Update


As for the Oxycontin, I took the prescription to Hirons Drugs on Wednesday, but when I went to pick it up, I was told that they didn’t have the pills in the prescribed strength (30 mgs), but only in fives and tens. I said, fine, give me enough tens to equal a month's worth of thirties. As I suspected, the pharmacist said she couldn’t do that without a phone call from the doctor.

The doctor's office was closed by then, so the next day, I called and left a message for him to call the pharmacy. Three hours later, the doctor’s nurse called me and told me to come and pick up a new prescription for the tens. I said that the pharmacist said that a phone call would suffice, so the nurse called the pharmacy, and then called me back to say that everything was good to go.

I called the pharmacy twice over the next several hours to see if the prescription had been filled. The second time I called, I was told that the pharmacy would need to fax a request form to the doctor, and that the doctor would need to fill it out, fax it to insurance, and wait for their approval, or else I would have to pay for the prescription myself. I asked how much it would cost if I paid for it myself, I was told $425 a month.

I then said—in a very nice way of course—fucking great, fax the goddamn form to the goddamn doctor. Then I called the doctor to verify that they received the fax, and the insurance to ask why, when my doctor had already written a prescription for the drug, he would need to send a separate request for the same drug to them and wait days for their approval before the pharmacy would fill it. Insurance said he wouldn’t because they weren’t going to pay for the drug anyway. I asked why, then, they had asked that the doctor submit a request, and was told that they hadn’t, that the pharmacy had misread the return code when it submitted the drug to insurance.

The lady at insurance did say that there was an appeal process the doctor could go through if he really, really wanted me to have the drug, but that the drug would still cost me a lot (although she had no luck in determining how much), and the success of the appeal was in doubt. I asked about substitutionary drugs and was given two options, oxymorphone and morphine. My payment for the first would be $95 a month, and for the second, $16 a month. I called the doctor back (this was yesterday), left a long message explaining all this, and never heard back. I just called again at 2:00 p.m. on a Friday, and asked to speak to a nurse rather than to voicemail. I was sent to voicemail, so I called back and again asked to speak to a nurse. No nurse was available, but the receptionist said she had spoken to one and that the doctor had started the appeal process. This means that I won’t be getting any pain relief for who knows how long. I'm about to call insurance to see if I can hurry things along, but I'm not optimistic.

I live with fear that if the doctor gets weirded out for any reason, he might refuse to give me any narcotics, much less the strong stuff, because he lives with his own fear, i.e. a raid from the DEA (Drug Enforcement Agency) if they think he’s prescribing more narcotics to more people than they, in their non-medical wisdom, consider appropriate. The ACLU (American Civil Liberties Union) is now suing the DEA because the DEA is requiring pharmacists to turn over records to them regarding who is getting narcotics and how many narcotics they’re getting. This is in violation of the Patient Privacy Act, but the DEA does whatever it damn well pleases, and Congress doesn't care.

Getting narcotics is an endless hassle. To give another example, last year I was getting them shipped to me via UPS once a month on a given day. I had to be here to sign for the shipment, but I never had any idea what time of day it would be delivered, so I had to stay in the house or front yard until it came, which was usually between 6:30 and 9:00 in the evening. I wouldn’t run a vacuum or do anything else that might keep me from hearing the door-knocker because if I didn’t answer the door, I would have to start the wait all over again the next day, and after three days, UPS would return the prescription to the pharmacy. One month, the shipment wasn’t delivered at all on the appointed day. When I called UPS to complain, I was told that it had been delivered, that I had signed for it, and that their new GPS system verified as much. This was just bullshit, so I concluded that the driver had stolen the shipment. If I hadn’t complained to the DEA, I don’t know if I would have ever gotten it, and part of it was still missing.

When, before UPS "found" the prescription, I called the pharmacy thinking they could turn up the heat on the UPS, they told me they wouldn’t be shipping me any more narcotics, implying that maybe I had stolen my own drugs in attempt to get the prescription filled twice. Well, I hadn’t even asked them to replace the narcotics because I knew they couldn’t do it without a new prescription, and I wasn’t about to ask the doctor for a new prescription, because I didn’t want him to think I might have stolen my own drugs.

Is it any wonder that so few doctors want to go into primary care medicine, and that one-third of the money that this country spends on medical care goes to insurance companies, companies that make money by refusing to pay for services and putting every roadblock possible in front of people who are suffering?

P.S. I've since talked to insurance twice and the doctor's office once. Insurance says the appeal process will take at least until next Wednesday, and they can't tell me what my copay will be. The only good thing I can say about all this is that I have been through many hassles with so many health insurance companies over so many years that I have come to expect that everything, every time will go wrong, at least for me. For the insurance companies, it's another story.

13 comments:

PhilipH said...

The NHS in the UK is struggling to meet demand but even so it is far superior to the USA health system. It beggars belief that so many people cannot get help for health problems unless they pay costly insurance premiums.
You have described how fouled up it gets when things go haywire.
Hope you are soon sorted with the pain-killers and that they give you some respite from all that you are experiencing.

Stephen Hayes said...

What a nightmare. Would moving to Canada or a country with socialized medicine be an advantage? I think your wife still works, but I know people overseas who are much happier with their healthcare systems.

lotta joy said...

Did you move to Florida and not tell me? We picked up one med at the pharmacy and it was suddenly $400 because I'm on medicare. Prior to this, the med was $20.

So I called insurance who said it was a tier 3 (out of pocket), but if my doctor would tell them it was NECESSARY they would place it at a reimbursement on a tier 2 level.

Doctor called. Nurse called. Faxes were sent. Insurance "took it on advisement" then told me "tough luck."

A lot of it has to do with the insurance company (in this case, medicare) presenting everyone with so many hoops that few jump through. The fact I, my doctor, my nurse, and the fax machine jumped through every one made NO difference.

WHERE does Shaniqua and Tyrone get theirs? If illegal drugs are rampant, it's not through us hoop jumpers. We have to squirrel away every pill we get but WE are the ones who get the stink-eye at the doctor's and the pharmacies.

kylie said...

and the idiots who run this country try to make it more like the US eveyday. who knows why FFS

Snowbrush said...

“It beggars belief that so many people cannot get help for health problems unless they pay costly insurance premiums.”

Having healthcare in America is looked by conservatives (as represented by the Republican Party) as like having a diamond ring—if you can afford it, fine, but if not, you will just have to do without, yet the Republicans in Congress enjoy the benefits of government run healthcare.

“What a nightmare. Would moving to Canada or a country with socialized medicine be an advantage? I think your wife still works, but I know people overseas who are much happier with their healthcare systems.”

I know nothing about moving, but, realistically, we’re not going to. I’m already further north than I would like to be (due to the shortness of the days in winter), so there’s no way I’m moving to Canada, and Europe is too far from Peggy’s family and the culture we’ve spent 60-plus years in.
As for Peggy, she retired last July, but she still has a bit over a year before she can go on Medicare, so she’s now on a minimal Obamacare policy. She and I are lucky in that we can afford most healthcare expenses, although we would be pressed to pay $425 a month for one drug. I know what it is to hurt and to be in desperate need of a doctors, drugs, and surgeries, and I know that there are millions upon millions of people in my country who are in similar circumstances, but are left to suffer and die through no fault of their own simply because of the greed that is enabled by our government, and I blame this primarily upon Republicans. While I’m no fan of Obama or Democrats in general (all politicians are owned by the people who put out the big bucks to get them elected), I really do hate the Republican Party. I have Republican readers who I love, but I can no more understand them than I can understand theism.

As for other countries, “All Consuming” in England had a doctor put in an urgent order for an MRI, but even though it was urgent, it took weeks for her to get it approved by the government. Here, she could have gotten it the same day.

Snowbrush said...

“We picked up one med at the pharmacy and it was suddenly $400 because I'm on medicare.”

Congress, in its wisdom, won’t allow the government to negotiate drug prices as does private insurers. Our country is said to be unique in this way, and it is why, although my drugs are developed here, we pay more for them than do the people in any other country.

“A lot of it has to do with the insurance company (in this case, medicare) presenting everyone with so many hoops that few jump through.”

I have few bad things to say about Medicare. They are: it’s idiotic for Medicare to talk about how much people’s financial security means to them and then turn right around and put our Social Security numbers on our Medicare cards. Second, the Medicare Advantage policies are impossible to decipher, but this is because they are run by private insurers and, again, Congress likes it that way. Third, they really need to do something about their refusal to pay for hospital admissions for observation because person after person is faced with bankruptcy because they don’t know this, and hospitals don’t bother to tell them.

“We have to squirrel away every pill we get but WE are the ones who get the stink-eye at the doctor's and the pharmacies.”

We are forced to behave like addicts because, no matter how much we hurt, we’re looked upon as possible addicts, so we have to be very careful about what we say and how we say it. It’s also true that the DEA is running a campaign to all but stamp out prescriptions for narcotics, and that the news media is only too happy to help by making it appear that the only thing narcotics are good for is killing people. I’ve been taking narcotics for years, and I’m still alive. I don’t mean to discount their dangers, but they do enable me to have a better life than I would have without them, and it bums me that I really don’t know if I’ll be able to get them when my internist retires, so I live in fear of that day.

“and the idiots who run this country try to make it more like the US eveyday. who knows why FFS”

When big business is in charge, a country is no longer run for and by the people but for and by big business, and that is the situation here. Obama wanted government run health care for all, but to get it through Congress, he had to agree to the demands of private insurance companies because they control Congress. This is why so many people hate Obamacare. Still he accomplished a few good things. For instance, putting caps on yearly healthcare costs, and requiring companies to insure people with pre-existing conditions.

Snowbrush said...

I have one other thing to say about narcotics. Since I ran out, I’ve been drinking rum for the pain. It is my first time to use alcohol to control pain, and it hasn’t been a success because it would take more liquor than I’ll willing to drink to significantly help the pain. Six shots of rum is nothing to me in terms of pain relief, but it’s certainly enough to make me feel loaded. I was surprised by how ineffective liquor is because I had heard that it’s a good pain reliever, which I suppose it is if you don’t mind staying roaring drunk all day. By contrast, narcotics have the power to greatly relieve my pain without making me feel loaded. If someone who isn’t used to them took a fourth of what I take, he or she would probably feel euphoric and then go to sleep, but I can carry on a normal life, as can people who take far more than I do. Yet, this is what the DEA wants to stamp out. I think they just want to justify their existence as an agency as opposed to helping the public.

Sue in Italia/In the Land Of Cancer said...

I was about to suggest finding a pharmacy that does carry the 30 mg dose thus avoiding the run around you got but then I remembered: hardly any pharmacies carry Percocet. A while back, I broke my arm and it couldn't be set. I was in much pain and had a script for Percocet. Little did I know the difficulty I would have getting it filled. My husband went to store after store until we found one. I wish the attending had suggested the hospital pharmacy but probably he was clueless about how difficult it was to obtain.

I am so sorry that you have to deal with this so often.

Snowbrush said...

"I broke my arm and it couldn't be set. I was in much pain and had a script for Percocet….hardly any pharmacies carry Percocet. ”

I hope you’ve posted about your arm, because I’m dying to know how things turned out.

I’ve heard that some pharmacies won’t carry narcotics because they’re afraid of being held-up (the one closest to my house has been robbed twice at gunpoint), but I’ve had no problem finding oxycodone (Percocet is simply oxycodone combined with acetaminophen, something that I try to avoid), and, until now, I've never even had a problem with getting a pharmacist to substitute one size oxycodone for another size--for example, three tens for one thirty--if she didn't have the size that the doctor ordered. However, the DEA is making things increasingly difficult for patients, doctors, and pharmacies, when it comes to narcotics, and they're able to get away with behaviors that are illegal and quasi-legal simply by claiming that we're in an emergency situation in this country due to deaths caused by the over prescription of narcotics. Americans have an unfortunate tendency to relinquish individual rights in a heartbeat when told that there's an emergency--just look at the Patriot Act. As for getting Oxycontin from another pharmacy, I'm limited to those pharmacies that have a contract with insurance. I could use another insurance-contracted pharmacy, but the cost would be the same, and I would have to go back to the doctor to fill out a new "Pain Contract," (a Pain Contract limits you to one pharmacy) or else the DEA might come after me. Nothing is easy in American medicine, especially when it comes to insurance approvals and narcotic prescriptions.

Sparkling Red said...

Ai ai ai, no es bueno!

Don't bother moving to Canada. Prescriptions aren't covered by our provincial health insurance plans, only doctor visits and procedures. Doctors up here are also very careful with their prescription practices, as their licenses can be limited or revoked for "over-prescribing" as defined by the governing colleges. Plus on top of that you'd get SAD and have to drive in snow for half the year. :-p

Sue in Italia/In the Land Of Cancer said...

By keeping my arm in a sling, the humerus managed to weld itself together in 3 months. But then I developed frozen shoulder which was almost as painful. I needed to do physical therapy. I had switched to Vicodin, about one fourth as potent as Percocet , after 2 weeks of the broken arm. They cut me off when the fracture healed so I took high dose Ibuprofen which wrecked my stomach lining. I took a bunch of rolaids which messed up the synthroid I took which then led to me being hypothyroid. After I got all of the above under control, I got cancer. After each surgery, I got a script for Vicodin, which I didn't really need but I keep them around just in case. I have some residual neuropathic pain from the surgeries, Taxol and or radiation but fortunately it doesn't last long. I can't imagine being in pain as much as you are.


CreekHiker / HollysFolly said...

Wow Snow! I'm so sorry you have to go through this

Snowbrush said...

“you'd get SAD and have to drive in snow for half the year. :-p”

This is true. I hate winter. Here in Eugene, Oregon, it just rains all the time, and being at the 45th parallel the days are awfully short for this former Gulf Coast boy.

“After each surgery, I got a script for Vicodin, which I didn't really need but I keep them around just in case.”

I guess I would be out looking for heroin. If I took enough Vicodin to make any difference, I would destroy my liver because of the acetaminophen.