That depends on the problem and the med. I could become dangerously dehydrated.
That’s why I said “rarely” instead of never, and mostly because he dragged my experience into his comment. Yes, if you get dehydrated, go to the hospital. They won’t have your medication, but they’ll have IVs. I hope it doesn’t come to that. 
But still, whoever provides your prescription drug coverage doesn’t give a rat’s ass if you have to go to the hospital, sad to say.
And it sounds like he’s saying if you can’t get a refill of *any *med, go to the ER. No, don’t. ER’s are for emergencies. It’s asshats who go to the ER because they ran out of their cholesterol medicine who clog up the ER for people who actually are having emergencies.
I just received this email.
Monday? Freaking Monday?
Agreed, that was one of the points I didn’t make very well in my reply above. I don’t know if Davidm has the same set up as me, but I have my medical insurance and separate pharmacy management. When I was with BCBS, my pharmacy manager was either ExpresScripts or CVS (depending on which plan, I had both at different times). I currently have UnitedHealthCare for medical and OptumRX for pharmacy management. When they’re completely different companies like that, that’s a very wide gap for things to fall through. The pharmacy only cares what your prescriptions cost them, and the medical insurance only cares what your medical treatments/diagnoses cost. You’d think one would feed into the other, but… apparently not. Each doesn’t give two figs about the other.
Ugh, I’m sorry. We have such a fucked up system when situations like this demonstrate that the organizations that are hired to supposedly protect your health clearly don’t understand the health ramifications of delays.
Regarding medical coverage vs pharmacy: this drug is not covered under pharmacy, it’s covered under medical. I think that’s because it’s an injectable.
That’s caused confusion in the past and I think may have been part of the current confusion.
Meanwhile, it’s past 3:30 on a Friday and I haven’t heard anything further. I’ve used what is probably the last dose. There’s some fluid left in the vial but I doubt that I can even get it into a syringe.
I may be stuck eating jello and yogurt for the weekend. I was feeling pretty good this morning but then I ate a poached egg for lunch and I ended up having to use the medicine.
Shouldn’t somebody be held responsible for this in some way? If they’re not held responsible then they have no incentive to do better.
I can certainly empathize as I suffer from RA and am on some specialty medications myself. As long as nothing changes - same Rx carrier, same pharmacy personnel, same provider personnel - life goes along smoothly, I pick up my new scrip from my doctor every month (annoying that they consider every person with a pain med to be a criminal these days, but I’ve gotten past that), take it to the same pharmacy, give it to the same pharmacist who calls the same contact at the provider. But if even one cog in that chain has a hitch, I wind up having to go to the ER because they are able to get the med for me.
I hate having to do that as I incur a $250 emergency room treatment co-pay each time I have to do that and am never reimbursed for it. But at least the option is available.
Davidm, have you considered asking your doctor for an alternate med until your situation is straightened out? It might not be as efficacious as the one you are using now, but it might be better than just flat out suffering with nothing?
I’m sorry, davidm.
If you don’t have to have this sent from the insurance company’s pharmacy, you might try to find a local pharmacy that will carry it. Not a CVS or Walgreen’s – something like a locally-owned pharmacy or compounding pharmacy might be better at working through this for you.
I refuse to have CVS Express Scripts fill my migraine abortive, because they fuck it up every time. They don’t do this with any other medication, only the one that is brand-name, expensive, and for which I have a quantity override.
And talking to those people is like talking to a barnyard animal, and about as effective.
Local pharmacies don’t carry it and in any case the insurance company has always required me to get it shipped by a specific specialty pharmacy. That may change now. I don’t know. But whatever happens I’ll have to obtain it in whatever manner the insurance company wants me to. I can’t just pick and choose pharmacies.
My fear is that after I get it this time, I’ll encounter the same bullshit for the next refill. I’m currently between jobs, but once I’m working again I can’t be sick 1 week in 5 just because I’m fighting an idiotic bureaucracy.
I’d like to get a lawyer and bring some kind of suit so as to avoid this kind of crap in the future, but lawyers cost money.
YEEEESSS!!!
I just got a call from Walgreen’s Specialty Pharmacy. They’re shipping 3 months worth to arrive tomorrow.
Oh, that’s good to hear!
How about someone in the media just to bring some attention to this problem? As mentioned, several of us have encountered similar situations, but it doesn’t seem like people realize that this can happen. And it’s also possible that it happens more than we realize.
I’d have to think about that. I’m not sure how much I’d want to publicize the fact that I have an unusual medical condition. I’m between jobs right now and employers don’t want sick employees.
Blue Cross. God I’m beginning to hate them. I have some coverage through them and last month they sent me an e-mail that 2016 rates were going up. Okay, that happens, but what they followed that with really pissed me off.
Included with their notice of rate increase was a little pat of their back. They were donating some money, $25,000 or $35,000 to some charity and would I like to donate too?
Not a chance guys.
One thing I will say is that the increase in my monthly premium for this year was only $7.74.
It happens a lot, because trying to get accountability at CVS Express Scripts is impossible.
Even media attention wouldn’t help, unless it was an ongoing thing picked up and reported over and over again, like the Shrekli dude.
I think the problems that I (and others) have experienced may not be problems with any one company but rather systemic problems with communication between the different companies. That’s a difficult problem to solve.
You can get things straightened out so that everything lines up; the correct prescription gets to the correct pharmacy and they have the proper authorization and ship and properly bill the insurance. This can then work smoothly for months or even years, but knock one piece out of place - you need to use a different pharmacy, or get a new authorization, or whatever, and suddenly everything goes tits up and you’re back to square one in lining up the pieces again.
Apparently what happened to me this time is that several pieces got knocked out of place at the same time. A new authorization was required, the insurance company was no longer using the old pharmacy, and there was apparently an issue with finding someone who could supply the drug. I think there was also a mistake made where someone somewhere assumed that this should be billed to the prescription plan when this particular med is processed through the medical plan (a mistake that’s been made before). Add to that the fact that it all occurred over a period that included two long holiday weekends and you have the perfect storm.
How do you fix something like that? My insurance broker is going to try to find a way to prevent this in the future but in some ways she’s as confused as anyone else (not that I blame her).
And I’m not sure what to make of the claim that this drug isn’t supposed to be direct shipped and never should have been, even though that’s what’s been happening for over 10 years. And she’s tried to convince me that what I really should be using is a completely different dosage form (a timed release intramuscular injection) that is not what the doctor prescribed and would be completely inappropriate in my case, but can be direct shipped. 
Why can one be direct shipped and not the other? I’m not even totally clear on the definition of “direct shipped”. I think it means shipped to me instead of picked up at a local pharmacy. But it would still have to be a special order which is shipped to a local pharmacy so what’s the difference?
And my local pharmacy says that they can’t order it. Maybe some other local pharmacy can? If so, why can one but not the other?
I have three months to resolve all of this so I don’t have to go through the whole thing again. That’s assuming that it actually does arrive tomorrow and that they send the right thing.
One apparent silver lining in all of this. I usually have a copay of 50% on this expensive medicine. When the pharmacy that’s shipping it called me, they said that it’s covered 100%. Since they’re shipping three months worth, that will save me a lot of money. I see three possible explanations for this:
[ul]
[li]It’s a mistake and I’ll be billed.[/li][li]The insurance company is doing that this one time because of the massive fuckup.[/li][li]There’s been some change in the plan, possibly due to the new healthcare laws.[/li][/ul]
Obviously I’m hoping that it’s the last reason. That sort of makes sense because a new rule might go into effect at the beginning of a new year.
Check your PMs.
Thanks. The medicine is being delivered today, but I appreciate your efforts.
Fedex tracking shows it arriving by noon today. So maybe I can have a decent lunch.
I have it!!! 
Yay!!
Frustration seems to be a built-in ‘feature’ of our medical system these days.