so they will actually answer, rather than "losing" my requests.
Has anyone ever thought of getting the press to help out? An investigative reporter might be able to put an awful lot of sunshine on these folks. And if anybody needs a lot of sunshine beating down on them, it's these insurance companies! Of course, it would probably take a big name in the news business to get enough exposure to do much good. Still, it's something to think about.
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Reiter's Syndrome 25+ yrs, fatigue, joints, muscles, migraine, brainfog| 25D 6 ng/ml |Benicar May06|Ph1 June06|Ph 2 Sept06|Ph 3 Jan 07|NoIRs K-Cream Zinc Oxide cream - Always covered!
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Meg Mangin R.N.
Research Team
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Posted: Fri Mar 10th, 2006 10:32 |
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Knochen,
A registered letter is an excellent idea. And when you are on the phone ask them to record the conversation. Use any tactic you can think of to let them know that you are going to make sure that you get your rightful insurance benefit. They will make things difficult for you in hopes that you give up. They key is to find out the details of the policy so you know if they are just putting their own interpretive spin on this prescription denial.
Don't forget to enlist the help of the person who sold the policy to you or your employer.
These kinds of problems, and worse, are legion. IMO, the entire insurance industry needs a congressional investigation. But they have a very powerful lobbying group so I doubt that will ever happen.
Best,
Meg
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Knochen
Advocate
| Joined: | Thu Feb 23rd, 2006 |
| Location: | USA |
| Posts: | 281 |
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Posted: Tue Mar 14th, 2006 22:12 |
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Just a short update on the insurance situation. It turns out that my insurance does not use Medco, instead they use Express Scripts. I searched the forum for any comments about them and came up empty. Is anyone using them, and were you able to get your full Benicar benefit?
I've been reading the "new" paper on the use of ARB and the immune system, and I would HOPE that might make an impact on the requests for off label use at the doses needed. In the meantime, I'm making a stab at a letter campaign. Nothing sent yet (work, taxes,& exhaustion) But it should be pretty well pulled together in a couple of days. Slow and steady wins the race. I'll concentrate on their policies first, saving the science for later.
Let us hope Trevor's efforts to get the FDA Orphan Products Development working for us comes to something.
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Reiter's Syndrome 25+ yrs, fatigue, joints, muscles, migraine, brainfog| 25D 6 ng/ml |Benicar May06|Ph1 June06|Ph 2 Sept06|Ph 3 Jan 07|NoIRs K-Cream Zinc Oxide cream - Always covered!
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Meg Mangin R.N.
Research Team
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Posted: Tue Mar 14th, 2006 23:21 |
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knochen,
In my experience, it is the insurance company that decides if they will pay for the higher dosage of Benicar. The pharmacy just fills the precription. Medco advertises themselves as pharmaceutical management so they may work with an insurer to keep costs down.
My insurer denied my claim. Both my mailorder pharmacy (Walgreens) and my local pharmacy (Med Shoppe) were happy to fill the order when they knew the insurer would pay for it. They would have filled it also if I had agreed to pay out-of-pocket. So the issue is not safety, it's cost.
Best,
Meg
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Reenie
inactive member
| Joined: | Wed Jul 21st, 2004 |
| Location: | Phoenix, Arizona USA |
| Posts: | 3381 |
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Posted: Wed Mar 15th, 2006 02:30 |
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Knochen,
My insurer requires me to use Express Scripts. Unlike most insurance companies being the ones that deny the claim, it was Express Scripts' pharmacist that I had to contend with, in my particular case.
The pharmacist denied the original rx written because of a possible "overdose" at the rx'd dose.
I had to get my MP Dr to fax them a new rx stating that he was aware that the amount being rx'd exceeded the manufacturer's recommended maximum dosage. In addition, the pharmacist required my Dr to confirm this on the phone with him before they would fill it.
Then, they filled the rx for me at the proper dosage needed and rx'd for me.
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Meg Mangin R.N.
Research Team
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Posted: Thu Mar 16th, 2006 11:30 |
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Reenie makes a good point. When a pharmacy or pharmacist refuses to fill the Benicar order it is because they are doing their job of double-checking to make sure a doctor has not made an error in dosing. After verifying with the doctor, that they have the correct dose, they will then fill the prescription.
If the insurer refuses to pay for the higher dosage of Benicar, the prescription can still be filled but the patient must bear the extra expense.
Best,
Meg
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Suzanne
Member in Phase 3
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Posted: Tue Mar 21st, 2006 10:53 |
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I was just called by my mail order pharmacy -- Medco -- of course. The pharmacist 'recognized' that I am using the Marshall Protocol. He even stated to me that he inferred this from the prescriptions, no one actually told him. He told me that Medco has made it a policy to not fill the Benecar prescription because the Marshall Protocol is 'unproven.' I first explained that I knew he was doing his job, but isnt' the 'liability' with the prescriber? He stated that this was simply the stand of the company. I have asked him to get me a person or place in the company to challenge this stand. He said he would. I await another call.
I am fortunately able to get the Benecar from the local pharmacy benefit, however, this seems an issue of principle...they have a contract to provide a benefit to us and they are making a medical judgement that it is not their place to make.
Has Dr. Marshall started any of the proceedings against them that he mentioned considering? Is there something we could accomplish as a group?
Last edited on Tue Mar 21st, 2006 10:54 by Suzanne
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Sarc 1990;lungs, arms, legs;Voltaren 75mg BID;off 2001;D1,25=38; D25=19 elim. Vit D 1/06; Beni q6h/use NoIR's 2/06;Detrol LA 4 mg od; Allegra 180mg od; Prevacid 30mg/day; 6/06 D25=14;begin Ph 3 12/06;5/08 D25=5
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Dr Trevor Marshall
Research Team
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Posted: Tue Mar 21st, 2006 11:16 |
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Suzanne,
No, they are not making "a medical judgement," they are making a commercial judgement. The medical peer-reviewed papers are in place, the FDA presentation is delivered and on file in the FDA Biosciences Library. I would file an appeal with your insurer, stating that my name was specifically used, and referring them solely to the FDA presentation in the FDA library and ask them what the heck their agent (Medco) is trying to achieve?
Marshall TG: Molecular genomics offers new insight into the exact mechanism of action of common drugs - ARBs, Statins, and Corticosteroids. FDA CDER Visiting Professor presentation, FDA Biosciences Library, Accession QH447.M27 2006
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