We've called the benefits department for Christian's employer 4 times in an effort to get an exception to use Biorx (our current specialty pharmacy). The first time they wouldn't talk to me because I'm not the employee. The second and third times the people Christian contacted were out of the office. The fourth time they told us that they don't give exceptions, and that we had to file an appeal with Express Scripts (our prescription drug plan).
I called Express Scripts 3 times last night. The first time my phone dropped the call and they didn't call back. The second time I was told that I had to go through Accredo (Express Scripts' specialty pharmacy) to get any information about how to continue using Biorx. Then I was transferred to Accredo, and they didn't know why I was trying to get any information from them because they are just a specialty pharmacy. The third time I called the woman I talked to was very helpful. Even though she didn't know exactly how to get the answers I was looking for she took the time to find the answers for me. The answer is that Accredo is the only specialty pharmacy that we can use and have Fiona's treatment and supplies covered.
I also talked to our rep at Biorx. She told me that they tried a test claim and it came back as zero pay. Express Scripts later told me that it had been rejected. One of the reps at Biorx did some research and found out that Indiana insurance code says that any healthcare provider (doctor, hospital or pharmacy) that is willing to accept the insurance company's terms has to be accepted into the provider network. I've contacted the state's department of insurance to see if they can help.
I used Fiona's last dose of Hizentra for her infusion yesterday. That means we have to order from Accredo to get her medicine for next week's infusion. I really wanted to avoid that. I'm disappointed that it didn't work out, and that it took more than a week to get the answers we are looking for.
The good news is that she is currently healthy. We can get her treatment. We have the ability to go back to an IV treatment in case something goes wrong.