Prescription: Change

I had a nice long chat with my health insurance company yesterday. In fact, they were surprisingly nice. Like, we’re trying to improve our image nice. Wonder why?

They still failed miserably to understand how their business decisions hurt people. But at least they were overly cheery in their epic failure.

After several calls to my doctor and to my pharmacy, we all concluded my only real solution was to ask the insurance company what it expected me to do. That’s how I landed on the line with the insurer.

The good news is that my copay will jump from $30 to $50 – not the $125 I initially anticipated. I’m not sure where or how I was expected to find this $50 amount seeing as how my exhaustive search turned up $125, but apparently, $50 is what it will be.

But the truly frustrating part of this exercise is what my insurer wants me to do if I want to pay less than $50/month for my medication.

It wants me to experiment with alternatives.

The insurance company’s pharmacist who spoke with me during yesterday’s marathon call offered me three generic alternatives to my current medication. However, none of the three were generics of my actual medication. They were generics for medications in the same class of medication as what I take. And as we all know, everyone’s body reacts differently to chemicals, and that’s why people choose to take one med over another.

For women, I can liken it to the great hunt for the perfect birth control pill. Anyone who has ever taken an oral contraceptive knows it’s a delicate process to find one that works just right for you. And when you do find that right fit, the last thing you want to do is abandon it and start experimenting again.

For men, imagine you have a headache. You can take Tylenol or Advil. Unless you are allergic to Advil. Then all you can take is Tylenol. But now Tylenol is a gazillion dollars a bottle, and you need an alternative. There is no generic Tylenol, but there is generic Advil. My experience was like a pharmacist offering you generic Advil as an acceptable substitute for Tylenol. It’s just not.

And in my instance, we’re not talking about aspirin. We’re talking about a medication with the possibility of much more complicated side effects.

I’m lucky I can afford the $20 copay hike, but I know so many people can’t, and we shouldn’t have to live in a country where people are forced to experiment with their health because they’re priced out of the medication that works best to make them well.

One thought on “Prescription: Change”

  1. Having heard stories similar to yours, I was in no mood to talk to the Medco pharmacist who called me a few weeks back. As soon as she said, "I want to review your medications with you," I ranted something about that being between me and my doctors and hanging up. The mere thought that they were about to suggest questionable alternatives to my meds just enraged me.

    I think if I had government insurance, I'd understand the need to audit patients' meds, to help keep costs in line. But I know it's a for-profit entity wanting to mess with my medicine cabinet. A pharmacist probably gets a commission when they succeed in slashing the cost of my meds. It's certainly frustrating.

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