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Medco stopped my valcyte and valtrex: Anyone else??

Discussion in 'Antivirals, Antibiotics and Immune Modulators' started by KC22, Dec 21, 2010.

  1. KC22

    KC22 Senior Member

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    I received a call last week where Medco informed that they will not fill my valcyte, valtrex or doxycyline anymore. The reason they gave me for the valcyte and valtrex was it was a drug not approved for my illness. I have heard of that before, but don't understand why they did it for 3 years and then suddenly stopped it.

    The other really shocked me. They said I had been on doxycyline for 2 years and could become resistant to the drug. I have a severe mycoplasma infection and my labs still show an infection. He said they would not fill it.

    Any ideas?
  2. August59

    August59 Daughters High School Graduation

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    I don't see how a pharmacist can refuse to fill a valid prescription. I can understand if he had question and consulted your physician, but the physician should have the greater authority. I'm geussing here, but I suspect that the pharmacist may have gotten orders handed down by insurance company (provided you are using insurance). Still, there should have been a letter sent at least 30 days ahead of time so that you could have adequate time to resolve this before termination prescriptions.

    I think I would have a lawyer call them as their handling of this poses a life threatning situation.

    Good luck and please follow-up with how this transpires!
  3. August59

    August59 Daughters High School Graduation

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    I spoke with my pharmacist today and explained your situation as you worded it. Acting solely as the pharmacist they do not have the authority to refuse the filling of your prescription. My pharmacist said that your pharmacist probably had concerns and checked with your insurance company which declined. My pharmacist said that your insurance should not have declined it, since you was already taking the medication, without giving you written notice.
  4. Anika

    Anika Senior Member

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    I know of another CFS patient who ran into problems with Medco, getting her long term prescription filled (I think it was Valtrex, definitely was an antiviral) - I think it was last year or may have been the year before. I was concerned because I also had Medco as part of my insurance then and was looking at doing an antiviral treatment (backed up by a series of test results). She did get some sort of letter from Medco, the reasons were generally similar to what you described. But, after her doctor wrote them back she was able to continue getting her prescriptions filled.

    It did make me cautious about starting a treatment if there's a possibility I would have trouble continuing due to insurance problems. Also, it shows how important it is to have doctor who will follow up with the insurance company if needed.
  5. KC22

    KC22 Senior Member

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    I was given a name of an attorney who works with this problem I hope. I just called and he is in court. I am going to be following up with this now. I did receive a letter from Medco saying as per our conversation on the phone these medications will not be filled: valcyte, valtrex and doxycycline. I am going to write and ask for the reasons in writing. They are putting nothing in writing. The pharmacist said since I can become resistance to doxycyline, they will not fill out. I asked him if he was my doctor because he sounded like he was. He said no, but told me I can't get the drug.

    When I called Dr. Lerner's office, nurse told me that this has been happening since last Jan. and she is getting about 1 call a day where they are denying the prescriptions.
    Dr. Lerner's protocol are these types of medications. I was waiting until after Christmas before I take this on. I am going to look for Dr. Lerner's and any other studies where it has been shown to help. I think this is just the beginning of our new health care. The insurance companies are going to be coming up with ways to cut to pay for the health care. You know they are going to keep their profits...
  6. Timaca

    Timaca Senior Member

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    I would suggest that you check your insurance policy. If it does not limit the amount of time you can get a drug, they you can likely still get the medication. Read your policy....get their denial in writing, then appeal their denial by writing back. If necessary, have your doctor write a letter stating why you still need the medication.

    Best, Timaca
  7. KC22

    KC22 Senior Member

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    Thanks, Timaca.. I decided not to call them. I need everything in writing. I will write them and ask for their denial in writing and then work from there. I don't know if Dr. Lerner is fighting the insurance companies; at least that is how it sounded on the phone when I called his office. I see him Feb 2nd so I will be asking about it.
  8. Timaca

    Timaca Senior Member

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    Keep copies of all your correspondence. Consider sending your correspondence with some kind of tracking so you know when they got it. State in your letter that you expect a reply in 30 days.
    Good luck.
    Timaca
  9. Anika

    Anika Senior Member

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    Thanks for keeping us posted. This is important for us to know.

    Quite a lot of the business of pharmacies is for "off label" uses. It's a slippery slope when they start denying common drugs for some off label uses, but not others.

    One question or idea: have you tried filling the prescriptions through a local pharmacy vs Medco? I seem to remember doing this once when I ran into a hassle with the mail order pharmacy.

    Please let us know what you find out from your attorney.

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