Some of you may remember a rant from me within the last year or so that involved a disappearing doctor, and the effect that had on some medication I take.

Got a new doctor. Got the medicine. Have now been on it for 19 going on 20 years.

Went to pick up a refill the other day, and all of a sudden it's a problem. Walgreens never called to say there was a problem. Insurance company, doctor, and Walgreens are all pointing fingers at each other.

Preferred medication, non-preferred medication. The doctor can fill out a form, but nobody an speak to anybody on the phone. Form may take days to weeks to be returned. When it is returned it may or may not be approved.

20 years, but all of a sudden there's a problem, and nobody can seem to figure it out.

I'm seriously considering checking myself into the hospital until they get things straightened out. They can provide medication there, and make sure the lapse in medication so far isn't causing any health issues.

Freaking ridiculous.

Yep I've seen that happen to others, they have a medication that's on one tier and then carriers change or they re-eval the medication tiers and require you to start taking other meds that are cheaper to see if they work first, even though you're on the high cost med.

It may be something like that and the DR or Pharmacy may not be the culprit, call your carrier and ask about the med and if any changes have been made as to it's qualifications on your plan.

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they have a medication that's on one tier and then carriers change or they re-eval the medication tiers and require you to start taking other meds that are cheaper to see if they work first, even though you're on the high cost med.

That's something along the lines of what the insurance company is saying, but the retail cost of the medication is roughly the same name brand or generic.

They put me on the generic for a few months, and my copay was higher than it was for the name brand. Put me back on the name brand for a few months, and can't get this refill.

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It may be something like that and the DR or Pharmacy may not be the culprit, call your carrier and ask about the med and if any changes have been made as to it's qualifications on your plan.

Been on the phone with everybody, and nobody can do anything. It's all up to the other people.

Walgreens could have gotten this process started faster by actually taking the time to notify me that the refill wouldn't be refilled. Instead they wait 4 days, and when I show up to retrieve it, tell me there's a problem. They can't say exactly what the problem is, but it's not their fault. I have to call the doctor or my insurance company.

I call the insurance company, and they can't do anything until they hear from the doctor, but no attempt was made to notify the doctor. The doctor can't do anything until the insurance company tells him what they need. The doctor can not speak to a representative from the insurance company on the phone. He was directed to a webpage to submit something.

So while everybody else gets to point fingers, I get to go without medication. Might hear something back within 48 hours. Could take up to 90 days.

Seriously........

I'm paying these people to handle these things. If I need to act as my own administrator to coordinate all of the minions, then why should I pay them? Oh yeah, the Democrats say I have to.

I'd say it's the Dr you are waiting on, the carrier has denied payment for the script, probably because it now has a process you have to go through to qualify for this particular medication to get it from the OEM.

Since there is a generic they are most likely requesting the Dr to certify that the generic wasn't working and that you require the OEM brand, which costs you less, but costs them more.

BTW I would shop the generic if they put it back to that or pay for the name brand yourself, which is where it will go most likely, I find significant price differences from pharmacy to pharmacy for the same script.

At Walgreens one was over $100, Publix $70 and $30 at Costco. Same pill....

Costco is a great source or Sams Club if you have access for scripts, they have a max markup on products that applies to scripts as well.

The only issue at Costco is I end up spending a few hundred on stuff when I go for my scripts LOL I joke that I have a $100 a bottle co-pay on my costco scripts...

It's about $700 a month my cost. Which I gladly paid out of pocket prior to be required to have insurance that costs me more.

I figured since I have to pay to have the insurance, they might as well pay for the medication that I'm forced to insure.

I don't mind getting ill, I could use the vacation. If the insurance would rather cover that bill than the meds, that is their choice.

I bet the doc has samples that could get you over the hump; or he could phone in an emergency supply for a week (unless is a Schedule II drug).

All kinds of options that all start with the Doc.

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All kinds of options

I prefer the option where I go to the pharmacy, pick up my medication, and go about my life like have been doing for the last 20 years.

Sure, I could jump through any number of hoops. And I did when I paid for things myself. Now I'm forced to pay all of these idiots to "handle" things things for me, and they do a piss poor job knowing that there will be zero repercussions.

I feel your pain ...

Dr. ordered a CAT scan for my wife in late Nov./early Dec. BCBS says "no - we need more info from Dr." Dr and his office call BCBS 4 times, no one will answer their call or call back.

Wife still needs CAT scan - BCBS won't help, Dr. office wants to help, but can't. I'm 95% sure that because we met our ridiculously high deductible (that's another rant), BCBS is just trying to push the CAT scan into January when the deductible resets and we would have to pay for the CAT scan out of pocket. A fact I told the BCBS rep on the phone.

So the BCBS rep actually suggest we go to the ER and get the scan. It's obviously not an emergency situation, but that's what she suggested. I'm 100% sure they would then deny the ER claim and CAT scan and stick me with a HUGE bill from the hospital. So I asked for that suggestion in writing. From a supervisor.

Of course she transfers me to a supervisor, and while on hold - we get disconnected. I call back, ask for supervisor. Disconnected again.

Gotta love this mess.

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Originally posted by a1abdj:

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All kinds of options

I prefer the option where I go to the pharmacy, pick up my medication, and go about my life like have been doing for the last 20 years.

Sure, I could jump through any number of hoops. And I did when I paid for things myself. Now I'm forced to pay all of these idiots to "handle" things things for me, and they do a piss poor job knowing that there will be zero repercussions.

Welcome to our new world where accountability isn't taught anymore as a key value; I am so thankful that the snowflakes are NOT responsible for making the sun come up or it's would just stay dark all the damn time.

I can't find any service hardly at all anymore where people give a shit. I've been in your exact same spot several times. I don't want my BP to rise any further, so I'll just leave you to empathize in commensurate commiseration.

Online pharmacy?. You have a Rx, right?

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Originally posted by ElToro:
Online pharmacy?. You have a Rx, right?

That's what I was thinking. I used to buy Asthma inhalers through foreign pharmacies. It's been a number of years, but I don't recall needing an prescription to do so.

It is entirely likely the doctor (or his office) is going to go to (or has gone to) the website to go to fill out the prior request.

It often is just the doctor finding time in his/her schedule to jump through the hoops.

I get probably between 2 to 10 request per day for prescription refills, prior authorizations, substitution request, etc. It can be a challenge to find the time between patients to the appropriate research on each request to give each request the attention required. I make a point to address all requests same day if I am in the office; however, same day means often I work after-hours to get requests submintted.

Unfortunately, this is what happens when reimbursements squeeze providers; I would be willing to bet that the office knows what to do and is just trying to help the doctor find the time...at least, I hope that is the case!!!

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Unfortunately, this is what happens when reimbursements squeeze providers; I would be willing to bet that the office knows what to do and is just trying to help the doctor find the time...at least, I hope that is the case!!!

The doctor is the least to blame with this. He has an assistant that deals with these things, and she has already held up her end.

The part that I have a problem with is why I need to be involved at all. These parties should have these things all worked out among themselves. I shouldn't need to spend hours of my day on the phone coordinating everybody.

When I filled the prescription, Walgreen's computer said "your prescription will be ready for pick up on Friday at 2:00 PM". So when 2:00 on Friday rolls around and they don't have it filled, they should have contacted me, the doctor, or the insurance company to say there was a problem. Instead I show up on Monday and get a deer in the headlights look.

Walgreens then says it's the Doctors fault. They "faxed" a request to the doctor and hadn't heard back. I call the doctor, and no such communication was received. When I press the issue, Walgreens says it the insurance company rejecting the prescription that they have previously had no issue taking care of.

Then I call the insurance company. They too blame the doctor. The doctor has to fill out their online thing because no real life person can speak with them on the phone. Great! Did they contact the doctor? Nope. When they decided they weren't going to cover this prescription for whatever goofy reason they have, did they contact me? Nope.

I confirmed the Doctor wasn't a mind reader, because they weren't expecting yet another call from me.

So what we have is a pharmacy that has an issue and can't be bothered to let anybody know, and an insurance company that has an issue and can't be bothered to let anybody know. Apparently their version of notification is simply saying no when you show up to pick up your prescription.

So far I've made a 40 mile round trip to the pharmacy with nothing to show for it, spent about 45 minutes there trying to figure things out, and then another hour or so total over the last 48 hours trying to move things along.

Still no medication.

I have a similar problem as of yesterday.

I take Crestor and have for several years, I have a statin intolerance, and have tried all of the others with very negative results.

Crestor is the high cost spread but the Doctor has gone through all of the required hoops and it has long since been approved.

Crestor now has gone generic and the cost has dropped to $34 for a ninety day supply.

But now I am now longer approved and must go through the approval process all over again. The entire system is nuts!

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The part that I have a problem with is why I need to be involved at all. These parties should have these things all worked out among themselves. I shouldn't need to spend hours of my day on the phone coordinating everybody.

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This is called the business of healthcare. It is all about the money. Hospitals, the government, Big Pharma, and Insurance Companies run the show. It used to be the doctors who might actually have the patient in mind. About 50 percent of physicians are employees. Young doctors want 9 to 5 jobs, like everyone else. As far as these folks are concerned you are not important.

There are doctors that have what are called concierge practices. You get unlimited time with them, preferred appointment times for a yearly fee. {It is not cheap}. You then get a catastrophic plan to cover the hospital and other high dollar costs. Might want to look into that.

This is something that provides a savings on drugs. It is no cost to you. I am not affiliated with it. It is not a scam and could save you some money.
https://www.goodrx.com/

Check out Blink Health too. Download the app. I posted about it last night. This and GoodRx are good options if you need it before they get the CF figured out.

Well, I got my medication last night.

The doctor's office called me at 9:30 AM to let me know that they "got approval" from the insurance company, and I was good to go.

I immediately call Walgreens and get their automated system that recognizes my number. It tells me that the insurance company had rejected their request, but they "were working on it", and "would notify me as soon as the issue was resolved".

Walgreens can't even call to let you know it's not ready when they promise, so I already know damn well that they aren't working on anything.

Stop by on my way home at 10:00 PM. I have them pull me up in the computer and she says it was rejected. I inform her that had been rectified, she hit another button, and all of a sudden there it is. She admitted that without me coming in, asking them to pull it up, and manually resubmitting it, it would have never happened.

Yet another example of the insurance company making a decision, but failing to notify those who need to know. Also an example of Walgreen's computer knowing that a customer had called to check on a status, but that computer not reminding anybody to actually do anything about it.

Ironically I get a letter in the mail yesterday from the insurance company. I can use their approved mail order pharmacy and save up to 25%! I called, and they said they could fill my meds for a $50 per month copay. I've been paying $50 a month at Walgreens. That's not saving anything.

Then it became clear last night when Walgreens finally filled my prescription. It's now $70. So the insurance company and their "partners" aren't saving you money, they're just raising the prices elsewhere to encourage you to do business with them.

So if you have been taking the drug for 20 years, how has it affected your kidneys?

Here is why generic drug prices are high? Are We to Become Serfs of the Drug Monopoly?

My article ignited a firestorm of activity in Congress aimed squarely at the FDA.

Back then, many members of Congress were upset that the FDA prohibited Americans from importing lower cost medications from other countries.

To underscore this consumer rip-off, I compiled a chart showing how much more Americans were paying for pharmaceuticals compared to Europeans.

This chart was enlarged by a congressman and shown on the floor of the House of Representatives. The purpose was to educate other lawmakers about the magnitude of the price-gouging.1

The eventual result was passage of a bill by Congress and signed into law by President Bill Clinton. The bill allowed Americans to import prescription medications from countries that sold them at a fraction of the price Americans were paying.
Image with Caption


The bill had one fatal loophole. If the FDA determined that it lacked the resources to ensure the safety of imported drugs, then the Secretary of Health and Human Services could nullify the bill with one stroke of a pen. And that’s exactly what Donna Shalala did in the final days of Bill Clinton’s term.

This cruel act of sabotage by an unelected bureaucrat set the stage for the staggering increases in generic drug prices that now make headline news.

The burden of high medical costs has reached a point that is unsustainable by the American economy. This problem will not abate until the public regains some control over Congress, which is currently dominated by pharmaceutical lobbyists.

As you’ll read in this article, the FDA wants to further benefit pharmaceutical interests by suffocating innovation in the dietary supplement industry.

No one has fought longer or harder against high drug prices than Life Extension®.2

We’ve exposed how off-patent generic drugs whose active ingredients cost only pennies are sold to consumers for hundreds of dollars.

Continued here:
http://www.lifeextension.com/M...As-We-See-It/Page-01

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New England Journal of Medicine Exposes Generic Price Scandal
March 2016

By William Faloon


No one has fought against high drug prices longer or harder than Life Extension®.1-20

The penalty for exposing health care corruption is endless governmental investigations aimed at destroying our organization. The tide may be turning in our favor.

The New England Journal of Medicine published a report that uncovered a drug price scandal that we’ve sought to expose for the past four decades.21

CBS News turned this consumer swindle into a headline report that graphically depicted the devastating impact that skyrocketing generic drug prices are having.22

The next day, I gave an impromptu speech at an Alzheimer’s seminar where I asked the audience to join me in amending the law to prohibit the FDA from granting monopoly status to generic drug makers. Virtually everyone in the audience said they would personally take the time to protest high drug prices at local congressional offices.

Two months later, 60 Minutes featured an in-depth report on today’s broken sick care system. A quote from this 60 Minutes broadcast relating to the Affordable Care Act stated that it is the product of an:

“… orgy of lobbying and backroom deals in which just about everyone with a stake in the $3-trillion-a-year health industry came out ahead—except the taxpayers.” 23

The 60 Minutes report went on to state there is “no way in the world that we’re gonna be able to pay for it.”

Investigative journalists have since corroborated how high drug prices are causing American consumers to become serfs of the pharmaceutical industry.

This month’s issue of Life Extension® reveals shocking new details of a price-gouging disgrace that is contributing to the insolvency of our sick care system.
New England Journal of Medicine Exposes Generic Price Scandal

Today’s medical system provides mediocre efficacy at prohibitive prices.

When you read news stories about municipal, corporate, or personal bankruptcies, the high cost of health care is a consistent underlying factor.

Misguided politicians believe that government subsidies, mandates, and giveaways can resolve high sick care costs.

Even a cursory glance at the extravagant prices of new medications exposes the falsity of this charade. When a single new drug can cost $100,000, and protocols are being developed that combine several drugs priced in this range, how can any form of “cost-sharing” be expected to work?

It has become mathematically impossible for these outlandish sick care costs to become “affordable” via government edict.

How Deprenyl Works in the Brain

For example, the bottle of the prescription drug Valcyte® you see pictured below with my name on it contains 60 tablets. The price for this bottle of Valcyte® is around $4,200. This works out to approximately $70 per tablet.

My cost for a four-month course of this medication is over $16,000. Some people are spending over $50,000 a year for this drug to stay alive—and this is often just one of many medications they need.

Continued here:
http://www.lifeextension.com/M...rice-Scandal/Page-01

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So if you have been taking the drug for 20 years, how has it affected your kidneys?

Luckily it hasn't. I'm on a fairly low dose, and the docs run blood work every visit to verify proper function.