Brand Necessary vs. Generic
I have spent the last five months fighting "the system" and guess what? I'm loosing.
I feel a little like Ziggy, "It's just you and me against the world (insurance company), and frankly I think we're going to get creamed". I suppose in most cases, even for me, generic drugs are a blessing. This time though the generic does not work and they don't care.
In October a patch came out to replace the one I have been using for almost ten years for blood pressure, and it cost us nothing. No co-pay at all vs $100.00. So, what am I complaining about? It's a patch and does not stick to my tough hide. The process that has evolved has turned into a fiasco.
Before we found that out I had to have my doctor write a script for the generic so I could get it filled, for nothing. Then for the next two months I paid nothing for my blood pressure patch, but my blood pressure was staying around 190/90 because the medication did not stay stuck. The insurance company said "move it to a less 'exposed' part of your body". Okay, I won't tell y'all just where all we tried that patch, but it still didn't stay stuck.
At that point I got really upset with the insurance person on the other end of the phone and told her to pass on to "whom ever won't let her do anything about the situation", that as their insured I had two options. Have a stroke and be hospitalized for weeks, costing them a little more than my co-pay, or opt for "the public option", whatever that turned out to be. Then I was on a roll and said, "maybe there is a third option, which would behoove you guys. That would be to just choose pain meds until my blood pressure took care of the whole situation".
In January I gave up and paid the now increased co-pay ($131.00) because I refused the generic. My doctor and I both wrote appeal letters to the insurance company stating "medically necessary" and they have 45 days to respond with their ruling.
Well, today I went to pick up my February refill and it had gone up to $156.00 because now not only do we have to pay the non-preferred cost, but the difference between the "market price" of the drug, and the generic price. Whatever that means. I guess processing the name brand must be a little like dragging the coast of Main for lobster or processing caviar. It cost about the same.
So, what happened today? I called the doctor again and asked to have a script faxed to the drug store stating name brand only based on medical necessity. I won't have it for today, which I should have, but maybe by tomorrow evening after four pm I will.
I know people who work for the insurance company are just that, people. I try really hard not to shoot the messenger since they are probably a little like the guy in Custer's battle with the Apache. They know they are going to get slaughtered, probably from both ends. (don't ask where that gruesome analogy came from, not today).
Besides all the conversation between the pharmacy, me, the insurance company (two different people) and the doctor's office, I had Hunter running around spilling his coke and talking to all the people waiting to get their medicines filled. He just climbed up beside this older man and started shaking his hand and telling him, who knows what? I'm sure the man didn't know nor did I. I guess only Hunter knows for sure.
Maybe none of you feel any better but I think I do. Hope you all have a good evening.
Love ya,
Nana
It always makes me feel better to vent. I'm sorry you are having so many problems with your insurance. I had a screaming match with Medicaid when Eric was out of work over Hattie's prescription. I felt bad for it because the poor girl could do nothing to help me. Your reference to Custer made me giggle, because it wasn't until the Night at the Museum 2 that I found out his name wasn't Custard. I'm glad I don't teach American history, or should I say parents should be glad I don't teach American history. I'll be praying about your patch, where ever you may be sticking it.
ReplyDeleteIt's really no wonder the government is wanting to "reform" the health care system, especially health insurance companies. We've been through the same routine with medically necessary vs. generic battle. Then yesterday we get a termination notice from BC/BS on Sandy's policy. Seems there was a rate increase of $48 that I forgot to include in January's payment. So, for "non-payment" of $48 they were going to cancel her policy. I went ballistic. Does a utility company shut off your power if you pay over $300 on your bill, but forget to pay $48? No, they just send you a reminder and ask that you catch up next month. Not the insurance company, though. Sorry. I, too, just needed to vent.
ReplyDeleteYou aren't the only one I've gotten that from, the need to vent. The really crazy thing about the name brand one is that the cash cost of the drug is only $345.00. I say ONLY but many co-pay is $156.00, nuts.
ReplyDeleteAlmaI am so sorry you are having to stress over this insurance thing. I know it is just plain people that are running these offices that have the power to say yes or no ......Power is a strange powerful thing when in the wrong hands. WE all know where this is really going, the insurance comopanies are not going to pay for medicine to help keep us older ones alive. Government will have the power to say if you can have a surgery or a drug....not the medical people. Scary, looks like God is getting us in a position where we are going to have no choice except to believe "by His stripes we were healed".....not generic drugs..............
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