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Dr Trevor Marshall
Research Team
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Posted: Sat Aug 14th, 2004 00:06 |
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| Please look at the message in the "Announcements" section above, this message is merely to remind you to look up at the top of this forum for information re MEDCO
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Dr Trevor Marshall
Research Team
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Posted: Sat Aug 14th, 2004 05:01 |
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I forgot to say that Medco looks after claims for Blue Shield, Blue Cross, and a host of other insurers, so you may not know which company refused your claim unless you look carefully at your insurance card. If it says "MERCK" or "MEDCO" then please contact me.
Medco administers prescription benefits for 60 million Americans, according their website:
http://www.medcohealth.com
So some of you almost certainly have been denied by Medco, even if you thgought you were dealing with "Blue Cross", or another insurance company. They subcontract the (cost-cutting) work to Medco.
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Admin
Administrator
| Joined: | Sat Jul 10th, 2004 |
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Posted: Wed Aug 18th, 2004 19:57 |
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| Bumping back up
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Rich
inactive member
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Posted: Fri Dec 10th, 2004 02:00 |
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In December 2004, I tried to fill my new prescription of benicar to begin the Marshall Protocol to treat sarcoidosis, under the care of a physician in Washington state. However, Medco refused to cover benicar for use under the Marshall Protocol. The Medco representative who called about it said that the company's attorneys determined that there is not enough known about possible impacts of long-term use of benicar at the required dosage. Our healthcare coverage is through Premera Blue Cross, with the prescription drug coverage through Medco.
Rich
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Rich Sarcoidosis 3/03 "remission" 5/04 MP 12/05
12,5-D 50, 25-D 40. Benicar 4X40 mg/day. 100mg mino 3/9/05, Phase 2 3/26 05,25-D22,1-25D 53: 8/15/05 25-D 27,1-25D 45.Phase 3 2/1/06 25-D 15
1-25D,29 Under care of MP literate Dr. Benicar 3X40 mg/day
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madwolf
Health Professional
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Posted: Wed Dec 15th, 2004 10:55 |
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Rich,
You have the option of taking the script to your local pharmacy and getting it filled there. You will pay a higher co-pay, but you can get it filled.
Don't believe their BS when they tell you that stuff. They don't believe it, either. It is all about money. It cost's them money to honor these scripts, and they don't like that. Remember that Merk-Medco is in business to make money for their share holders. The only way they can do that at the ridicuously low price they charge your insurance company is to say no to anything that is not generic. You can say "Thank you" to our Insurance Commissionar here is Washington. Hopefully, she lost her bid to become AG, but I doubt it, the People's Republic of King County is too highly populated to be offset by the rest of the state.
madwolfLast edited on Wed Dec 15th, 2004 10:56 by madwolf
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Dx: Psoriatic Arthritis, FMS/CFIDS, Raynaud's Restarted Phase 1 in Noremember 2007 Current 25-D is 35, Non-MP meds: Armour thyroid, 60mg qd. Cymbalta, 60mg qd. CoReg CR 40mg hs. (BP still stable) Januvia 100mg qd, Byetta 10 mcg sub-q bid.
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Paula Carnes
Banned
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Posted: Thu Dec 16th, 2004 19:34 |
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Mad Wolf,
You wrote:
You have the option of taking the script to your local pharmacy and getting it filled there. You will pay a higher co-pay, but you can get it filled.
My experience was just the opposite. My local pharmacy was not allowed to fill the Benicar but when my doctor contacted Merk Medco mail order they filled it with no questions. Who knows.
Paula Carnes
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Arlene
inactive member
| Joined: | Tue Nov 16th, 2004 |
| Location: | New Jersey USA |
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Posted: Wed Jan 5th, 2005 18:42 |
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I have Medco and UnitedHealthcare. UHC is being difficult just in general with reimbursments. I have been lucky that my husband's company has an health care advocate service which has walked me through the steps to reimbursment.
Medco had refused all but 1 month's supply of Benicar when I originally handed in the script. To make a convoluted story short, when we called for clarification, the pharmacist was told one thing, I was told another and the Doctor's office was told a third different way to proceed to resolve the difficulty. I called the advocat group and they were disturbed.
It ends up that Medco can only fill 34 tabs per 24 days each cycle and then needs authorization from UHC to fill for any additional tabs. The Advocat's group contacted UHC and I did an appeal. UHC may not pay for any of the money I already spent on Benicar even if they rule for me, because I purchased before the ruling. Great. That was on 11/27/04. The appeal should take 2 weeks, BUT this IS the holidays, UHC said. No reply yet. Arlene
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CFS'93,Lyme/Borreliosis'02,hypothyroid,restless leg, sleep distb, Synthriod,Mirapex,Ambien,DHEA. 12/2/04-Benicar q6h, Mino start 12-31-04, Quercitin Q8H, 1,25D/D 11/04-68/18, 1/05-40/28, 9/05-14/9 PhaseII 4-19-05
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Paula Carnes
Banned
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Posted: Thu Jan 6th, 2005 18:11 |
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Arlene, we have Medco mail order prescriptions with Blue Cross. My husband and I have had no problem getting a three month supply by mail. We cannot get it at all using our local pharmacy. They are not allowed to fill the amount we need for the MP. I do not understand why some have a problem and others, like myself do not.
We have now used 3 different doctors and upped my dose to 4 a day and still no problem.
I wish I could help you. I am probably just adding to your confusion.
Paula Carnes
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Arlene
inactive member
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| Location: | New Jersey USA |
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Posted: Sun Jan 9th, 2005 21:33 |
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Hi Paula, Are you saying that you get 3 months of Benicar or 120 40mg tabs x 3 = 360 tablets, they send that to you? WOW! Considering how much I pay now that would be a very good thing. Arlene
Last edited on Sun Jan 9th, 2005 21:38 by Arlene
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CFS'93,Lyme/Borreliosis'02,hypothyroid,restless leg, sleep distb, Synthriod,Mirapex,Ambien,DHEA. 12/2/04-Benicar q6h, Mino start 12-31-04, Quercitin Q8H, 1,25D/D 11/04-68/18, 1/05-40/28, 9/05-14/9 PhaseII 4-19-05
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Paula Carnes
Banned
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Posted: Sun Jan 9th, 2005 23:36 |
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Yes, I use the mail order service of Medco and they send three months' supply. It costs around $60. I don't know why this has worked for my husband and me. We have insurance with Blue Cross/Blue Shield of South Carolina where my husband was a state employee and is now retired but still covered.
We cannot get Benicar at this dose level from the local pharmacy where we fill all our other prescriptions. We have to use the mail order provider. My Lyme doctor did call Medco when I first got the prescription filled. Then my husband's doctor did the same - one doc is in PA the other in NV, so it doesn't seem to be where the doctor is but where the provider is.
It's a mystery. Wish I knew some way to help you. I think Dr. Marshall has talked with Medco and can't figure out why some of us get service and others don't.
Paula Carnes
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Dr Trevor Marshall
Research Team
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Posted: Mon Jan 10th, 2005 00:30 |
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I am still following up on how to deal with this Medco issue. I am hoping that I can get someone from the FDA to speak at our upcoming conference so that we can get all the issues explained.
I am continuing to work on other possible resolutions, but at this point Medco does seem to be fairly random with how they deal with applications. Maybe it depends on whether Medco feels it can prevail in arguments with any particular Doctor. I just haven't seen a pattern yet.
Meanwhile, the obvious thing is to beat every bush by trying various pharmacies (including some of the smaller chains, like "Medicine Shoppe") to try and make sure you get the best deal.
..Trevor..
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Arlene
inactive member
| Joined: | Tue Nov 16th, 2004 |
| Location: | New Jersey USA |
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Posted: Tue Jan 11th, 2005 00:59 |
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| Dr. Marshall and Paula, I will call Medco about the mail order route and let you know what happens, random isn't it? Arlene
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CFS'93,Lyme/Borreliosis'02,hypothyroid,restless leg, sleep distb, Synthriod,Mirapex,Ambien,DHEA. 12/2/04-Benicar q6h, Mino start 12-31-04, Quercitin Q8H, 1,25D/D 11/04-68/18, 1/05-40/28, 9/05-14/9 PhaseII 4-19-05
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pls
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Posted: Tue Jan 11th, 2005 03:08 |
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My insurance is with Blue Cross of Florica and, of course, Medco. I was just unable to fill a one month prescription for Benica at the 4 times a day dose.
I was going to wait to see how this played out before sending in a mail order prescription. But given what I read here, I'll send in for a 3 month supply tomorrow.
++PLS
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Dr Trevor Marshall
Research Team
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Posted: Tue Jan 11th, 2005 06:28 |
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Please let me emphasize. the FDA DID NOT SET A MAXIMUM DAILY DOSE. This 40mg number is a figment of MEDCO's interpretation, not what the FDA wrote in the prescribing information.
In fact, the graph in the prescribing information goes to 80mg, and the safety officer commented that the safety data appeared fine at 80mg, but limited to trials shorter than a year duration. Some of the safety studies cited by the FDA go to 320 mg (single dose).
Precribing instructions:
http://www.fda.gov/cder/foi/label/2002/21286lbl.pdf
Complete FDA file:
http://www.fda.gov/cder/foi/nda/2002/21-286_Benicar.htm
..Trevor..
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Reenie
inactive member
| Joined: | Wed Jul 21st, 2004 |
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Posted: Tue Jan 11th, 2005 14:48 |
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pls, Paula,
The reason you may have a problem filling an rx for one month, but may not have a problem sending in for mail order, (like I do) for a 3 mo supply may be due to the fact that:
1) when an insurer has rx insurance coverage and a mail order available, it costs them less to have you get your rxs thru most mail order services they provide, although I've had many rxs that I would have preferred to try first, for one month, since I ended up not continuing to take them.
2) your insurer may require you order all rxs thru a mail order that you will be taking daily, such as Benicar. I know I must send in all daily dosed rxs to my mail order service or my insurance will NOT pay for them.
3) the only meds I can take to a local pharmacy are short duration rxs, such as an rx for a week or two duration. For ex, something written to take for a specific infection or condition which would most likely not be renewed. If a renewal is required, they only cover one or two, then send me a letter stating they will NOT pay for this rx again unless I mail order it.
None of the above points made had anything to do with the dosing of the med. The first time I tried to get Benicar filled, via mail order, they phoned the Dr for an explanation. Once he explained the reason for the dosing, which he did, (to help lower my 1,25-D levels) the insurer approved and paid for the rx, since the pharmacist had NO disagreement w/filling the rx, as per the Dr's explanation, although he didn't really understand the Dr's reasoning, but didn't feel it was unreasonable since the Dr seemed to know what he was ordering and why.
BTW, I always get the Dr to write an rx for the 3 mo supply w/3 refills, making the rx available w/refills, without a new rx for one yrs supply. This way, I have NO problem once my rx is approved the first time.
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Paula Carnes
Banned
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Posted: Tue Jan 11th, 2005 18:22 |
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I have no problem filling any prescription at my local pharmacy. This includes massive doses of antibiotics in the past, and daily meds I have taken for years.
I was not able to fill Benicar at the dosage needed for the MP. But when our doctors called Medco and placed the prescription by phone, the doctor only had to confirm that the dose requested was correct. We have had no problem since. I don't fill any other prescriptions by mail, but I should because they are cheaper.
This is the toll free number on my Medco paperwork if some want to call. PLease do not mention me. I don't want to lose my prescription. LOL
800-711-3450 Do ask if this is the national number or just for South Carolina. I do not know.
Paula Carnes
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Ike
inactive member
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Posted: Wed Jan 19th, 2005 01:35 |
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I have been buying Benicar and paying for it myself, (which I can ill afford to do).
The Veterans Administration supplies me with some drugs. The pharmacist there says they do not carry it but substitute something else. That,
however, the doctor (nurse practioner) could probably get it for me if she so chose. Do you know of anyone getting Benicar from the VA?
Might you be able to recommend information that might be helpful for my doctor to put in my chart if I were to go talk to the nurse at the VA about this?
Thanks -- Ike
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1,25 D 42 25 D 18 ArmourThyroid150 mg,Selegilene5mg,Neurontin600mg3x,L-Serine,PercocetAmbienPRN,vitE&C&minerals,CoQ10,NeuroPS,Benicar 4x40,Quercetin, Mino 11-15-04 25mg.
FMS,MCS,CFS, Pelvic pain
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Dr Trevor Marshall
Research Team
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Posted: Wed Jan 19th, 2005 07:15 |
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There is nothing that can substitute for Benicar. It is unique in its ability to deal with immune disease. You might print out our paper at JOIMR, at this link:
http://www.joimr.org/phorum/read.php?f=2&i=53&t=53
..trevor..
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Sue from St. Louis
Member in Phase 2
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Posted: Sun Jan 23rd, 2005 00:58 |
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Carol in St. Charles, MO told me to let you know that Medco has just refused to fill a new RX for Benicar despite the fact that I have been getting it from them for over a year. The person who called me was Glen Melick (800-999-8825 EX 5563). He informed me that Medco has decided not to fill the RX at the high dosage until they have "efficacy and long-term studies" as to its safety at such high doses. He said they were "familiar with" the MP and "not convinced" that Benicar is safe or effective in the treatment of sarcoidosis.
I was furious and gave him a piece of his mind. Since our benefits are through Deimler-Chrysler (husband retired from there), we plan to contact the Union and the Union's lawyers.
Can a pharmacy refuse to fill a doctor's RX legally? I checked with Walgreens and it would cost me $280 a month for the Benicar instead of $5 for 3 months supply. This is totally crazy. Any help you can give would be appreciated.
Sue in St. Louis
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Sarcoidosis/CNS 1,25D48, D2511, MP 9/06, Mod Ph2 11/07 Synthroid, Diclofenec, Cymbalta, Wellbutrin, Lasix (as needed), amitriptyline, NOIRs, cover-up, low lux home
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Dr Trevor Marshall
Research Team
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Posted: Sun Jan 23rd, 2005 01:16 |
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Sue,
I have sent copies of the FDA safety data to Medco's Corporate lawyer, but Medco is ignoring that FDA data. Hopefully Daimler-Chrysler will intercede. You might point out to DC that the alternative "therapy du jour" for Sarcoidosis is Enbrel/Remicade, at over $1000 per month, and that is not curative.
You might also FAX DC a copy of the upcoming conference brochure 
..trevor..
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