Today’s blog post is going to detail for you the
struggles of getting a medication (especially one the insurance doesn't want to pay for). Because I’m always sleepy on
Zyprexa and I crave carbs like crazy and have gained a bunch of weight, my
psychiatrist decided to switch me from Zyprexa to Latuda. The following is last
week’s “adventure” trying to get my Latuda before my trip.
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Monday after my appointment, my doctor sends my
pharmacy the prescription for Latuda. Within a short period of time, the pharmacy
sends me a notification that the prescription has been delayed and the reason
given in the email is it is out of stock. OK, they can get it within 24 hours
because of my location. Not a big deal. I can get it Tuesday, right? Fast
forward to Tuesday. I’ve heard nothing from the pharmacy, so I call them to find
out why. They say the insurance needs a doctor’s prior authorization and that
they faxed my doctor to let them know. Not the same reason they gave me at
first and frustrating, but I figure one more day turn around won’t be too big
of a deal.
On Wednesday I still haven’t heard anything, so I
called the pharmacy again. They say they’ve heard nothing from my insurance, so
my doctor must not have sent the prior auth yet. Frustrated, I call my doctor.
They say the pharmacy never faxed them! I don’t know if my doctor’s office
dropped the ball or the pharmacy, and I don’t care at this point. I’m just
grumpy that a day was wasted because my doctor and the pharmacy didn’t
communicate correctly. The doctor’s office personnel say they’ll get on it.
I figured it wouldn’t be processed until the next day,
so imagine my surprise when a couple hours later I get a message from the
pharmacy saying it’s filled! Knowing that it’ll probably have a higher copay
than my other medication, I call to find out how much out of pocket I have to
pay. The pharmacy says I have to pay over $1000 out of pocket. Um, that’s not
happening. That’s more than we pay for rent. I ask if my insurance denied it,
and the pharmacy says yes, because I need to try other therapies first (meaning
other medications). Bull crap. I’ve tried almost every med out there for
bipolar disorder. Tired of playing games, I call my insurance to find out what
the hell is going on. Their answer? They haven’t received the prior auth yet
(which I anticipated). Then they say a basic prior auth might not be enough.
They need my doctor to list all the medications I’ve tried before so they have
proof that I’ve tried other meds before this one. So I had to call my doctor
again, now it’s after hours, and I leave a rambling voicemail saying what I
need. I still don’t have my med and at this rate I’m worried I won’t have it
before I go out of town, which I really need. I’m beyond frustrated.
Thursday rolls around. Because I don’t want to let
this sit, I call my doctor to find out what’s going on with the prior auth.
They say they sent it to the insurance earlier that day. There’s nothing more I
can do besides wait. So I wait one more day. On Friday I call the pharmacy to
see if it’s been approved. They say it hasn’t. So I call my insurance. Again. The
beautiful moment happened: they told me they had just approved it and were
contacting the pharmacy! Yay! I’m going to get my med! And before my trip too!
Or so I think.
I wait a little bit to give the pharmacy a chance to
get the approval from the insurance. Then I get a message from the pharmacy: my
prescription is delayed. Tired of this BS, I call them. The lady who answers
says it’s out of stock at the location I normally go to. I don’t understand how
they can be out of stock. On Wednesday they had filled the prescription for me
at the over $1000 price. That prescription should still be there. Which means
they should just be able to give it to me. The lady can’t help me with that,
but, she says, there’s another location in my city that has it. I ask which
location, and she can’t give me the cross streets so she tells me she’ll
transfer me to the location so they can give me the address. I am transferred and
I start talking to the guy. I ask him if the medication is in stock. He says it
is not. I ask to be transferred back to the pharmacy I normally go to. He says
he’s at that pharmacy. I ask if he can check to see if the other location has
my med. He says he has no way of looking up what another location has in stock.
I ask him who I just talked to then, and he has no idea. My best guess is I was
talking to someone at a central call center for my pharmacy and that they made
a mistake and transferred me to the wrong pharmacy. But I’m not sure.
I’m getting more and more frustrated at this point,
and worried that I won’t get my medication that day, and since there is no
shipments on Saturday, if I can’t get it on Friday, I won’t get it before I go
on my trip Sunday. After pressuring him for answers, the guy at the pharmacy
says he’ll call the other pharmacies in the city and see if one has my med. And
then I can call back in a half hour. Ready to cry or punch something, I
complain to my mother in law about what’s going on. She tells me to go to the
pharmacy and not leave until they can give me a location with the medication,
even if it’s in a city nearby and I need to drive to it. I agree that seems
like a logical plan, so I go to the pharmacy.
The lady up front seems helpful. She goes back to make
sure the medication is out of stock. Then she talks to the pharmacist to see
what’s going on. He says he just finished calling the pharmacies in the city
and there are two locations with my medication. I’m finally getting somewhere! But
I don’t trust leaving without knowing for sure my prescription is transferred and
that I will be getting the medication that day. So I ask the lady if she can
transfer it while I’m there. She was a good sport and called the other pharmacy
and transferred my prescription. With the knowledge that it would be ready in
10-15 minutes, I drove to the other pharmacy and FINALLY got my medication. I
was so so very relieved! I did so many happy dances! I got my medication before
my trip after all! Yay!
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Here’s the thing that bugs me. If I weren’t in a good
spot emotionally, there’s no way I could advocate for myself as well as I did
last week. No way in hell. I would have given up, cried a lot, and/or tried
waiting for it to resolve itself. None of those options would have gotten me my
medication, especially not in time for my trip. And I really needed this
medication. Like, it’s made the hugest difference in my alertness already! And
I can wake up without feeling groggy. It's wonderful. I still need to wait to
make sure it handles my moods the way it’s supposed to, but the side effects
have been minimal and I’m really really hopeful. But I wouldn’t have the med if
I hadn’t been so pushy.
The fact that it takes so much stress and so much
pushing to get a medication that the insurance doesn’t want to pay for is
ridiculous. A prescription should count as a prior auth. Also, the fact I tried
multiple medications should have been in my insurances files. But they make
patients (and doctors) jump through so many hoops before the insurance company
will cave and pay for a med. I shared my story with people in a bipolar support
group and I heard story after story of people who have had to do the same thing
in order to get the medication they need. It’s simply not right.
I’m so grateful it all worked out in the end, that I
got my medication (and before my trip!) and that my insurance finally paid for
it. Now we keep fingers crossed that it’ll handle my moods the way it’s
supposed to.
