The Waiting is the Hardest Part

I suspect most people really don’t like changing insurance. Forms to fill out, checking that your doctor takes the new insurance, getting prescriptions transferred…it’s all a pain in the ass, plain and simple.

However, if you are somebody with chronic pain, it’s even worse. As I am finding out. My insurance just changed. I dutifully checked that my doctors all took the new insurance, filled out the forms, and got my mail-order prescriptions transferred.

Except…

My pain medication is a brand name. The generic no longer works for me. Of course, the insurance company would rather have me on the generic (see: cheaper for them), so they denied the prescription. Now my doctor has to ask for pre-authorization (because clearly, *the prescription they wrote is not ENOUGH authorization*), which the insurance company (those people who want to spend less money on me) will either approve or deny.

“It can take anywhere from two days to a week,” the doctor’s office cheerfully informed me.

So, they might accept it. Which solves the problem. Or, they might not. Which IS a problem. It’s $200 a month — which a poor freelancer such as myself cannot afford.

My friendly pharmacy neighbors up in the Great White North will happily mail it to me. But because, for reasons that escape the understanding of my pea-eyed pointy head, it’s listed as a Schedule V drug by the FDA. So my friendly pharmacy neighbors in the Great White North cannot charge me a discounted rate.

So, no insurance approval = no pain meds. That’s the basic equation. The one medication that keeps the pain at a manageable level so that I can function will be out of my reach.

But for now…the waiting is the hardest part.

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9 Responses to The Waiting is the Hardest Part

  1. Violet Tigress says:

    Waiting really is the hard part.

  2. Sasha says:

    I just changed pharma coverage myself, and found out (via letter) that one of my insulins wasn’t covered, but a similar one (that I had successfully used before) was, so when I saw my endocrinologist this week, I had him write me a new scrip.

    Yesterday, I got another letter from them saying that they don’t cover *this* insulin, either – despite what I was told…

    Argh.

    The really annoying thing was that the insurance changeover was a complete surprise. Having some notice to shop around would have been nice.

  3. Zelda says:

    Oh lord. That is sucky nine ways to sunday. I mean its not like you can choose not to take this med, or you can cheerfully decide that you can function without it.
    Every time I hear more about your health system, I realise how lucky we are in Australia – sure we pay insurance premiums, but nothing like what you do, and we don’t have to get permission from our insurance company to get medicines….

  4. pennylrichardsca says:

    SE Smith’s post today (or last night) seems to be going in similar directions–“be patient” and “try harder” both being the kind of useless instructions that don’t fit the realities of chronic illness and disability:
    http://meloukhia.net/2012/02/just_try_harder_the_health_bootstraps.html

  5. Amy says:

    I’ll never understand why a bunch of beaurocrats with no medical knowledge whatsoever get to make these kinds of coverage decisions that are so vital to patients.

  6. Summer says:

    Celebrex is supposed to be covered for me, after jumping through a bunch of hoops. However a month later I’m still waiting for my script. Let’s not even start on how the only 2-3 specialists who know anything about my condition don’t take my insurance. Thinking about something else now….

  7. Spacecadette says:

    I’m finding out that the trick is to *keep asking*, with Medicare. The first time, you get NO!, then No, then No?, and then hopefully, you get well, okay, but you’ll have to pat more. If that doesn’t work, try to get the manufacturer to put you in they special circumstances group — you’ll get the drug free or very low cost. Helps if some of your other drugs are from the same company.

  8. Adotnon says:

    I find it staggering about the U.S. insurance system that they seem to offer the *least* amount of care possible to people who need it most (chronic illness patients).

  9. Tori says:

    Yup. I switched insurances several months ago — to discover that the generic I had been taking was no longer covered but that the corresponding name brand was. However:
    Because it’s not the most common of medications, my pharmacy doesn’t keep the name brand in stock. They’re willing to special order it for me, but this means they need to special order it every month.
    Every single time, it fucks with their computer system. That is, I go to refill my prescription, their system tries to kick it to a generic automatically, and someone has to call me to verify that I want the name brand. Then they order it, and I get it 3 business days later.Which, I’m lucky enough to have a pharmacy that is always professional about this every month, but you know what would be awesome? Not needing to plan my medication refills to include a week of bullshit red tape every time.

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