Tag Archives: prescriptions

Not Fun and Games

Sometimes, as much as we’d like to, it’s hard to temper the hard truth with diplomacy.

I’ve been trying to calm down ever since I received a letter from my prescription provider, Express Scripts. I’ve been trying to choose my words carefully, trying to understand the other side of the equation, trying to consider how this makes me or the plan I’m a part of better.

Let me tell you, that’s a tall order.

The letter states that I can no longer take part in the automatic refill program through Express Scripts unless I move from the Novolog I’ve been using for a long time, and which works best for me, over to Humalog. In other words, if I have a prescription for insulin, I can get my prescription renewed every 90 days. But only if I use the insulin on their formulary list, which is Humalog.

Now, you might be thinking, this can’t be non-medical switching… you can still get the Novolog, right? First world problems! Stop yer bellyaching!

They’re making it harder and harder for me to still get the drug that works best with my diabetes.

I’ve got nothing against Humalog. It just doesn’t work as well for me. So already, I’m paying three times as much (through my plan) to get the Novolog every 90 days. I’ve been doing this ever since the “preferred drug” on the formulary was switched from Novolog to Humalog.

Additionally, I stayed with Novolog in spite of underhanded dealings where reps from Express Scripts shoved prescriptions in front of my endocrinologist, telling her I asked to switch to Humalog, which is a big fat stinking lie.

Now they’re trying to put roadblocks in my way again.

There’s not a medical reason for this. They’re simply doing it because they want to. Because they really want me to start using Humalog. And they’re trying anything they can to get me to switch.

Non-medical switching, in one form or another, is standard operating procedure for pharmacy benefit managers like Express Scripts. Instead of making it easier to get the drug that helps keep me alive, or at least not making it more difficult, they’re actually paying people money to come up with new ways to keep me from getting it. In subtle and not-so-subtle ways.

This is just another example.

So, my choices, after taking the time to, you know, do my best at managing a 24 hour, 7 day a week condition, are:

1. Spend more time calling and complaining, trying to get Express Scripts to change their minds, as if they were an actual organism with an actual mind

2. Spend more time asking for a refill every 90 days, even though it wouldn’t cost Express Scripts one dime or one minute extra to keep doing things the way they’ve done them. For years.

3. Make the switch to Humalog and get the automatic refill every 90 days

I will likely go with #2, though doing so makes me very unhappy. But hey… happiness or unhappiness are not part of the equation when it comes to pharmacy benefit managers. For Express Scripts, there’s only one part of the equation that counts. And I think everyone knows what part that is.

It’s time for our government to protect its citizens.

I’m so mad I could spit.

I watched an interview yesterday on CNBC with the CEO of Mylan, which is coming under fire for enormous price hikes on their Epipen product, which helps people suffering severe allergic reactions stay alive. Now it’s pay up or stay alive. Sound familiar?

CLICK HERE for the interview, then come back.

Well, it looks like common sense isn’t lacking for just male CEOs in this country. At first glance, you might think this is a woman who doesn’t get it. But she gets it, far more than she tries to show in this interview. Only what she gets is different from what the rest of us who depend on a drug to stay alive gets.

Don’t give me platitudes about how the entire healthcare system is failing us without giving us detailed examples of how your company is not part of the problem. And announcing a “rebate program” for patients doesn’t count. It’s a way to hold people at arm’s length, making them fill out more paperwork, make more phone calls, dangling the carrot just out of reach. It’s also probably a tax write-off for you, though probably not as big a tax write-off as moving your “headquarters” out of the USA was. Believe me, there are MANY people who are more frustrated by this than you are. “Facts are inconvenient to headlines”? Really?

This goes back to my post from last October. This CEO’s constant misdirection on the topic of drug overpricing shows that Mylan doesn’t really care if someone dies because they can’t afford an Epipen. Why should they care? If there are ten patients with severe allergies in a room, and one of them dies because they can’t afford an Epipen, what does that mean? If I’m Mylan, it means I have to ship less product, but since I’ve raised the price of my product 600 percent in the past few years, I’m still making more money than when I had ten patients paying the lower price. Win-win!

“Pharmacy Benefit Managers” (yes, I put quotes around that faux title) that work for prescription providers like CVS/Caremark and Express Scripts are to blame too. They’re trying to get as much money as they can, and they’re pretty successful, even if no one can think of a single reason why their jobs are needed in the first place.

Recently, Slate.com has weighed in on drug overpricing to note that this kind of practice is costing insulin-dependent diabetes patients dearly too. Welcome to the party, Slate… where have you been?

So the questions are the same as before. What can be done? How do we get Congress to act? How do we get companies to stop forcing patients to choose between rent or complications, keeping the lights on versus dying?

It is abundantly clear that companies don’t care about anything except revenue. They will not budge, nor will they stop this unethical and unpatriotic practice until they are forced to do so.

I just can’t go into another post about what the diabetes community needs to do to reverse this setback for patients. We’re all tired of this, we’ve seen more than enough examples of excessive greed, and it’s starting to wear on us. But I can tell you what is needed:

The United States Government must get involved to protect patients reliant on drugs to stay alive.

This means the three branches of our federal government… the Legislative, the Executive, and the Judicial, must work together to determine and support policy and pricing that protects patients from seeing these kinds of increases in the future. Our government actually does have the power to do something about this, and if they’re unwilling to act, they’re as much to blame for needless complications and deaths as the drug companies and the prescription providers.

Here are a couple of ideas. I’m just spitballing here, but what the heck, it’s my blog. Let me know what you think:

Limit price increases. Simply put, enact legislation that limits how much of an increase can be implemented for drugs. All drugs. Period. With no exceptions. This is the one item where people might cry “socialism”, to which I say no one ever said anything about no profits for companies. Mylan was already making a huge profit on Epipen before their recent increases. Lilly was already making a huge profit on Humalog. Novo was already making a huge profit on Novolog. And Express Scripts was already making a huge profit on all three.

Are your company’s headquarters outside of the USA? Then the U.S. Government should set the price. Mylan (and many, many other companies, including Medtronic) have gone through a process known as “inversion”, where most or all of a company’s execs and offices remain in the USA, but all their paperwork lists them in a lower tax country, like Ireland, for example. Fine. You want to do that? The federal government should now be allowed to set the price on all medications you sell inside our borders. Actually, let’s amend that to say the Feds should set the price on all items sold to patients in my country. You were making a profit already. Enough of a profit to buy a company in another country and then make that company’s “headquarters” your own so you could skip out on paying U.S. taxes. I don’t see why we can’t say, pay taxes in our country or you have no voice on pricing. American capitalism should only extend to American companies. I know, you’re probably worried that they wouldn’t release new drugs in the USA. Trust me: they’re not going to walk away from the biggest economy in the world, regardless of what they say.

Show some guts elected officials. It’s pretty much down to you now. You are going to have to step up and protect patients. Choose to support us through your words and your actions. This is an issue that affects every registered voter in America.

Show us you’re worth voting for. #PatientsoverProfit

Prescription burnout.

I’m fortunate. I have access to and participate in medical, dental, and vision insurance through my employer (The Great Spousal Unit is also covered under my plans). It’s not cheap to have this coverage but, for the most part, I’m able to manage the costs. Despite needing to schedule appointments and, you know, actually go to doctor appointments, I’m able to do what I have to do to navigate my way through the healthcare system here in America.

Except when it comes to prescriptions.

Dealing with prescriptions is hard. The reasons for that vary, but they’re mostly related to the number of items I have to keep track of, the fact that they all seem to need to be renewed at different times, and the stupid way my prescription provider operates.

For the record, I get insulin, plus backup insulin, glucagon, a few daily pills I need to take, and test strips through my prescription provider.

Almost all of these, except the glucagon kit and the backup insulin, which I don’t need to renew all the time, are on different rotating 90-day schedules. Meaning, I have to go to my provider’s website and renew my prescription, or my doctor can electronically submit prescriptions to the provider. Though that turned out to be a major hassle with the provider, which I’ll explain farther down the page.

I generally don’t suffer from diabetes burnout, but I do suffer occasionally from prescription burnout. It’s not that I have to renew my prescriptions every 90 days. It’s that I may need to renew one prescription this week, and another in three weeks, and another ten days after that, and another the following week. Keeping track of which script needs to be renewed when takes some doing.

I try to keep track of it on my Outlook calendar at work. That works okay, except when I’m not at work, and as long as the Exchange server doesn’t go down and wipe out everything I carefully scheduled (which happens occasionally).

Then there’s the cost. My provider introduced a huge change in their formulary list this year, which is costing me an additional 1200 dollars during 2014. I don’t even want to go into that.

So there’s the volume of everything that needs to be renewed, and the quirky scheduling of everything, and then there’s this:

When renewing my prescription online, the provider has my credit card information so they can process my order at the time it’s placed. So they have my credit card information on file.

The last time I visited my endocrinologist, she was kind enough to get me new prescriptions for things I had run out of refills for. The best part was (or so I thought), she was able to send the script directly to the provider so they could fill it. Great, right? Ummm, no.

A couple of weeks (or so) goes by, and no prescriptions. Part of the order included my insulin, so I’m starting to worry a bit. I give the provider a call. It turns out they haven’t filled my prescription because they “didn’t get payment yet”.

Me: You have my credit card information on file… what’s the problem?

Prescription provider phone rep: We can’t fill the order without your authorization of payment.

Me: You do it when I renew prescriptions all the time… how is this different?

Prescription provider phone rep: We can’t fill the order without your authorization of payment.

Me: This is a highly inefficient way of doing business. My doctor sends the prescription directly to you, then I have to wait to find out it’s not coming, then I have to call you, then you tell me I have to provide payment when you already have my credit card info on file.

Prescription provider phone rep: We can’t fill the order without your authorization of payment.

Okay, I realize there’s a difference between “providing payment” and “authorization of payment”, but still… why do I have to find this out on my own? Why was I led to believe my prescriptions would be shipped when they weren’t? Why was I not told that they were waiting for my okay before filling my order?

I don’t want to say the provider did this on purpose. I don’t think their purpose was to deny or delay my prescriptions. After all, if they don’t fill a prescription for me, they don’t make money. And that’s where the problem lies.

It’s just my opinion, but it seems to me that prescription providers, more than any other entities providing goods, services, or prescriptions through an insurance plan, are not about the patient at all. Not in any way, shape, or fashion. No… they are purely profit centers, and they operate as such. I don’t think my provider wanted to deny my coverage. I just think they skimped on customer service and expediting orders in an effort to make a few extra bucks. They hired someone to think this all out, but they didn’t pay top dollar, so what they got was a system that doesn’t really work at all.

And they don’t seem to care about it, because, let’s face it… once I’m on their plan, they have me for the entire year. At that point, they don’t have to be nice, or helpful. They just have to squeeze as much money from me as they can. If they have a stupid, inefficient way of doing that, who cares? They know I’ll be back when my next prescription needs to be filled.

I suppose it hasn’t occurred to providers yet that better customer service could help expedite orders, rather than having them sitting in a queue somewhere. More orders, more money, more profit. And I suppose it hasn’t occurred to them yet that a superior level of customer service could have a positive effect on patients, and the plans they’re covered under, which might make their plans more appealing to additional clients in the first place. More orders, more money, more profit. That requires too much forethought, I guess. I wonder if they even know what that word means.

Oh yeah, it’s prescription burnout I’m feeling. Or prescription provider anger. Either way, it’s not healthy. And my provider is perfectly okay with that. As long as I keep coming back for more.
 
 
 

No More Strips!

Long story short: I ran out of test strips for my Accu-Chek® Nano meter yesterday.

How has my life gotten so busy that I let myself run out of test strips without refilling my prescription?

I think that this may be my form of diabetes burnout. I’ve got to admit it: I’m growing tired of making doctor appointments, going to doctor appointments, remembering to carry all of the stuff I have to carry when I leave the house, and yes, refilling prescriptions.

The thing is, I think I do a pretty good job of taking care of my diabetes when I have everything I need. When I’m fully stocked up with drugs and durable medical supplies, everything is great. When I’ve just finished my latest round of doctor appointments and next quarter’s appointments are already on the calendar, no problem.

But right now, thanks to some extra work, a trip here and there, working out more, and a couple more extras in my personal life, my schedule seems to have moved into the cray-cray stage right now.

Or so it seems. Actually, I think this may be just a symptom of the fact that I haven’t caught up to my schedule yet. In other words, I’m probably more than capable of handling everything on my plate. But I haven’t quite ramped up the discipline to my schedule to the degree that I remain stocked and appointed properly.

I’ll be okay in the short run– I’ll be using my old Bayer Contour® meter until my new prescription comes in for the Nano. And this gives me a chance to finally break out the Contour NextLink meter that Medtronic sent me a while back. So it’s not all bad, though my BG tests may be “23 percent less accurate” for a few days.

If I’ve ever felt diabetes burnout, or been close to diabetes burnout in the past few years, it’s at times like this. But like all bumps in the road with this sucky condition we have, I have to do my best until I get the ship righted again. Because really, do I have another choice?
 
 
 

Really?

Okay, first rant of the new year coming up…

I’m beyond needing to order test strips. I’ve resorted to using my old meter because I knew they would be expensive right now. To explain this would take a month of blog posts, so I won’t bore you with it here. The situation is this: I have a pretty great prescription plan at work, but there’s this time, usually in the middle of my plan year (which is now), when I have to pay for everything out of pocket for a period of time. And that time is now.

Well, I decided that I really do need to order new strips for my current meter, so I told myself I would bite the bullet and order the strips. Then I found out how much it would cost:

TestStrips

That’s nearly $1.00 USD per strip, people. I guess I should be happy they only want to give me an 88 day supply this time (in case you’re wondering, 7 50-strip packages equals 350 strips, divided by 88 days = 3.98 strips per day).

I’m all for companies making a profit on their product. But I also believe in a little fair play. I know it makes me sound like a “free market capitalist”, but if you’re going to produce a product that’s so expensive, shouldn’t I have the ability to shop around for the same product elsewhere? Either from another prescription provider or another manufacturer? Or both?

I know that the manufacturers will say that their product is proprietary, and they shouldn’t have to share it, and they’re doing everything they can to “create efficiencies” and keep costs to consumers as low as possible. It’s still a test strip, manufacturers. You’ve been making and marketing test strips for 25 years or more here in the USA. I grant that accuracy is an issue, and I’m glad you’re all working on it. But can’t you just make the strips you’re already making more accurate? And can’t all of you make the same test strip, and work on making that more accurate? Sounds like that alone could “create efficiencies”.

My take: Profit away, test strip manufacturers and prescription providers. But if it’s going to cost so much for something I really need, you should be willing to show me how much of a profit there is in 88 days worth of test strips. And I should be able to search for the same product elsewhere, from multiple vendors. Trust me… I’m going to be a loyal customer for the foreseeable future. I just think that when push comes to shove, diabetes necessity should trump profit (and accessibility should too). Is that too much to ask?
 
 
 

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