Monday, March 09, 2009

Prescription Trouble

I’ve had a recent experience that I just had to share with all of you. You see, my new employer, as part of our medical benefits, has employed a mail order prescription drug company to fill all of our “maintenance drugs”. You know them. They are the ones we have to take every day (sometimes twice or more). The rule is that we are “allowed” to have three retail pharmacy refills of a medication before we are “required” to use the mail order pharmacy. The Insurance company makes it pretty easy to remember when you have to do that. They just stop paying for the meds.

My dearest Ellen has been trying to get in to see her endocrinologist in order to get the necessary prescriptions for the mail order pharmacy (they won’t take a transfer or photocopy). The doctor has been OK authorizing her refills, but we were up against “the wall” and had only one more refill before being cut off. The doctor could not see her for four months since it wasn’t an emergency. As a result, we hit the wall and weren’t getting her meds paid for. We were able to get an “override” for a retail pharmacy refill from our insurance company, but we were “cautioned” (more like scolded) that this would be the ONLY override we’d get. In the meantime, my wife decided to change doctors, finding one that would take her almost immediately. We thought she was in the clear.

However, the new doctor would not write her a refill prescription because 1) there were still active refills on her bottle and 2) the doctor wanted to take a gallon of her blood to check her “levels”. Back to square one. We contacted the insurance company to explain our plight. Needless to say we weren’t received well because we had ALREADY used our ONE “override” the prior month. ARGH! No amount of explaining could provide the necessary refill. We were weeks away from another doctor visit. I decided to go to my HR group and see what they could do. They were very nice about it, sympathetic you could say and they were able to get me in touch (via email) with a “member advocate”. I thought this was a step in the right direction and we’d have more meds than we could handle in a few days. I articulated our situation (not being able to see a doctor in a timely fashion and quickly running out of medication in the process and having no more overrides) in a brief email and waited for the response. This was our golden opportunity.

SLAM! That was sound of opportunity slamming the door. The “member advocate” should have been more aptly titled “Policy quoter”. She advocated following the insurance company policy and nothing more. One of the more impolite quotes from the “advocate” was “… if your wife is in need of her medication, her Dr. is the only one who can write a prescription for it. Without a prescription, her medication is not able to be filled at any pharmacy (retail or mail order)…” DUH! How about taking a step outside of your protective policy bubble and see if you can help me keep my wife from running out of her medication!!

We ended up paying out of pocket for a supply of the medication (50 dollars for the initial 20 dose amount with an option to get another 50 dollars worth more) on which to get by. We are still waiting for the doctor to get the blood test results back. That should take about a week. I’m hoping we get something before we have to exercise that other 50 dollar option.

I can hear some of you saying “Feh” at my chafing at 50 bucks of medication. Sorry, I don’t have very deep pockets.


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