Wednesday, January 29, 2014

Verifying Shipment and Delivery of Specialty Drugs is Critical

I've said this before and I feel the need to say it again. If your baby is getting Synagis or any medication through a Specialty Pharmacy on a regular basis, be sure to be in contact with the appropriate entities about the order, shipment, and delivery of the drug well in advance of any doctor's appointments.

I talked with our pediatrician's office this morning to verify Emily's upcoming appointment and also inquired about her Synagis shipment. I shouldn't be surprised, since this is becoming the norm, but Emily's holy grail -- her Synagis -- has not arrived -- and again, the person who handles the shots is not in the office today. 

I called our Specialty Pharmacy (which is affiliated with our insurance company) and was shocked to learn that there is a hold on our account -- and that no medication will be sent out until payment is received. Synagis is a time sensitive drug and should be given every 28 to 30 days during RSV season. Although we haven't received any bills in order to pay any outstanding balances, I paid for the balance due over the phone so that Emily can receive her Synagis shot on-time. 

The Specialty Pharmacy customer service representative indicated that Explanation of Benefits have been sent out. Given my previous work experience, I know that an Explanation of Benefits is not a bill and mentioned this fact. The representative indicated that Explanations of Benefits are sent out in advance of bills and verified my home address for the future. Interestingly, our account was on hold, in part, for Emily's last Synagis shot which was administered less than 30 days ago. 

I am disappointed that we did not receive any correspondence or calls from our Specialty Pharmacy or our health insurance company about any billing problems. It appears disease management (and customer service) is on the back burner. One would think that a Specialty Pharmacy/health insurance company would be in close contact with its medically fragile customers when situations like this arrive in order to ensure that they are receiving necessary medications on-time to reduce the length of costly hospital stays. One would also think that a billing cycle would be at least 30 days.  


  1. Good thing you are so diligent about checking on the delivery status of Emily's Synagis. Keep on keeping her healthy!

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    2. Thanks, Cindy Jensen. Keeping tabs of specialty drugs is more challenging than I had ever imagined. One would think that more efficient processes would be in place to help ensure that medically fragile adults and children get the drugs they need when they need them most. That being said, we're doing everything we can to stay on top of it!