I have been trying to refill my prescription for more than 3 weeks, and now I won’t have it when I need it, by Tuesday.
I have been on this prescription for a long time, around 7 or 8 years, and it works. It’s a hormone, and it’s not a life-saving drug, but it sure does make my life better, especially for several days a month. For various reasons, I went off of this drug twice in recent years, and each time, I had bad PMS symptoms. The moodiness was really horrible. Plus I didn’t get a period. It’s obvious my body reacts better when I am on this drug.
When I started this drug, my insurance covered it with a $40 copay. Later, it was covered with a $10 copay. Now, it may or may not be covered. They haven’t decided yet.
The process started a few weeks back when I called the pharmacy. I was out of refills. They called the doctor. I called the doctor. The doctor sent the refill. Then the insurance company told the pharmacy that they needed prior authorization from the doctor. The pharmacy then contacted the doctor’s office. They were closed for the week of Christmas and new year’s. It’s a small office, just the doctor and one staff member, but I was still annoyed. Next, the administrative staff member tried to send in the authorization, but there was confusion about the insurance, so she called me. I had forgotten to tell them about my new insurance. Oops. Ok, that was totally my fault. I scanned a copy of my new insurance card and emailed it to her. She told me she received it and would take care of everything. More than a week went by and I didn’t hear from the pharmacy, who was supposed to call. So I called them. I assumed everything had gone through and they had just forgotten to send the order. Nope. It turns out, the paperwork from the doctor’s office didn’t go through. They contacted the doctor’s office and the paperwork was sent. I got a call from the pharmacy that the insurance company was processing it and that it can take up to three days. Then today I got another call that it might not go through. I asked how much it would cost out of pocket. I figured I could pay $30 or $40 if I had to. It’s $104. Hmm, not in the budget. I called the insurance company. They told me to call the company that handles their prescriptions. Those folks told me it was still being processed. Apparently, they need the doctor to explain why he is prescribing this particular drug, instead of having me take something else. They called his office, and were told to call back on Tuesday.
I need the new prescription by the noon dose on Tuesday. Let’s say the doctor gets back to the insurance company on Tuesday and actually satisfies their questions. Let’s say the insurance processes things quickly and sends approval to the pharmacy on Wednesday. The pharmacy is quick, and could probably send it out on Thursday. That means I could receive it by UPS on Friday. 3 days too late. And that’s if they move quickly. That’s if they even approve it at all. I won’t take a different drug, not with the kinds of side affects I’ve had in the past. But then, what choice will I have?
So it looks like 1 month wasn’t enough time to refill this prescription. And I found the flaw in my supposedly-great health insurance. It could be a rough month. As the time approaches, I’ll have to warn my friends about my likely upcoming moodiness. And that will be around the time I expect to hear about the disability insurance appeal, so I’ll be on edge anyway.
There are many, many ways that the system lets us down, that it seems to put the needs of the patients last, that it makes an already bad situation even worse. This is just the one I’m dealing with today. By tomorrow, I’m sure I’ll be dealing with another.