Can a mail order pharmacy legally do this??? (doctor, coverage, patient)
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I have been on a particular medication for 2 years. It is quite expensive (about $4000 a month) but due to a "copay assistance program" from the drug manufacturer everyone taking it can sign up for a zero copay card.
This medication never cost me a cent. Each month I would get a text telling me it was time to refill my med, and all I had to do was reply "yes." All was fine, until last month. Long story short, unbeknownst to me the copay assistance ended, and the specialty pharmacy, Accredo, is now billing me $1250 for my last shipment. I did not authorize this charge. I did not even have a credit card on file with Accredo because I didn't want a huge surprise like this to ever show up on my card.
I have spoken with several people at Accredo. I have asked them to show me anything proving I authorized that charge. Nothing was mentioned in the text message that the refill was no longer zero copay. (I have stopped all future refills for now).
I'm thinking of talking with an attorney just to see if what they are doing is legal. I cannot fathom that any company can legally ship an unreturnable item to a consumer, then tell them the unexpected price after the fact and demand payment.
Any thoughts on this?
I have been on a particular medication for 2 years. It is quite expensive (about $4000 a month) but due to a "copay assistance program" from the drug manufacturer everyone taking it can sign up for a zero copay card.
This medication never cost me a cent. Each month I would get a text telling me it was time to refill my med, and all I had to do was reply "yes." All was fine, until last month. Long story short, unbeknownst to me the copay assistance ended, and the specialty pharmacy, Accredo, is now billing me $1250 for my last shipment. I did not authorize this charge. I did not even have a credit card on file with Accredo because I didn't want a huge surprise like this to ever show up on my card.
I have spoken with several people at Accredo. I have asked them to show me anything proving I authorized that charge. Nothing was mentioned in the text message that the refill was no longer zero copay. (I have stopped all future refills for now).
I'm thinking of talking with an attorney just to see if what they are doing is legal. I cannot fathom that any company can legally ship an unreturnable item to a consumer, then tell them the unexpected price after the fact and demand payment.
Any thoughts on this?
It sure sounds rotten. I guess you found out how much it was when you opened the package? I'd be really pissed too.
I'm curious why their pharmacists never called you to tell you the manufacturer card ran out. Have you tried calling the manufacturer to see if they will help you out?
I'm not sure who you could call, or if the insurance commission in your state would help you out since it's a pharmacy. I think that would be my 2nd phone call to see.
I've never heard of Accredo specialty pharmacy. Their website doesn't say much except download their app to get started.
Did you signup with that Pharmacy to fill your prescription (you made the decision to use them based on personal reasons or insurance coverage) or were they assigned to you by the manufacture's co-pay program (the manufacture required you to use that pharmacy)?
I have used mail order pharmacy often and every time they require me to approve the shipment and they tell me what the cost is before shipping, because they bill me. I agree with contacting your state insurance commissioner.
You need to WRITE to your mail order pharmacy, sending the letter registered so you can prove they got it. Talking on the phone means nothing legally. Have they sent you and demand letters? Why go to the expense of a lawyer until they send you something official. It sounds like they are trying to scare you into paying for something that they screwed up by not notifying you about.
But the TEXT is just a refill notification with a rapid response. Customers are still required under their Terms & Conditions to view the prescription so they are aware of the current pricing, refills remaining and any other issue with the prescription. The TEXT is just a quick way to authorize the refill that was indicated on the Patient Portal. If a person has become so complacent that they just fat finger every text and fail to do what is required in the patient terms and conditions (Login and check the actual prescription and pricing) whose fault it that?
Another example is when you use a pharmacy's quick refill (such as the Kroger system), all you do is enter the prescription number and it's an authorization to refill it. Nowhere does it provide the pricing as that's your responsibility to check your account to see what is being changed, whose paying what and if covered or not under insurance. Many large pharmacy chain or mail orders have quick response systems where reordering is just a click away without any pricing information. That is why in order to use those systems, you have to agree to be responsible for monitoring your prescription status especially if using some non-pharmacy discount, incentive, payment or assistance program.
It's legal. If you're ever on a high dollar medication and are getting manufacturer or copayment assistance, be sure to find put how long the assistance program lasts upfront so you don't run into any surprises. These programs typically have time limitations and/or dollar maximums and run through the manufacturer. It has nothing to do with Accredo.Unfortunately these programs don't last forever.
Accredo just ships the medication that your physician prescribed. If the manufacturer or your health insurance declines coverage then unfortunately the bill is coming to you.
Did you provide Accredo with your health insurance info or is the $1250.00 balance after they already ran it through your health insurance?
The terms and conditions are always buried in the fine print somewhere. $1,250.00 is a deal considering you got $96,000.00 worth of medication for free for 2 years.
You might reach out to the manufacturer to see of they could extend the assistance for one more month since you were not clear on how long the program lasted.
Did you signup with that Pharmacy to fill your prescription (you made the decision to use them based on personal reasons or insurance coverage) or were they assigned to you by the manufacture's co-pay program (the manufacture required you to use that pharmacy)?
Accredo is who my insurance requires that I use for this particular medication.
It's legal. If you're ever on a high dollar medication and are getting manufacturer or copayment assistance, be sure to find put how long the assistance program lasts upfront so you don't run into any surprises. These programs typically have time limitations and/or dollar maximums and run through the manufacturer. It has nothing to do with Accredo.Unfortunately these programs don't last forever.
Accredo just ships the medication that your physician prescribed. If the manufacturer or your health insurance declines coverage then unfortunately the bill is coming to you.
Did you provide Accredo with your health insurance info or is the $1250.00 balance after they already ran it through your health insurance?
The terms and conditions are always buried in the fine print somewhere. $1,250.00 is a deal considering you got $96,000.00 worth of medication for free for 2 years.
You might reach out to the manufacturer to see of they could extend the assistance for one more month since you were not clear on how long the program lasted.
Yes, I said exactly that to my husband. But it is not feasible for me to continue the rest of my life paying that copay, so I'll have to see what my doctor suggests.
It still seems very sleazy that they didn't notify me of the amount prior to shipping the medication. In fact, I remember getting a phone call several years back from a mail order pharmacy (different one, different job & insurance) to tell me that they always notify the patient if the copay is over $200. I guess I wrongly assumed that was standard. And I definitely was wrong to assume that I was safe by not giving Accredo my credit card number.
What other business ships something to a customer with no payment on file, and without telling the customer the cost? I had no idea this was possible or legal. (Still not convinced it's legal)
Accredo is who my insurance requires that I use for this particular medication.
So you're saying the insurance company has told you they will refuse to pay a penny if you used any other pharmacy in the USA?
Quote:
Originally Posted by kayanne
It still seems very sleazy that they didn't notify me of the amount prior to shipping the medication.
But they did. On day one of you submitting the prescription there was a cost to you involved in that prescription. In your case, you were using insurance and/or a manufacture's assistance program to get it for nothing. So, it seems you never bothered to check what that prescription was costing you because by the time all the other assistance and payments were applied, your portion was $0.00.
Now you're complaining because after two years of not so much as trying to figure out what the prescription cost you every month. You have to realize that insurance and payment assistance programs are just payments being applied against the pharmacy charge, not that you are getting it free from the pharmacy. You were being charged an amount every refill by the pharmacy just someone else was paying the bill for you.
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