It was a routine trip to the pharmacy. I had seven prescriptions to pick up. That right there says something. Somehow a seven prescription pharmacy trip has become “routine.” Three of them had been called in over the phone. Four required me to hand signed pieces of paper to the pharmacy staff. I understand the reasoning behind requiring paper with signatures, yet the need for it adds layers of complication to my life. Any time the prescription needs a refill, I have to call the doctor’s office and either physically go get a piece of paper or plan ahead to allow time for them to mail the paper to me. Add in the fact that the insurance companies keep track of when they last filled the prescription and they won’t fill early, so there is a window of only a few days during which I’m allowed to refill a prescription before we run out. I always try to hit the early end of this window because sometimes the pharmacy doesn’t have the pills on hand and they have to be ordered in. Tracking all of this has become routine. I’d done the math, calculated the windows of time, and taken myself down to the pharmacy to pick things up.
Then the pharmacy register rang up at $500 instead of the $35 I was expecting.
When I picked a healthcare plan last November, I paid close attention to the prescription copays. I picked a plan with $5 copays for their Tier 1 medicines. Tier 2 costs $35 and Tier 3 is $175. It is a system designed to encourage people to switch to the Tier 1 medicines. I don’t really know all the reasons that medicines get assigned to various Tiers. We had some stress in January because my kids had to be switched to a different form of their medicine because capsules were Tier 3, but caplets were Tier 1. Then we had to get special permission for Howard to be on the same medicine because anyone over the age of 18 needs a doctor’s approval, but under that age the insurance company doesn’t require preauthorization. So we jumped through hoops, and settled everyone onto their medicines. And all was well for a couple of months. I was relieved each time I picked up a prescription and it cost only $5. We’d paid much more than that in years past and it had been a financial burden on our family.
“That price can’t be right.” I said.
“You can call your insurance company” the pharmacist said. So I stepped over to a bench and called the customer support number on the back of my insurance card. It was a long phone call with multiple waits on hold while I watched my frozen groceries in my cart slowly thawing.
The systems around health insurance are arcane and complicated. I have to make far too many phone calls because automated systems aren’t as automated as they should be. Yet any time I’ve talked to an actual person on the phone, both for my insurance company and for the government healthcare marketplace, they have been very kind and helpful. The pharmacists are helpful. I end up with this sense that we’re all tangled up together in some weird bureaucracy where the key focus is not on best treatment, but on appeasing the computer system so that treatment can be extracted.
The customer support lady looked up the pharmacy order and found that I’d been billed at a Tier 3 rate. She looked up the medicines and they were all listed as Tier 1. Then she looked at another place and they were listed at Tier 3. Ultimately she had to put in a support ticket to…somebody… to figure out which Tier is accurate. There might have been a change in the formulary listing for these medicines or maybe it was just a mistake. She says she’ll call me back once she hears back. I have her name and number, because I fully expect that in a day or two I’ll have to call her because she hasn’t yet called me.
In the meantime my kids are taking medicine once per day and we’re running out of pills. It may be that the insurance company has changed these meds to Tier 3, which would mean that I have to research and figure out which medicines are comparable and are Tier 1. Then I have to call their doctor and discuss a med change with him, discussing the options and what possible consequences there might be from switching medicines. Then I would either have to drive to Salt Lake City (2 hours round trip) or wait two days for the prescriptions to be mailed to me. After which I then have to make another trip to the pharmacy (40 minutes round trip).
Just today my “routine” trip to the pharmacy cost me 2 hours and significant emotional distress. And I still don’t know how much more time it is going to cost.
So when people accuse parents of putting kids on meds for the parents’ convenience, excuse me if I laugh out loud in derision. There is nothing convenient about this. I would dearly love to be able to skip it all. I wish that willpower, diet, and exercise had worked for us. That would have been lovely. I track and manage all of this medical mess only because I can see that the medicines make a positive difference in the lives of my family. As an ancillary effect, my life is better too, for which I’m grateful. But better is not the same as easy and it definitely isn’t the same as convenient. The minute my family members don’t need medicine anymore I will ditch the stress and expense. I think that some of them will reach that. I suspect that others will need medicine for most of their lives. For this week, I’ll be tracking remaining medicine, waiting for phone calls, and making phone calls. Again.
UPDATE: The insurance company called me back the next day. It was a glitch in their system. The pharmacy re-ran the prescriptions and they came up at the correct $5 rate.