Thursday, December 10, 2009

Same as it ever was, the sequel

While I feel the need to write about a Christmas “miracle” – which involves my discovering a song so heinous that it makes Huey Lewis and the News look like Rachmaninoff in comparison – it’s also been a while since I’ve written about the scourge on this earth that is BCBS of IL. And I do strive to write about all things festive around the holidays, so what’s more festive than dealing with the minions at BCBS on this cold, blustery day? Not much, I’d say, so off we go!

So let’s recall that last Friday, I had the migraine-from-hell, the one that the generic Imitrex did absolutely nothing for. Nada. Goose egg. On a 1-10 level of pain, I’d give it an 8, just below the 9 that was having shingles when I was in Kiev and couldn’t get any medication until my dad smuggled some over to me via Lufthansa. I’m reserving the 10 level for some heretofore unseen apocalyptic level of pain that surely exists and that I will yet visit in my lifetime.

But I digress. Point being, after this tomfoolery I did a bit of the googling and discovered that I’m not the only one for whom “Dr. Reddy’s” doesn’t do jack shit, so I figured I’d call my doc and see about getting a prescription for something else, i.e. something that actually works as intended. It’s sooo annoying to keep popping pills that are about as effective as sugar wafers. So I leave a message with my doc, and the nurse calls me back.

Me: yes, the generic Imitrex was totally useless, so I figured I’d see about getting a prescription for something else.
Helpful nurse: Okay, that makes sense. What’s the generic you were taking?
Me: Dr. Reddy’s.
HN: Wha....did you say....Dr. Reddy’s? That’s the name of it??
Me: Yep.
HN: Really? Could you spell that?
Me: R-e-d-d-y-apostrophe-s...
HN: That’s seriously what it’s called? With doctor like d-o-c-t-....
Me: No, doctor as in D-r-dot. I know, it’s unbelievably hucksterish, like Dr. Reddy’s Miracle Elixir, isn’t it?
HN: That’s for sure. Wow. I
Me: Yep, I know.

I actually go get the package to make sure I’m not just MSUing, and no, they have the name of the active ingredient there, sumatriptan succinate, and then right above it where the non-generic has Imitrex, it has Dr. Reddy’s. Classy. What brain trust came up with that, the same guy who suggested the name Aciphex for the acid reflux drug?

Anyway, the nurse speaks to my doctor, who’s happy to write a prescription for Maxalt or the one she likes, Treximet. But, wise to the ways of the asshats at the insurance companies, and recalling how Imitrex itself would cost me around $200 for 9 pills, I tell HN that I’ll call insurance directly to see which drugs they cover under my prescription plan, which is supposed to be a $10 co-pay deal. Right.

This morning:

Me: I’m just trying to find out which migraine meds are covered under my prescription plan, so my doctor knows which one to prescribe to me, since the generic doesn’t work.
BCBS Lackey: Okay, what meds would you like me to look up?
Me: Maxalt, Treximet, Imitrex.
BCBSL: Okay, let me put you on hold, I’ll be right back.

(5 minutes pass as she checks with Simon Legree, aka her supervisor.

“It’s some pesky woman whining about her migraines. You know, the usual blah blah blah,” she notes, rolling her eyes. “What should I tell her?”

“Bah, tell her the usual – none of that stuff’s covered. What are we, a charity?? Our CEO is at the bottom rung of salaries of health insurance company CEOs,” he bellows. “You want to talk tragedy, look at that, his paltry $10M! Not her fucking migraines! Tell her to put a bag of frozen peas on her head, like the rest of us do!”

BCBSL, smirking – “Will do, boss.”

“Bwahahahahahahahahahahaha!” they cackle together gleefully.......)

BCBSL: Okay, this is what we have: for any of these medications, you need prior authorization.
Me: Umm, what’s that?
BCBSL: That means that we need a request from your doctor to prescribe these, and then that request needs to go through multiple channels here to be authorized. Maybe. There’s no guarantee that it will be.
Me: But wh...
BCBSL: Your doctor will have to note that you’ve tried every other medication and it hasn’t worked...
Me: Bu...
BCBSL, continuing: .....and oh yes, the process will take 7-15 business days. Though again, there’s no guarantee that it’ll be approved.
Me: Bu...
BCBSL: And the Imitrex and Treximet are non-formulary, so you’d pay 50% of the cost. The Maxalt is formulary so you’d only pay 35%.
Me: So for Imitrex, I’d be paying half of the $243 that NINE PILLS now cost??
BCBSL: That's right. IF we let you have them in the first place.
Me: So what do you cover with the prescription co-pay?
BCBSL: The generics.
Me: You only cover the medications that don't work for me.
BCBSL: Right.
Me, after a moment of stunned silence: That’s.....bizarre. How do I get this authorization from my doctor?
BCBSL: They have to fax us a form.
Me: They have this form, and your fax number?
BCBSL: Oh yes, of course!

10 minutes later, on the phone with Karen, the HN at my doctor’s office:

HN: Okay, what did you find out?
Me, giggling helplessly: Sorry I’m laughing – this is just beyond absurd. Apparently we need a special dispensation from the Pope to get these medications.
HN, also laughing: The Pope? That shouldn’t be a problem at all.
Me: That’s what I figured too.

After explaining the situation, it turns out that she has no forms and has no idea what to send them or where. So back I go to calling BCBS to see if they can fax a form to my doctor’s office for them to fill out and fax back. Are we all clear on this? I’m not sure I am.

Me: So I’m calling to see if I can get this form faxed to my doctor’s office as they don’t have it but need to fax it to you to request some migraine meds that I apparently need prior authorization for.

I’m now talking to someone from Prime Therapeutics, the company that handles prescriptions for BCBS.

PT woman: Okay, do you mind if I get some information from you first? Your doctor’s office will have to call a number to get this form faxed to them, but if I have that info from you I can make sure I’m giving you the right number to give to them.
Me: Sure.

I give her the info, and then she looks up my meds.

PTW: Hmm, I’m showing that Imitrex does NOT need a PA. It’s non-formulary so you’d pay half the cost, but you don’t need authorization.
Me: Really? You’re sure?
PTW: That’s what it’s showing. And the others you mentioned – those don’t need a PA eithe.....
Me, rushing to get off the phone: Thanks, that’s awesome! Love you, gotta go! Talk soon! Best to the kids!

I quickly call my doctor’s office:

Me: Now they’re saying I don’t need authorization – let’s strike while the iron is hot!! Call the pharmacy! Order those pills!

This has only taken me all morning to deal with, of course. So far.....

No comments: