Optumrx refuses to fill dicyclomine for UC

Sorry about your struggles with insurance, unfortunately seems to be the national past time of the chronically ill. We've all been there and done this.

What medication are you trying to get filled, you do not say it above?

Firstly, why not the 20mg capsules...is it available? I've only used tablets.

Dicyclomine (only generic available for the past 2 years) in Manitoba, Canada is no longer covered by Pharmacare as of 6 months ago....which sucks because I've used it for 31 years. It's almost $1 a pill...increased cost of 100% now that it's generic and the only player in the field. 😠 Even the brand name (out of the game) didn't cost that. 😒

I've never heard that it could cause toxic megacolon. All my GIs have offered anti-spasmodics to me. They do nothing for me, however, and I've tried them all, even Donnatel, which is supposedly the strongest. That's ridiculous your insurance won't pay for it.

Pharmacist took my request and recorded it and said there's nothing he could do. Dr has sent the Rx back again, and it's showing in my account but this will be the 5th time.
Between my wife and I we've spent probably 40 hrs over the last 6 weeks using high up contacts in insurance and @ OPTUM to try to work out all their issues. Dicyclomine is the most innocuous of all our drugs and its the worst battle. All oor Rx's were not filled unless we fought!

Indirectly, yes. I've been given an account managers direct # @ Optumrx. I tell him about the history of order deletion and he can't find any records. What else sucks is there is zero record in my account of any order shipping info. Nothing before such as pending, nothing after shopping such as ship date, tracking # or delivery date. All there is is an email saying it shipped, with no tracking #.... It's all total blindness. This company has cut every corner they can. Worst service in 40 yrs of my working life.

Not sure you will get anywhere by just having the doc keep sending the prescriptions. It sounds like your doc needs to have a peer to peer conversation with the pharmacist. Optum should have an appeal process that the doc will need to follow.

All of my mail orders through Optum have a link to track the package once it's shipped. The only issue I remember having with them is they changed formularies in mid year and I suddenly couldn't get a refill of a med I had been taking until my doc sent in a request for pre authorization (it was quickly approved).

Definitely talk with your benefits administrator at your job. They should be able to help you sort through all of this. Call the rep at Optum as many times as necessary. Since your doc just sent in another script, they should be able to see it and can stay on top of this. Ask them how to appeal the pharmacist decision.

Good luck!