Pharmacy

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#1

Pharmacy

I am having difficulty with my pharmacy. Now not the staff, they do a fine job and I am pleased as can be with what they do. The know me, they laugh and chase my scripts most time. When I show up, they provide great service, I have never (in over 4 years) felt rushed or put upon. In short I love the staff.

The call in for refills procedure is also pretty good. I get my script number I call it in, they reject it if I am out of refills, and if I am out of refills they will call the doctor and sometimes the doctor will respond. Usually after a few days I have to call but at least they try.

The quality of the prescriptions seems fine. I mean let’s face it I can barely tell if my water pills are working, so who really knows? My grandmother used to claim quite alarmingly that someone was stealing her meds. She claimed it was for drug dealers on the corner. Unfortunately, she always thought her water pills were being seized by the local drug lords and sold on the street. I tried to tell her often that these pills were not likely being stolen for the amount of payback they would net. I have no idea what a water pill would fetch but I doubt it would be much.

Actually I can see the poor drug dealing selling the water pills:

Client: Man all I do is pee
Dealer: Well I go the finest sources; it must be the purity of the product.
Client: Man wait I have to pee, I will be right back.
Dealer: Dude stop eating so many grapes you are OD’ing on those ?

I know my grandma never would have thought that this was funny but I can imagine similar conversations if her suspicions were true. Now in fairness we knew exactly why grandma’s pill supply was out of kilter. For most of her life grandma counted on my mother to sort her pills. When mom went blind she was too proud to give up the monthly pill sort. Knowing mom was sorting them meant maybe half of the pills made it to the correct spaces. Oh to make the point, when mom was in the hospital, grandma sorted her owner pills, so grandma was perfectly capable of doing so. It was just easier to have my mother come over to do the sorting. Goodness knows why for certain? At any rate I am good with the water pills. I seldom run out and if I do the script gets refilled quietly. Not at grandma’s.

Anyway the problem I am having is insurance. I receive a drug that I take 60 MG per day of. I have done this for well over 5 years, and it is related to my heart. I mean it is not difficult to figure out. In five years I have had exactly no issues zip, zero, nadda, none. Ok so on Labor Day weekend I need a refill. I call it in and all seems well. I have remaining refills, the pharmacist is happy to take it and fill it.

Well here is where things go really bad. When the Pharmacist attempted to fill the script, the insurance company disallowed it. The insurance company reported that the doctor (yes doctor) needed to fill out a preauthorization form and get approval for 60mg. The insurance company would gladly fill 30mg but not 60mg, which is what I had been using without incident for over five years.

The pharmacist felt abridged to call the doctor and ask that they obtain a new prior authorization. The doctors off did what doctors do and issued a new script. But I didn’t need a new script; I need the doctor to comply with some kind of mysterious procedure. Well anyway the pharmacist feeling things must have been set up again asked the insurance company for approval. The insurance seeing a mass effort to defraud it issued several warnings that this script was being abused. Well ok this is more than a water pill but like the water pill if you really want to abuse something this would not be it. I didn’t mention but the drug is simvastatin (Zocor) and its incidence of abuse is way lower than many other things I take without issue.

Ok so now I am labeled as a potential simvastatin abuser and as such the insurance company calls me. Now mind you a human did not call, rather it was an automated voice and let me know I or someone in my household might be abusing simvastatin. Imagine the pain of going to rehab. It would go something like this:

Leader: Meet rick a drug abuser
Me: I did abuse drugs and I am sorry I am trying to kick the habit.
Leader: Rick we always try for full disclosure here, what was your drug of choice?
Me: Simvastatin (Zocor) and I got it bad. I was following my doctors’ orders.
Leader: This is worse than I thought you will need advanced treatment, come with me so you can start detox immediately.
Me: But, but, but,
Leader: no buts here, you’re going down.

Imagine the shame on my family when they come to see me. Psst psst, could you bring simvies? Man don’t let the guard see you. That guard guy can spot simvies at 500 yards. Oh and no bottles, last time I almost got caught.

Good grief I almost had myself locked up when the phone rang. It was Frank with the insurance company it seems the company has a programing error and there is no pre authorization required, I am taking an acceptable dose, forget the abuse call. So I say hey Frank can I get my simvastatin now? Long Pause Well no. Why not, I ask? Simvastatin is not a life threatening drug. In fact it is likely not needed in your case. You have great cholesterol control, this is just an insurance drug, and is not needed every day. Really, well when can I get it? Try Monday or Tuesday, and if the automated machine calls again about the abuse thing just ignore it.

Ok Frank, by the way I cannot wait to tell my cardiologist, simvastatin is really a feel good drug, something doctors just sort of prescribe for fun. By you know I have seen her angry. If I were you I would not answer her call, things might get testy. Well if she wants to call we can discuss it. No you don’t understand, this is going to be ugly. Well I am sorry for the foul up. Yeah Frank you keep saying I’m sorry, and you will need rehab when she is finished with you. Because Frank you may not have an ■■■ to sit on. Just a warning, as one who has taken her wrath, I would call in sick that day. Silence, followed by thank you Mr. Phillips and a hung up telephone.

Maybe my grandma had the right idea after all. LOL

-30-

Rick

#2

I had a somewhat similar situation with another drug and my insurance company. Turns out my dr's office suggested I check the website GoodRx, and voila, I got the qty and dosage I needed, AT A LOWER COST, and no prior auth required, and totally bypassed my INSURANCE !
I checked GoodRx and see they don't offer 60mg, so you could try getting 2 RXs, 1 for 20, 1 for 40. My dr told me that many of the generic drugs are coming 'pre-packaged', so they are much cheaper, and does not require a pharmacists time to carefully count out the pills. So when I used the GoodRx 'coupon' for my situation, I got a qty of 60 of a generic, prepackaged in 2 bottles of 30 each. My insurance had denied a prior auth for that qty, and would only allow 27 pills in 25 days, regardless of dosage.

#3

Imagine when when your pharmacist tells you the insurance company tells you that you're using too many test strips. Hmmm, a Type 1 diabetic for 49 years and the entire world tells you that the more control you have the better (which you get from monitoring yoru glucose levels) but the insurance co., thinks you are selling extra strips on the street (I felt just like you...Hey buddy...need some cheap test strips so you can poke your finger and bleed?) I am actually writing a drug proposal to my state rep about this very issue! It's funny but then again it's not.

#4

Roger, it is not funny. One of the terrible outgrowths of the internet is the reselling of test strips. Looking at Ebay tells us why these awful rules are are happening. I use about 10 test strips a day and it is a struggle to confine my use to x number of strips per day. I agree with you we are all being punished for the actions of a few, but unfortunately that few are trying to profit by selling extra strips. We are all being harmed, and while insurance companies and medicare are bad actors in this drama, it is those idiots on Ebay and those of use who buy off them who need to be disciplined.

I cannot understand, with such needs, why people do not give extras away. Those of us who need test strips are harmed by those who buy or sell strips off of Ebay. Roger, I agree with you.

#5

Sorry Rick! When I read this I didn't realize which way you were going with it. Yes, of course when a person can't get their meds or supplies when they are supposed to, it can be frustrating for sure. Acusing you of abusing is way past that. They should have made it up to you since it was their error. I'm glad that it was corrected.

#6

Terrie: Actually I meant it as tongue in check, you read it right the first time. I do think this stuff is so darn funny. Anyway, My response to Roger is really different. This issue with test strips here in the US is maddening. Medicare limits type 2's to 1 test strip per day and type 1's to 3 or 4 test strips per day. Heck some days I use that number before breakfast. So it is really two different things. My meds., that part is funny. The test strips on medicare is just plain awful. Carry on my friend, keep the sweet sarcasm, I love it, always.

This gray market of massive test strips being sold on Ebay, when so many of us cannot even get a test strip, is abhorrent. You log in to Ebay and you can see how many are for sale. Medicare took that to mean they were giving to many test strips. The pendulum swung the other way and we end up with all of us being punished.

#7

To be on the safe side, I'm going to go with the serious Rick whom I don't know as well. :)

I agree, lacking strips is not funny. I can't believe they'd do that. Not being able to get your drugs is just as bad. Thankfully that was cleared up quickly. Stupid glitches in technology and stupid people who don't know how to use technology properly.

Most of those strips for sale on eBay must be stolen. I can't see people selling their expensive strips for half price unless they have addictions. Nice of Medicare to make an excuse with eBay to slash strips from innocent Diabetics who need them. If they're watching eBay, then they are reading these sites too. They hear the complaining.

Hopefully Obamacare gets things rolling in the right direction. Sadly, drugs are getting scare also and did I hear correctly? Made in other poorer countries. Is that why we've been getting some generics lately? No one mentioned it to us.