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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.
