New insurance and can’t get my medication

TLDR: I have a new Anthem California HMO insurance plan. For three weeks they have been saying they will be sending out the ridiculously expensive biologic that I take for arthritis but haven’t. What are my options?

The Background: I recently moved states (back home to CA) so I had to change insurance. I have always had PPO’s but I’m self-employed and couldn’t afford $800/month for the cheapest PPO so I went with the HMO (for the low, low price of about $400/month).

I knew I would need a referral from a GP to see a specialist (and that whole chain would take 2-3 months at least) so I had my old rheumatologist send the prescription to the specialty pharmacy for the new insurance. Gave them the copay assistance info, they say “great, looks good, we should be sending it out in the next few days.”

When it doesn’t arrive, I call and they say, “oh well you need a prior auth.” I say, “Okay, um, were you going to mention that at any point? Maybe could have said something last week but okay…”

Doc sends in the prior auth and the pharmacy says “great, looks good, we should be sending it out in the next few days.” Then doctors office lets me know it’s been rejected but that no reason was given and they’ve asked but aren’t hearing back. Fast forward thru several hours of phone calls, a half dozen reps later, and no clear explanation on why it’s been rejected but the doctor’s office is supposed to call back and provide either more information, a different diagnosis, or about 3-4 other possibilities (I got a different answer from each person I spoke with).

The doctor’s office has called back but I’m still waiting and I’m just at my whits end with the insurance company. I’ve left out a bunch of maddening details (ie, insurance still has not notified me that the prior auth was denied – I only found out bc the doctor’s office let me know – isn’t that a requirement?). For this specific medication, it’s super important to not skip doses and I’m starting to have a flare up.

Is there anything I can do (other than checking in with them daily)? Am I just at their mercy?

I’m going to call the manufacturer’s patient assistance program in the morning and see if I can beg them to send me a dose or to cover the cost for the insurance to send one but I don’t think that’s an option bc they’re not a pharmacy and I don’t think it works that way. Arg! Any ideas?

*I will just add, I am super grateful to the doctor’s office and the medical assistant. I’m not even seeing them anymore but they have been helping with this stupid insurance company. If they weren’t helping with this, I don’t know what I would do.