Last November I started researching prescription drug plans. After speaking with several companies, I chose Humana because it is a well-known company, the premium was reasonable, and I was assured that my husband's medication for diabetes would be covered.
I spoke with Mike Leone, Terry Holmes, Ramiro and Jessica, just to name a few, about the fact that my husband's prescription was Janumet. I was assured that while Janumet is not a generic drug, there would be no problem getting it approved by the company's Clinical Pharmacy Review Board. What a laugh!
I enrolled my husband in the middle of December and received confirmation by a letter dated December 27. Later, we received a letter dated January 7 saying that because we had not had a drug plan before, there would be a slight penalty each month (only for that year). That was something we could live with. A letter dated January 10 was received with details of his coverage.
Now comes the fun part. We started the process of getting Janumet approved. My husband's doctor faxed the prescription to Humana. On January 9, I spoke with Brian to set up shipping of the prescription every three months directly from their pharmacy, and I spoke with Tanieri at Humana about the forms to get Janumet approved. Humana faxed back a form to be completed, which the doctor's assistant completed on January 9.
On January 12, I spoke with Deana at Humana to see if the form had been received. It had not, so the doctor's office faxed the form again. On January 14, I spoke with Sandy at Humana to determine whether everything required had been provided. I was told that the form had not been received. The doctor's office faxed the form again.
On January 22, Robert at Humana said the form still had not been received. However, we did receive a one-month supply of Janumet with a notation that no more would be shipped until the proper form had been received.
The following people and the dates I spoke with them give you an indication of the effort I made to get Janumet approved: Nicole (January 24; the doctor's office again faxed the form after being told it had not been received); Jeannie and Veronica (January 25); Alisha (January 28); Latosha, Donnie, Esther and Deanna (January 30); Francisco (February 4), who said the form had been received and was being reviewed; and Danielle, Evy and Tina (February 6), when I learned that the form still had not been received despite being faxed by the doctor's office five times.
I spoke with the doctor's office on January 30 and was told they would fax the form again and then call to make sure it had been received, so there could be no further delays.
On February 12, I called Humana and spoke with Amanda, who transferred me to Sue. Sue confirmed that the form had finally been received but the authorization had not come through. I stressed the importance of getting this done since the medication was running out. I said that my husband had taken several drugs before Janumet and that Janumet was the one that worked. I told them that he really needs the drug. He already suffers from nerve damage in his feet due to uncontrolled diabetes.
Sue put me on hold for quite some time and then came back to tell me that Janumet had been denied. She said Humana was not convinced that enough other drugs had been tried. I explained that I had been told there would be no problem getting Janumet approved and that this was the only reason I had signed up with Humana. She said this was not the first time she had heard that. While Sue was very sympathetic, there was nothing she could do.
Needless to say, I am going to cancel Humana. Since the enrollment period has expired, there is little hope of getting another plan in place this year, though I plan to try.
I think it is terrible that representatives of insurance companies can tell someone something, have them enroll in a plan, and then completely disregard the information previously supplied. A patient's doctor should be the one to decide which medication is required. Diabetes is a terrible disease. When a medication is found that can control the disease, there should be no question of it being covered. Everyone knows the damage that can result when it is not controlled. Insurance companies are only in the business for the money. They try to push old and outdated drugs on the unsuspecting public with little regard for the effects.
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