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ewood3
LIF Zygote
Member since 1/12 3 total posts
Name:
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NYC Teachers - PICA
Hello,
I am a NYC teacher starting a cycle of injectables (Follistim), but I am very confused as to how this is paid for by insurance.
I know the UFT Welfare Fund / Medco does not cover this medication, but on the GHI website, it says that injectables are paid for by the NYC PICA program through Express Scripts.
Is the PICA program run through GHI? Do you receive a "PICA" card with an identification number on it for receiving prescriptions? I tried calling Express Scripts to figure out more about this, but I felt like I knew more than the service representative. Similarly, GHI was of little help over the phone.
Any clarification would be incredibly helpful. Thank you!
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Posted 1/24/12 9:27 PM  |
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Daisy21
My Little Loves
Member since 6/10 1133 total posts
Name:
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Re: NYC Teachers - PICA
You would need to order your meds through Freedom Pharmacy. Be sure your doctor knows to order your meds through them. They are great, but also the only company we are allowed to use. All the insurance reps are useless. When you talk to Freedom, give them all your insurance information and they will get it covered. It is covered through GHI/PICA but it is very difficult to get someone that knows that when you call.
When you order your meds, be sure your doctor orders you the maximum quantity. We are only allowed 3 fills of each medication per lifetime. So even if you only need two follistim pens, make sure they order you 8 or 10 (whatever is the max) in case you end up needing them for additional cycles. The copay will be the same.
Good Luck!
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| Posted 1/24/12 10:09 PM |
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gina409
TWINS!
Member since 12/09 27635 total posts
Name:
g
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Re: NYC Teachers - PICA
Posted by Daisy21
You would need to order your meds through Freedom Pharmacy. Be sure your doctor knows to order your meds through them. They are great, but also the only company we are allowed to use. All the insurance reps are useless. When you talk to Freedom, give them all your insurance information and they will get it covered. It is covered through GHI/PICA but it is very difficult to get someone that knows that when you call.
When you order your meds, be sure your doctor orders you the maximum quantity. We are only allowed 3 fills of each medication per lifetime. So even if you only need two follistim pens, make sure they order you 8 or 10 (whatever is the max) in case you end up needing them for additional cycles. The copay will be the same.
Good Luck!
this! i found out about the refil after and meds r so freaking expensive!
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| Posted 1/24/12 10:59 PM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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Re: NYC Teachers - PICA
DH's a teacher and I'm on his plan. Call PICA directly at PICA-800-467-2006. Give them your UFT info and they will give you a PICA ID# and card. When you give your insurance info to your clinic to order your meds...give them your UFT Medco Insurance info and your PICA # for injects. I go through Freedom Pharmacy. I think when I first spoke to PICA they said I had to use Express Scripts...but that was not true.
BTW...since we are on the subject, I have been able to order 3 refills of Cetrotide and then get a prescription filled for Ganerilix. Does anyone know if PICA will allow me 3 refills of Follistism even though I've reached my limit on Gonal-F?
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| Posted 1/25/12 1:02 AM |
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ewood3
LIF Zygote
Member since 1/12 3 total posts
Name:
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Re: NYC Teachers - PICA
Thank you so much for your reply. All of this information is incredibly helpful!
Just wanted to check - do you have to have the Optional Rider to take advantage of the PICA program?
Thank you again!
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| Posted 1/25/12 11:45 AM |
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Daisy21
My Little Loves
Member since 6/10 1133 total posts
Name:
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Re: NYC Teachers - PICA
Posted by ewood3
Thank you so much for your reply. All of this information is incredibly helpful!
Just wanted to check - do you have to have the Optional Rider to take advantage of the PICA program?
Thank you again!
Nope, everyone has it.
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| Posted 1/25/12 12:01 PM |
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Daisy21
My Little Loves
Member since 6/10 1133 total posts
Name:
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Re: NYC Teachers - PICA
Posted by classc1
DH's a teacher and I'm on his plan. Call PICA directly at PICA-800-467-2006. Give them your UFT info and they will give you a PICA ID# and card. When you give your insurance info to your clinic to order your meds...give them your UFT Medco Insurance info and your PICA # for injects. I go through Freedom Pharmacy. I think when I first spoke to PICA they said I had to use Express Scripts...but that was not true.
BTW...since we are on the subject, I have been able to order 3 refills of Cetrotide and then get a prescription filled for Ganerilix. Does anyone know if PICA will allow me 3 refills of Follistism even though I've reached my limit on Gonal-F?
I was told that it might work. I never needed to try it, but the woman at Freedom said sometimes it works. I hope it works for you!
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| Posted 1/25/12 12:02 PM |
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ewood3
LIF Zygote
Member since 1/12 3 total posts
Name:
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Re: NYC Teachers - PICA
Thank you again everyone!
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| Posted 1/25/12 12:50 PM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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Re: NYC Teachers - PICA
Posted by Daisy21
Posted by classc1
DH's a teacher and I'm on his plan. Call PICA directly at PICA-800-467-2006. Give them your UFT info and they will give you a PICA ID# and card. When you give your insurance info to your clinic to order your meds...give them your UFT Medco Insurance info and your PICA # for injects. I go through Freedom Pharmacy. I think when I first spoke to PICA they said I had to use Express Scripts...but that was not true.
BTW...since we are on the subject, I have been able to order 3 refills of Cetrotide and then get a prescription filled for Ganerilix. Does anyone know if PICA will allow me 3 refills of Follistism even though I've reached my limit on Gonal-F?
I was told that it might work. I never needed to try it, but the woman at Freedom said sometimes it works. I hope it works for you!
Thanks..it worked for me with the Ganerilix/Cetrotide...I was shocked...so MAYBE it might work with Follistism..we shall see. BTW...you were the one that helped me when I first came on here and had no idea how to get injects approved or under what program!! Thanks!!
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| Posted 1/25/12 4:58 PM |
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