Thursday, March 21, 2013

Prescription Wars

Coming to a pharmacy near you is the latest assault on our healthcare system.

I am on a couple of maintenance medicines, which I have been on now for over 15-20 years. Due to recent changes in the healthcare system I have encountered problems when attempting to refill existing prescriptions for two of my medicines.

Overnight, it seems, the insurance company has deemed that the prescriptions needed pre-authorization. This means paperwork and delays in refilling prescriptions that my doctors deem necessary for my health and well-being.  That translates into frustration, and right now, being out of one medicine waiting for the process to complete.

In both cases my insurance company determined that the medicines that I have been taking for over a decade are no longer covered and that in their estimation, not my doctor's recommendation, I had to try a different formulations before the medicines which have been working so well for almost two decades could be approved.

I have questions!

Why did this all have to wait until I needed a refill before it was made known to me? Surprise!

Why didn't my insurance company notify me before it became a personal crisis that the medicines needed to be "preauthorized?"

How can something that I have been taking for almost 20 years be "preauthorized?" Time travel?

Why has it taken over two full weeks to resolve this situation and I still do not have the medicine? Recognizing that I began the process which what I thought was a valid refill which can only be refilled within seven days of running out.

Why does the insurance company believe that they are more familiar with my medical situation than the doctor I have been seeing for 15 years?

Why did this become "MY" problem to resolve? It has taken an appointment with my doctor, multiple calls to the insurance company and multiple visits to the pharmacy to get resolution even though I do not have the medicine in hand. I'm told by the pharmacy that it is on order. My insurance company has decided upon something so obscure that the pharmacy doesn't stock it!

Is this Obama-care? Everyone has healthcare but no one has health care from medical professionals? Insurance companies determine the level of care. Does the emperor have any clothes?

The story of my second medicine is not nearly so dramatic. The insurance company denied my claim despite documentation from my physician and so I am paying for it out of pocket rather than use the approved substitute.

At some point I am going to try to package this situation for my Representative and Senators in Congress so that they can hear first-hand the impact of their decisions.

-- Bob Doan, Elkridge, MD

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