Every one of us has experienced a time when someone does something we think is unjust or unethical, something that completely ignores what is in our best interest. We want to strike out and make them stop!
Last Friday, I went to our pharmacy to pick up a prescription for Robin. “That’ll be $479,” the clerk said.
“What?” I couldn’t believe what I heard.
”Your drug insurance is no longer covering that,” she said. “It’s no longer on their formulary.”
“How can that be? How can they drop a medication in the middle of a contract year?”
“Well, all I know is that this is the cost now for a 30-day supply.”
I left it there and came home to talk with Robin.
On Monday, he contacted our Medicare Part D drug company. During a two-hour marathon, Robin explained to different people up a chain of command that he must have the drug. It’s necessary and one that he can’t just stop “cold turkey.” Even if he could switch to another drug to take its place, he’d have to have enough pills to taper off.
At last he talked with someone higher up who agreed that if Robin’s health care provider completed a form confirming that this was “an emergency situation,” they would work with him to provide the drug for him at the formulary cost the rest of this year.
Next he called his doctor and talked with his nurse. “They will be faxing you a form. Please let me know when you receive it.”
Tuesday we received no call, so Robin called again and left another message with the nurse.
Wednesday, he had still not heard from the nurse! Robin called once more, but he still sounded calm and polite. When he got off the phone, I fussed at him. “You should have upped your tone,” I said. “She needs to know how urgent this is. You only have enough pills to last until the end of this week!”
Thursday he finally got a hold of the nurse. She did receive the fax, she said, the doctor had signed it, and they were faxing it back to the drug company. She would call our pharmacy and ask them to sell us just enough for ten days.
Robin picked up those ten pills yesterday. Each one cost over $7.00. Meanwhile, we’re hoping that our drug company will be adjusting their actions toward us before those ten days run out.
Our drug company states in their formulary book that they will give a 60-day notice if they change their formulary in the middle of a year. Also, they state that if a client comes in for a refill of a drug that is no longer on their formulary, the client will be able to pick up a 60-day supply at the same cost. That has NOT been our experience!
We’ll continue to deal with all of this. Robin has an appointment with his doctor next week to discuss the possibility of transitioning to a different medication before the end of the year. And we will also be exploring the possibility of going with a different drug company for 2016.
What a frustrating and maddening situation this has been!