Nancy Barber (nlbarber) wrote,
Nancy Barber

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Health Insurance Joys, Round 2

Yesterday I realized that the samples of Nexium were almost exhausted, so I called the doctor's office to explain that the drug was working, I would like a prescription, but that my insurance company wouldn't cover the Nexium and recommended Prevacid or Aciphex. And while we were at it, would the doctor consider if I could use one of the lower cost alternatives to Lipitor, which would cut my insurance co-pay in half. Oh, and while we were doing that, I'd also like a second copy of each prescription so I can start using the Aetna mail-in pharmacy program at 1/3 the cost of a retail store. (I do not envy the life of the doctor's receptionist, or whoever it is that has to take all these sorts of calls and try to keep them all straight.)

It being Friday afternoon, I wasn't sure they'd manage to get the prescription called in (I arranged to pick up the copies of the prescriptions on Monday morning). Nonetheless, I stopped this morning on the way home from Jazzercise, and there was a bottle of Prevacid waiting for me. BUT: the insurance wouldn't cover it. I yelped, and explained that this was the drug the insurer's Web site recommended instead of Nexium, and so they went to investigate--after dealing with another customer's insurance problems. When they got to me, their computer eventually said that this drug requires "prior authorization" (back to that phrase that this context). When I still looked baffled, they called the insurer and were informed that as of Jan. 1, all drugs in this class require prior authorization.

So, rather than pay the full retail price, I elected to wait until Monday when the pharmacy can consult with my doctor and try to get over the prior authorization hurdle. And I've spent the day reflecting on the incredible inefficiencies of this system--the time it takes for me, for the pharmacy, for the doctor's staff, and for the doctor to go through these rounds of "what drug can be prescribed, and what will it cost the patient". I'm no fan of the latest and greatest new drug that's just a tweak of an old one, and don't mind taking older drugs or generics if they will do as well for my problem. But can't we come up with a better system than this for determining what that drug is?
Tags: health

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