CVS Can't Get Its Billing Straight, Tells Patient He Has To Pay For His Own Kidney Transplant Meds

Chris has to take the immunosuppressant drug Prograf because of a kidney transplant, and it costs nearly $300 for a one month supply. Yesterday, he found out that someone at CVS corporate has instructed his local pharmacist to start billing him directly, apparently because his secondary insurer hasn’t been paying for nearly two years.

The pharmacist on duty at CVS tells me they got a call from CVS Corporate, instructing them to bill only Medicare B (B pays 80% for imunosuppressants) and to “not” bill secondary insurer N.J.P.A.A.D. (New Jersey Pharmaceutical Assistance to the Aged and Disabled), but to bill me instead. $296.47 for 1 month supply of Prograf.

The pharmacist said it is because P.A.A.D. has never paid their portion for the 21 months I’ve been on the medication.

I asked for a rejection printout and she told me they couldn’t do it because it will come out “APPROVED!!!” No name of who called. No printout. Just some ghost at CVS corporate.

To me, it’s a problem between CVS and N.J.P.A.A.D. Part of my kidney transplant evaluation was to prove that I could get my anti-rejection meds paid for. I know of people with full time jobs and what they thought was “good” insurance, get denied transplant surgery even though they had a donor only because they couldn’t get the meds paid for!

He wrote back this morning with an update:

P.A.A.D. tells me that CVS has been billing the entire amount instead of the 20%. P.A.A.D. will email CVS corporate and clear things right up! LOL I have 4 days of anti-rejection meds to hold me over.

(Photo: strangelv)