To Whom It May Concern,
My husband, Christopher Minerva, was a Senior Corrections Officer at the New Jersey State Prison until he was attacked by an inmate in August of 2010. After this attack he was forced to retire due to the injuries he received. Shortly before his retirement paperwork was finalized, he was diagnosed with stage 4 Thymoma cancer in 2012 and was given a 10 year life expectancy. After many doctor visits, several setbacks and many hospital stays he is thankfully in remission. One of the setbacks was an additional diagnosis of the autoimmune disease Mystenia Gravis. Chris spent a month in hospital at the University of Penn trying to recover from steroid poisoning, which put him in multiple organ failure. After that hospital stay he finally came home to then be sent to the emergency room with a perforated bowel and diverticulitis. While in the hospital recovering from surgery to give him a colostomy bag, he suffered a fall and tore his peck tendon muscle. He returned to the surgeons in 2017 to have the colostomy reversed, this surgery failed and he came home with a temporary ileostomy bag. After 3-4 months he was finally able to have this surgery reversed and all systems reconnected. To say my husband has been to *** and back is an understatement, he is currently 43 years old and has averaged at least one surgery a year for the past 6 years. He is currently set to have surgery to repair his bowels that are pushing into his stomach in the beginning of May 2018.
While Chris was receiving strong Chemotherapy, one of his many doctors prescribed him Marinol. At the time Chris was having many of the usual side effects that come with Chemo, however the stomach issues that had always plagued him became intensified. When the doctors prescribed the Marinol, this helped with his nausea as well as the chronic diarrhea that he experienced. This one medicine had not only helped get him thru the Chemo treatments but it also helped settle his stomach so he could function on a daily basis. He has been receiving this medication for nearly 6 years and has been to numerous doctors and hospitals that were all on board with him receiving this medication. In February of 2018, we went to our local pharmacy to refill his 3 month supply of Marinol, that in the past was never a problem. The pharmacist told us that our new Prescription Plan manager, Optum RX were requiring a pre-authorization to refill the medication. We were told by Optum RX that this was a 3 -5 day process and after multiple calls and hours on the phone we were given a courtesy 5 day fill. We quickly went to the pharmacy to get the 5 days of medication and patiently waited for his script to be authorized. My husband received an automated message from Optum RX stating his claim was denied and that if he wished to file an appeal our doctors would need to provide a lengthy amount of additional information including all past medications, dosage and reason for failure. Our doctor’s office provided all the necessary information to Optum RX and we were told that it is a 6 day process. After spending 2 hours on the phone with Optum RX and being bounced to 4 different people we were able to get a 30 day supply of his medication released. At this point my husband was without his medication for several days and his stomach and intestinal issues flared up. He ended up in the hospital for 3 days due to dehydration and severe diarrhea and stomach pain, he also lost 22 pounds.
While my husband was still in the hospital, I called Optum RX to find the status of the appeal. Optum RX had again denied his claim. The hospital doctors that were treating my husband wanted to increase the dose of the Marinol he was receiving because it helped his symptoms so well. This process of filling a simple script that truly helps my husband has become a pharmaceutical nightmare for my family. Chris has been on multiple medications over the years and none have helped his symptoms as well and as consistently as the Marinol. The stress and anxiety that has been placed on Chris and my family is unbearable. My husband is anxious and scared to eat, because he has a limited supply of his needed medication. When his stomach issues flare up again, he faces another emergency room visit and stay to get everything calmed down again. Marinol helps treat his chronic symptoms of stomach pain, nausea and diarrhea and keeps him out of the hospital, without it we are facing many reoccurring visits to the emergency room with possible hospital stays. These flare ups and uncontrolled symptoms can also further aggravate and strangulate his intestines and ultimately cause death.
The denial of this one medication has now generated a hospital bill of roughly $25,000 or more. Optum RX is insisting that his doctors find something else to treat his symptoms, this requires multiple visits and possibly multiple medications, many of which have failed in the past. This may also require additional blood work and testing. Marinol works for my husband, why would the State of New Jersey want to put out hundreds of thousands of dollars to pay emergency room, doctors, hospitals stays and additional medication and testing when one script can eliminate many of these additional costs?
My husband nearly gave up his life serving the State of New Jersey. He has more medical issues than some 80 year olds. He has a wife and 3 boys that need him and want to spend as many years, days and minutes with him as physically possible. Spending hours on the phone fighting with Optum RX, and spending days in the hospital away from one another is not how we want those years, days and hours we have left to spend with each other to go. Our family needs to have this medication covered by our prescription plan as it has in the past.
We appreciate any and all help that you can provide our family. If you have any additional questions please feel free to call my husband or I.
Christopher & Janice Minerva
Product or Service Mentioned: Optumrx Marinol Prescription Refill.
Reason of review: Order processing issue.