The Harassment Plan

After years of painful experiences and even more painful delays, I’ve learned then when I deal with my health insurance and/or my specialty pharmacy, I need to adopt and execute a harassment plan. This is a schedule by which I make calls and bother the involved parties to actually do their jobs so that I can get an insurance approval, refill medications, and so forth. I’ve learned, painfully, that without this harassment, I can’t count on getting the mission accomplished, nor can I expect to receive my medication in a timely manner to keep with my treatment schedule.

Obstacles in getting my RA medication

My latest example is when I had to refill my biologic medication. In January I started a new insurance, so I proactively called them in the beginning of the month to ask about if I would need new authorizations for existing prescriptions. I was told it would be OK, but this was not the actual truth.

I next called my pharmacy (which happened to be the same as under my previous insurance) and was promptly told that they had lost (or erased) all of my previous prescriptions and that I had never been a customer before. “How surprising!” I said “When I am holding several prescriptions from you on my shelf!” I guess they appeared magically. The conversation didn’t end well. Thankfully, my husband was able to call back and get the prescriptions recovered and moved to my new insurance.

I had to wait a few weeks before I would be able to refill my biologic, but I called as early as possible because I was expecting trouble. It was a good thing I did! It took five days to get a refill approved!

Day 1: I called to order the refill and was told everything was all set and I would receive it in two days. They said I would be contacted if any problems with my insurance came up (like needing re-authorization).

Day 2: Like a chump, I didn’t call the pharmacy again to confirm because I have a life to live and a job to do.

Day 3: With no word or shipping confirmation I hear that little voice in my head that says “something is not right.” Even though my medication is supposed to arrive (No problem!) that day, I called in the morning. I am told there is a problem with my medication and that insurance denied because they need a new authorization (the longer story is that my husband had to call both the insurance and the pharmacy benefits manager to find this out). So all my efforts to get in front of this potential problem failed and I lost several days because no one from the pharmacy called to let me know. I’d still be waiting for my medication unaware if I had not called. I calmly registered this complaint. (As an aside, they call me all the time to leave robotic messages about refilling medications or that I need to call them about an important medication matter, but cannot bother to lift up the phone when there is a real issue that I need to address.)

I write a message to my doctor asking for help with my medication authorization and my husband calls and speaks with an assistant. The pharmacy is supposed to fax a form, but they never did. The assistant is going to follow up.

Day 4: I check in with my doctor’s office. They still didn’t receive the form, so my husband calls the pharmacy and asks them to fax to the doctor. He signs and sends back to the pharmacy.

Day 5: My husband calls the pharmacy in the early afternoon and a miracle has occurred: my medication (that I’ve already been on for months) is approved! Yay! But they lost my co-pay assistance card or ran the wrong one, threatening a steep bill. I call the pharmacy back and give them the co-pay card (that they have had for months) again and ta-da my copay is fixed! The medication will arrive on Tuesday.

Will this process ever improve?

Seriously, this is ridiculous. Why does it take five days and two people (a patient and a spouse) to get my medication? I can’t even say I’m getting it in a timely manner as it is coming nearly a week later than planned. Why does this heavy burden of doing other people’s coordination job fall onto our heads? And at what point will my many complaints about lack of coordination and follow through with health insurance and their pharmacy benefits manager be heard and addressed as a waste of time and money (and my very frayed patience)? I’m not counting on it anytime soon. I can’t afford to, because as frustrating as all this is, it is not as bad as my not having a harassment plan and not getting medication. At some point though, I wish the people getting paid big bucks to handle this job would actually earn it (note: my husband and someone from the insurance company actually joked about the big bucks the pharmacy benefits management company make to handle all the things he was calling about)!

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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