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Payment Hassles with Caremark regarding Raptiva
from Nancy M.

Has anyone has a problem with paying for Raptiva? 

A little over a year ago, I was put on Raptiva.  My company has a distribution center (Caremark) that distributes the Raptiva and then pays Genentech or the drug company.  Several weeks later I received a bill for $900.  I totally freaked out.  I was not told it would cost $900. I called Caremark and a nice lady there worked with me to get the assistance card from Raptiva, as I could not afford this medication.  Not long after that, my derm took me off the Rapitiva and it was taken off the market. I threw out the portion of Raptiva that I could not use and worried about the effects it could still have on me. During the last year, I continued to be billed for the $900 - but was told by Caremark not to worry about it, they would put the billing back through. Now, a year later, Caremark is telling me the drug company will not honor my assistance card because it was obtained "after" I received the first shipment of Raptiva. Caremark also said they are turning the bill over to a collection agency! 

Has anyone else had difficulty with this? 

1. I was not informed the shipment would be $900.00 

2. I qualified for the assistance card as soon as Caremark applied for me, so why shouldn't it be retroactive to that first shipment? I would have qualified earlier. 

3. Why would I have to pay for a drug that was taken off the market?   Even if I used part of the first prescription – it was determined by the manufacturer to be a dangerous drug. 

I am a single, 60-year old lady. trying to retire and take care of my elderly folks. I feel it is wrong for the drug company to "not" refund Caremark for a drug they had to take off the market. I feel it is wrong to have to pay for the drug.

Can anyone advise me? Is this a lost cause? Do I need to pay the $900 because I have no options? 

Any advice or guidance would be appreciated.  -Nancy M.

*****

Ed’s Response: It sure does sound like you're being “drug behind the truck” on this one, Nancy. If you haven’t already, please do contact the National Psoriasis Foundation about assistance with this. It would seem to me that Caremark has dropped the ball badly in your case. And now they’ve relegated you to a nagging piece of paperwork, which should be criminal.

If you can, collect any and all paperwork and/or notes you can find that relate to your prescription and its fulfillment – including asking Caremark for a COMPLETE statement of your account with them. They will want to argue that you are not paying because the drug was pulled off the market, at no fault of their own. You will want to argue that you thought you had this co-pay covered (or at least reduced) by applying for and obtaining an assistance card from Genentech, and you would not have accepted the drug if you had known you would be required to pay $900. Then, call NPF at 800.723.9166 and start with the ‘insurance help’ office.

Good luck to you! Meanwhile, posted at FlakeHQ soon, we may hear from others who have survived similarly ghastly experiences. -Ed

***

Nancy’s Response: Ed, Great News! I contacted the NPF per your advice.  Oh my goodness! Bethany at extension 550 is incredibly knowledgeable and helpful.  She contacted Genentech and they are going to reimburse me!

Sweet! I am sending Genentech my bill, and they are sending me a check, and I will pay Caremark. I sent an email to Caremark on March 19th asking them to note in my file that I was working with the NPF and Genentech to resolve this issue.  Today when I sent them a note regarding the reimbursement coming, my contact responded that she would send her supervisor a note to remove my bill from collections.  I was not pleased with this. I sent her an email requesting confirmation when this happens, and reminded her that I'd sent the email on the 19th to avoid it being turned over. In an email response from her, she stated: “[W]e cannot remove from status of collections, just because the customer told us that they are working on the claim with a foundation. This does not guarantee that Caremark will be getting paid for the date of service. However your email was sent to me today stating that it will be paid. We will be removing it from the collections status for 30 days, this email will be your only confirmation.... So this does not guarantee that it will not go back to collections after 30 days.”

Caremark is still not very friendly. It's like they don't believe what I'm telling them. 

Anyway — just thought you would like to know how helpful your advice was.  Thank you! 

Kind regards, -Nancy M.

*****

Ed’s Response: Thanks for sharing the good news, Nancy. It sounds like Caremark is taking a normal course of action trying NOT to get in battles between pharmaceuticals and patients while protecting their own investment in rendered service. They could be nicer about their interaction with you, but I think they were being honest about their untenable position in the dispute. Regrettably, these are the kinds of issues that arise in our ever-more-complicated pharmaceutical delivery systems when exceptions to the way things are supposed to work occur. In your case, Genentech was trying to do everyone a favor with the co-pay purchase cards, then the relatively sudden removal of Raptiva from the market changed everything. Caremark was not very diligent in letting you know your co-pay would be $900, but then everybody breathed a little easier when the co-pay purchase help seemed forthcoming.... All unfortunate, but NPF was able to intervene and I sincerely hope their arrangement will unfold within 30 days, so you don’t have to get those nasty letters from collections again.  If you do, give Bethany another call. ;) -Ed

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