Friday, February 21, 2014

Navigating the Drug Nation


Refilling drug prescriptions is supposed to be easy. It used to be.

Hub turned the magical age of 65 in December and became a card carrying Medicare recipient. He crashed this artificial age barrier and now concedes the crossing over makes him feel old.

Once upon a time an e-mail reminder prodded automatic prescription renewals. A yearly doctor’s check-up sometimes initiated prescription changes, but adjustments occurred seamlessly.

That was pre-Medicare life. We now find ourselves in new territory.

The New Year dawned and it was time for hub’s yearly check-up as well as time to renew prescriptions.

The saga began with blood work needed before seeing the doctor. Very early one bitter cold January morning we bundled up and walked the couple of blocks to the clinic. The lab does not schedule appointments, and early arrivals usually do not wait long.

The clerical assistant checked him in and took his new insurance card to scan and process. A few minutes later – as he waited to be ushered into a room for the blood work – the assistant informed us the lab was not in hub’s insurance company network and would not pay for the test.

I grabbed my cell phone and found the number for another clinic nearby. They were open and accepted hub’s insurance. We walked the couple of blocks to the clinic and completed hub’s blood work.

A few days later hub drove to the doctor’s office. Everything went well and there were no medication changes. He handed his new drug prescription card and insurance card to the girl behind the desk. She scanned them to his file and he was on his way. The office would fax his prescription to the mail order company handling his account.

Unfortunately nothing is easy when dealing with bureaucracies.

Hub went online a couple of days later to check the status of his prescription. He could not find his account.

The old account – pre-Medicare – was gone. It took us a few minutes to locate and log into his new account. Same prescription drug mail order service, different account, and the two – pre- and post-Medicare - do not communicate.

It took four days, somewhat longer than the 24-36 hours the customer service rep assured us it would take, for the prescription to appear online.

This gets confusing. But what doesn’t with government bureaucracies?

Over the weekend hub received a canned voice message from the mail order company informing him his credit card was rejected.

We quickly fixed that glitch. In December we received updated credit cards, but the latest information had not made it into hub’s file. In addition hub’s Medicare is through his ex-employer. I do not understand how it works or why health care administrators are confused. All I know is that the system is complicated and involves endless paperwork.

Initially rejected by the insurance company’s clerical office, a couple of frustrating phone calls solved the payment problem.

Then another voice message from the mail order pharmaceutical company – obviously not too many real people work at this particular company – tells him he will receive a letter explaining that he needed a doctor’s evaluation before the prescriptions could be filled.

More phone calls followed, the goal being to reach a live person to question.

He just went to the doctor a couple of weeks ago.

That doesn’t count. Since he is on a new insurance plan, prescriptions are not automatically renewed, even though the request was sent directly from the doctor’s office. The insurance company/Medicare provider requires the use of certain drugs before others can be prescribed.

In other words, try the cheapest drugs – usually generics – first. If they do not work, then other - more expensive  - drugs can be prescribed. Hub went through the drug testing on his body a couple of years ago. He is on his current meds because cheaper, generic ones did not work.

Why must he go through the process again?

Meanwhile hub had only a couple of days of pills left.

The doctor, hub, and the insurance company eventually came to a meeting of the minds. The doctor sent a prescription to the local pharmacy to be filled immediately. The mail order pills would not be shipped for another couple of weeks.

So hub bundled up once again and trudged to the drug store, only to be informed by the pharmacist that  the prescription could not be filled because the request was denied by the insurance company.

After another series of phone calls, the pharmacy was permitted to fill 10 days worth of pills. Hub paid for them. He was charged $30, although the retail cost was much, much, higher.

Meanwhile the mail order service decided to overnight the drugs. That was on Monday. The package arrived Wednesday. Two overnights, but let’s not nit-pick the small stuff.

The system may improve when hub’s newbie status is no longer new. Meanwhile, refilling prescriptions previously accomplished automatically turned into a time-consuming and expensive scenario involving doctor’s appointments, phone calls, pharmacy visits, and overall frustration.

I wonder how people who are sick handle the bureaucratic rigmarole. I imagine it makes them weaker.

I suspect some people give up, unable or unwilling to maneuver through the red tape.

I now fear entering Medicare-induced madness in a couple of years.

I pray for good health.

Or maybe I will let my kids handle everything. Payback time…

7 comments:

  1. I'm confused. Are you talking about Medicare Part D? Because Medicare alone doesn't cover drugs, I don't think. Mine doesn't, anyway. I had to choose an insurance company, through Medicare Part D, when my company dropped retirees from their drug plan, and the new insurance company sends me a booklet telling me which meds are covered each year. No problems.

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  2. Voice of experience: Don't count on things getting easier when your hub is no longer new to the system.

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  3. Wait until the ACA is fully implemented? I just got everything figured out, so it's time for the government to confuse me again. The only thing I am sure of is that the insurance companies are doing fine! Dianne

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  4. This fall it will be my turn to enter the land of Medicare. I can't say I'm looking forward to it -- - on many levels.

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  5. "Unfortunately nothing is easy when dealing with bureaucracies." ... amen!

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  6. It is a known fact -- researched and confirmed -- that stress causes an increase in illness and pain and a lengthening of recovery time. All costly matters. And yet everyone in the medical industry has done everything possible to increase stress in those they are supposed to be serving. It must be that paying more for stressed-out patients is still more cost-effective than truly providing the services they need to stay healthy and/or regain their health quickly. That's the only reason for any of the decisions made by the industry, no matter what they try to make us believe is being done for our benefit. Yes, pray for good health.

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  7. I'll be on Medicare this year. We belong to Tricare (military) so there won't be too much confusion with the drugs and such, thank goodness. I hope.

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