The Pulmonary Hypertension Association shares praise or suggestions for improvement with our contacts at specialty pharmacies. Fill out the form below or call your pharmacy:

• Accredo/CuraScript/ExpressScripts: 866-FightPH (866-344-4874)
• AllianceRx Walgreens Prime: 800-445-3674
• Cigna Tel-Drug: 855-326-7463
• CVS specialty: 877-242-2738
• Humana Specialty Pharmacy: 855-478-8405
• OptumRx: 855-856-0536
• Synergen Rx: 888-975-2191

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Name *

First

Last

Email *

Address

Address Line 1

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Pharmacy & Medication

Which pharmacy is your comment about? *Accredo/Curascript/ExpressScriptsAetnaAllianceRx Walgreens PrimeCigna Tel-DrugCVS/CaremarkDiplomatExactus (formerly Wellcare)Humana Specialty PharmacyKaiserOptum RxRxCrossroadsSynergen RxOther

You answered OTHER to the above question. Please provide the name of the pharmacy

Which PH medication from the above named pharmacy is your comment about? *Adcirca (Tadalafil)Adempas (Riociguat)Flolan (Epoprostenol Sodium)Letairis (Ambrisentan)Opsumit (Macitentan)Remodulin (Treprostinil Sodium)Revatio (Sildenafil Citrate)Sildenafil Citrate (Generic)Tracleer (Bosentan)Tyvaso (Treprostinil)Uptravi (selexipag)Veletri (Epoprostenol)Ventavis (Iloprost)Other

You answered OTHER to the above question. Please provide the name of the medication

Other Pharmacies

Have you or your patient used a different pharmacy in the last 12 months for this drug? *

• Yes
• No

You answered "Yes" to the above question. Please select the pharmacy name hereAccredo/Curascript/ExpressScriptsAetnaAllianceRx Walgreens PrimeCigna Tel-DrugCVS/CaremarkDiplomatExactus (formerly Wellcare)Humana Specialty PharmacyKaiserOptum RxRxCrossroadsSynergen RxOther

You answered OTHER to the above question. Please provide the name of the pharmacy

What is your role

Are you aPatientCaregiverNursePhysicianOther

You answered OTHER to the above question. Please provide a brief description.

About how long have you been taking a PH medication delivered by a specialty pharmacy (include any specialty pharmacy that has delivered to you)?

Years

Months

Feedback Topics - Select all that apply

Refill Process

• Process too long/complicated
• Can’t start refill process early enough without fear of medication running out
• No reminders from specialty pharmacy about need to refill
• Other

Billing

• Billed to incorrect insurance or credit card
• Billed for incorrect item
• Treatment is too expensive
• Issues with existing grants/financial assistance
• Other

Call time

• Overall call time too short
• Overall call time too long
• Hold time too long
• Other

Customer service skills

• Lack of knowledge of PH
• Representatives unfriendly or unwilling to help
• Other

Medication delay and delivery concerns

• Damaged or missing materials
• Delivered at the incorrect time/date (including late shipments)
• Medication delivered when only left with three or fewer doses
• Prior authorization issues
• Missed dose of medication
• Currently experiencing a missed dose of medication
• At risk of experiencing a missed dose of medication
• Other

My pharmacy did well in the following areas

• Smooth refill process
• Prompt, accurate billing
• Call time appropriate to concern
• Prompt, accurate delivery
• Friendly, knowledgeable customer service

Are you currently experiencing a missed dose or are you at risk of missing your next dose of medication?

• Yes

This form is not for emergencies or case management. Patients are encouraged to contact their specialty pharmacies in instances of missed doses.

Comments

Please share any other information about your experience with this topic, including any other organizations you have contacted for assistance and whether or not you have dealt with this topic before.

By checking this box, you give permission for the information provided in this form to be made available to the Advisory Board and your specialty pharmacy. If provided, your name and contact info will be used to assist you in resolving your issue. *

• Permission granted

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