Limited Use & Section 8!

I just recently started submitting my drug receipts to trillium drug plan for reimbursement. I’m still getting used to how their system works.

I have coverage through my place of work as well, however I do not have 100% coverage. Whatever my place of work does not cover will go through trillium. Once I’ve paid my quarterly deductible, trillium will reimburse me for the rest of my drug costs.

I had mailed my official drug receipts to trillium for evalutation. About 2 weeks later, I got a response in the mail in an 8 x 11 envelope. In many cases, receiving a large envelope is good news (ie when you apply for university and you’re receiving an acceptance letter). In this case, this large envelope was basically telling me that I needed to obtain a limited use form and/or a section 8 in order for my cellcept and omeprazole to be covered under the plan. For limited use, I have to fit under a certain criteria in order to be eligible to receive coverage for that drug. For example, the omeprazole for me is covered under limited use because of the reason I’m using it (for my stomach/reflux,etc.) So basically what I’m going to do is forward to them a copy of a new prescription for that medication, where on the prescription my doctor wrote a limited use code and also stated that this applies for my previous omeprazole prescriptions as well.

When if comes to cellcept, I do not fit under the stated Limited Use criteria. It states that I can be covered if I have had a transplant, and it lists different types of transplants. But I don’t have a transplant….I’m taking it because I reacted badly to cyclophosphamide. This is where the section 8 comes in. My doctor has to fill out this form requesting that trillium allow me to receive coverage for this medication because I cannot take cyclophosphamide due to the side effects and negative reactions I’ve had to it. I now have that letter as well, so I have to forward that to an individual review board, where they review my doctor’s request and then say “Yes” or “No” to his request with an explanation.

I’m going to scan both the prescription and also the section 8 form and email them off, as that is one of my options (wee, technology! Hopefully that means it won’t take FOREVER!)

I hope everything works out well. I don’t want any more delays….nor do I want to have to beg my doctor to write me another note. I feel like I bother him and my nurse Rose so much! It would also be nice to get back some of that moolah that I’ve dished out already in order to adequately medicate myself.