9 Oct, 2018 → by ClaimboUser957022
Prior & post authorization fails, Massachusetts
Just trying to refill asthma meds (Dulera) that I've been on for last 6 years, and because its not on there limited list of covered meds, had todo prior authorization with doctors office 4 times because they claim never got it (I was at office in person and watched them place the pa.). Then get letters in mail stating no generic avail and to tell me (not suggest) other drugs that I tried 6 years ago by THERE doctor that does not have my prior medical history and never examined me or reviewed my recent blood work, then lies by saying according to there records, I've been sent the older non-effective meds which never happened, Doctors office then appeals this decision and wait months. Then they sent another letter stating its been approved but they don't send approval to original care mark pharmacy and its still not filled. Call them both and then Pharmacy tells me the price which is more that buying without insurance. They deny this so that you won't ever make the deductible. Why deny all this if your not going to cover it anyways. 2nd issue now is with a very expensive drug called Fasenra, I had all authorizations approved, did the 3 month dosage and now tufts will not approve and let the maintenance refill go through. They simply just do not respond to the order. Not what you expect for a 15K a year multi member plan is it? Deny, Delay and Disclaim all.