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Trials and Tribulations



My trial: Learning how to navigate through our new drug insurance plan.



My tribulation: see above.




I’m getting pretty close to age 54 now and I’ve never dealt with any medical insurance other than our HMO-Kaiser Permanente.



Now, for those who don’t know, Kaiser has their very own pharmacy located in each and every single clinic and hospital. In fact, the hospitals usually have 2-one for the outpatients and one for the inpatients.




The staff is usually helpful, courteous and treat you like a person-not a card number or a statistic. At least I can say that for the ones I’ve dealt with-don’t know about other counties in Cali or other states. This is only my experience, for what it’s worth.




My “trial” began when my husband’s employer decided that they’d drop the Kaiser pharmacy and give us a private drug plan. In short-we get to keep the medical, but not the pharmacy. Obviously, this was the cheaper route for them.




We found out in a rather rude way about this change-I went to go fill a prescription and they informed me that my total for the one generic drug was $64.88! I said, “No, we only pay $10 for a generic.” The tech, said, “you know, I thought something sounded odd-you’ve never paid more than $25 and that was for your name brands.” She checked and informed me we no longer had drug coverage with our plan.




“What?????”




I told her I couldn’t afford the meds and please put them back. I mainly said that because my head was spinning with the knowledge that I had 3 weeks’ worth of a drug in my fridge that had an asking price of $1,588 a month!!!




Got home and guess what? In the mailbox were our new cards for our “pharmaceutical needs”. I called and asked for the price of the prescription (the tech gave it to me) and with the new policy, this one was $10. Phew!




However, I called “specialty drugs” and asked them about my high end designer drug and was told, “We don’t cover that-you’ll have to find a way to pay for that yourself!”




Stars and dizziness hit. So did a wave of queasiness. I called my rheumy who said that “They can’t deny you this life preserving medication. If they do, you can sue them. I have their number from a few other patients, they will approve this, don’t worry.”




A couple of days later an e-mail from my wonderful rheumy was in my box-it had the approval code and my new order number.




I think I’ve mentioned that my rheumy is the best doctor in the world, no?




However, our new plan-it seems everything other than typical antibiotics runs us about 2-1/2 times the amount we normally paid the Kaiser pharmacy. My “life preserving drug”-it was $25; we are now paying $75. My restassis was also $25-I paid a few cents under $50.




Then came the need for another month’s supply and some idiot in this department put down that I had 1 order, which was thrilled-they forgot to put the “2” next to that one that was on the prescription. There I was and the nurse and the doctor going through the entire process again.





Still, at least I’m getting what I need.




Now for the “good” news-after 8-1/2 years on that “life-preserving” drug-the rheumy and I decided that despite trying to re-boot its former efficacy, I’ve pretty much run its use into the ground and it’s now time to move to one of its cousins.



Sigh-here I go again.