If you think you are in control of how you manage your health, you are in denial or not well informed. You and your health care provider may come to a mutual decision about your taking a certain, specific medication and he or she can write a prescription for you to obtain it, but you still may not be able to get it. Neither you nor your doctor are in control of that decision. Your insurance company is.
More and more medical insurance companies are turning to third party pharmaceutical partners to handle the dispensing of the medications you take. And they have the power to prevent you from receiving the medication your doctor ordered for you, at least using a reasonable co-pay. They can go so far as to specifically tell you what other drug you CAN have.
I just tried to obtain a re-fill of a medication I have been taking for a few months which is working for me. But it has no generic format. My medical insurance provider made a change on my behalf January 1st passing off the responsibility for approving my monthly maintenance medications and other drugs I may need, approved and requested by my physician, to a company that uses a secret formula to determine if they will approve the prescription – MONEY.
For the past few days I have been talking to my pharmacy, who has told me my re-fill was “blocked” by my insurance company. I called my insurance company and they said I needed to talk to my doctor to get “prior authorization” and have him send it back to the pharmacy. I did that. BUT, it turns out my insurance company is not involved in the decision to approve what my doctor wants me to have. It is another company that is in control and they want me to have something else. And, they have the legal power to do this.
For the record my insurance company is Aetna. And, for the record they are now using some company called Express Scripts to approve or deny the prescriptions my doctor and I agree I should be taking. I just spoke to someone at Express Scripts. The person I spoke to admitted they blocked my re-fill because it had no generic formulary. Therefore they want me to call my physician and have him call them back with a prior authorization for a completely different medication Express Scripts says I can have. Isn’t that great?
People were concerned about Communism and Socialism in the 1950s but that fear went away along with the bomb shelters people were building in their back yards. We have a much larger problem than the Russians today, big pharmaceutical companies dictating to us, through third party administrators working with our insurance companies as to what we can obtain, at a reasonable cost (read: co-pay).
I am mad as hell and yet…I am stuck. I have had to acquiesce to the terms dictated to me today by a drug pusher (not the doctor) – a company that does not know me and never met me has decided what is best for me. Do I sound pissed? The most difficult part of writing this was using language that is acceptable and not offensive to the weak at heart.
Nobody, and I mean nobody had better get in my way today...damn it all…
