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Systemic Frustrations

stories of our broken healthcare system

Admin Doc | HealthSystemHelp.org | 02/22/2020

 

Systemic Frustrations

 

So, I established with a new doctor today. She was nice.  She called in refills of all of my medications.   I waited 4 months for this appointment and took my last BP pill today.  I kind of stretched my other medication to make it last until this appointment.  I know many other people do this too. But I didn’t want to mess with my BP meds because I had felt like it was a little high anyway.  

 

So, then I go to the pharmacy.  Walgreens is a preferred pharmacy for my BCBS HMO. To digress a minute, I chose this option because it was the least expensive.  My family has some hereditary chronic diseases, so we are higher utilizers than average.  We pretty much max out our deductible every year so choosing the one with the lower total out of pocket cost was a no brainer.  BUT it is an HMO.   That means that nearly everything we need must have insurance company authorization.    Even some generic medications that we have been on for years have to have an authorization. 

 

What is the purpose of these authorizations?  The insurance company will say it is to make sure they are medically necessary.  Most doctors don’t have time to mess around prescribing things that are NOT medically necessary.     So, this is kind of bull.    They do it as a barrier to try to get providers to think twice before they prescribe things and to try to dissuade them from prescribing anything too expensive. 

 

Back to the Pharmacy

 

Back to the pharmacy…. I go to pick up the prescriptions and of course, I leave Walgreens with nothing. 

Their supplier can’t get my BP med (one of the most common in the country).  Other suppliers can get it but not theirs. At least they were honest with me.  I have seen other chain pharmacies tell patients that their medications were unavailable and sent them back to their doctors asking to change their therapy, when it is just that it is unavailable to them and if they go to a different pharmacy, they can get it. Changing people’s Blood Pressure meds because of insurance coverage or systemic availability issues is not something doctors like to do.  BP meds are very important, and one is not interchangeable with the other.   

Since I was out of my blood pressure med and needed it right then, they transferred my prescription to the pharmacy across the street and I went over there to get it.    Maybe I should transfer all my prescriptions to the other pharmacy.  I don’t know it if is “preferred” or not, but they were friendly and have a drive-through.

For my other medications, my doctor sent it 90-day supplies because that is easier and ends up saving money for the system down the road.   The pharmacy did not have 3 months’ worth of my inhaler so they couldn’t fill it until they order more.  They did not have enough of my thyroid medication, so I had to wait for that to be ordered. Then my diabetes med… well that is brand name and needed a prior authorization.  4 days later and I am still waiting on that, but I stretched it out, so I have some of that left.

 

This is our system.   It is TOOOO HARD!!!!!.  It does not have to be this hard.   I have been on the same meds for over months and am doing well.    These barriers are just that …. BARRIERS to being able to take care of ourselves.    The insurance companies have because giant money sucking barriers between our healthcare dollars and our actual care.    Something has to give.

 

See next article to see how I saved over $250 on those prescriptions. 

 

 

Post Author: Admin Doc

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