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Author Topic: Anyone having problems getting Synvisc Injections Approved through Medco?  (Read 2820 times)

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Offline SmplySweet1021

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One of my last options before knee replacement is Synvisc injections...we tried Supartz in 2007 and they didn't work. I'm 23 I would rather not have a knee replacement yet. Though my insurance and drug insurance (Medco) denied my injections, we've been trying to get them put through since Thanksgiving and to no avail. Funny thing is, we never received a letter that they had been rejected.

We will now have to pay out of pocket anywhere from $400-1,000 to get the synvisc injections. Wasn't sure if anyone else was having this problem? My doctors office has been amazing and they have been trying also on their side to get these through. I was told I'm already the 4th patient that has been rejected this year alone.

We are going to try another cortisone shot and hope that holds, last time I had about 4 months of slight relief and then full blown pain came back.
2005 - Blown PCL & LCL due to Riding Accident, Surgery to repair
2006 - New Surgeon due to Problems
2007 Scope & 2 non dissolving screws still in knee
Supartz, Synvisc, Cortisone injections- Didn't Work :-(
Grade 3 Osteoarthritis at 24 yrs old

Offline debbieo

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Re: Anyone having problems getting Synvisc Injections Approved through Medco?
« Reply #1 on: February 02, 2009, 08:56:19 PM »
Ok--here's the deal. Medco is not your answer.  I have medco also. They rejected me. You have to go back to your ins co (I have United)
and they are the ones who OK this. Not Medco. But you have to get to the right person not the one on the phone that normally talks with you. In customer service you ask for a supervisor, that person will typically have the right answer and they will send the info to the Specialty Pharmacy which is medco--CVS Caremark. Be sure you write everything down customer service person date, supervisor, date.
Orignially I was told the supervisor would call me but did not. I recalled and got an quick response. He said the info that you need is not clear to customer service reps.
Here is a phone number that might help you. It goes to the specialty pharmacy for Medco. Now I cannot say this number will work for you and I will deny that I have ever heard from you  ;) 1 800 238 7828.
I just had my first injection 15 minutes ago. Heres hoping some pain relief. I will be surprised. I had a broken tp. Some arthritis has deveoped. But I really think I have an architectual problem  ???-which means knee replacement surgery in my future. My OS says I will tell him when.
Good luck and let me know if I can help some more
debbieo
tkr 9.14.09  tibia fracture 04
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http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=48797.0