notdeadyet Date Rated: 9/30/2015 12:05:43 PM
Think of the worst government bureaucracy you've ever encountered - wrong information, long waits, mistakes, delays - and you have MedicareBlue Rx. In 2014 I was prescribed the generic drug duloxetine. MedicareBlue Rx covered it as a generic in tier 2, with a monthly copay of $18. In 2015 MedicareBlue Rx reclassified it as a brand-name drug in tier 4, with a monthly copay of $95. Wow. My doctor appealed for a tier exception under Medicare rules. Appeal denied, for the reason that there were no suitable drugs in a lower tier. My doctor appealed again, naming another drug. Appeal denied, this time for a different reason. Now the reason was that I had not tried all similar lower tier drugs. What? First, it was there were no drugs, now I hadn't tried them all. I appealed for an administrative law hearing, stating that duloxetine was classified in the wrong tier as a brand drug, when the drug is a generic, and naming three similar lower tier drugs MedicareBlue Rx had covered, that I HAD indeed tried, but that hadn't worked. I argued that trying three other drugs should be enough. At the hearing the MedicareBlue Rx representative told the judge that she didn't know why a generic drug was reclassed as a brand drug and she also repeated, wrongly (again), that I had not tried similar lower tier drugs. I won the appeal. MedicareBlue Rx is now required to cover duloxetine at the tier 3 price, saving me $73 per month. I applied for reimbursement for the 4 prescriptions I had bought at the tier 4 price. MedicareBlue Rx has only reimbursed me for one. I am now having to appeal to get the other three reimbursements. At first, I thought MedicareBlue Rx was run by incompetents, but the company tries too hard to say no. Now I believe it's run by people who are not ethical. This is not the insurance to buy!
All these appeals, the research, my phone calls, writing, took hours and hours. This is not the insurance plan to get!