Health insurance

Rant About Big Pharma

/ Missy Goodnight / Leave a comment

Has this ever happened to you? Let’s say your health insurance forces you to use one type of pharmacy, a mail-order pharmacy. But they will allow for medication at, say, CVS, as long as you get a 90-day supply. The medication you are on is $60 a month retail, and $25 with commercial insurance and a manufacturer coupon. So you go get your 90-day-supply of medicine and are willing to pay the $75, but CVS says that the manufacturer won’t allow a coupon on a 90-day supply. So you call the mail-order pharmacy to get it filled, and the mail-order pharmacy says they won’t take the coupon. Like, they just say no. No reason is given, just no. “We don’t accept coupons of any kind.” So you can’t get the 30-day refill at CVS, because your insurance says no. And you can’t use the manufacturer coupon because the pharmacy your insurance is making you go through won’t take it. No, this has never happened to you? Just wait, I’m sure it will.

Healthcare in our country is so jacked up, that this is the sort of thing that happens on the reg. Now mind you, this happened to my husband and it’s for medication he could probably come off of for a few months, or switch brands, it’s not like brand-specific or saving his life everyday when he takes it. But, he’s been on this medication for several years now and has been paying $45 a month, then one day they just upped their price of the medication. Presumably they had their reasons. I mean, nothing changed in the way they manufacture or sell it. There were no changes to the “fillers” and what not. But I’m trying to be optimistic here and assume that it wasn’t just the pharmaceutical company being greedy bitches (because I have friends who work for big pharma) but…

I keep thinking about people who are not covered by health insurance. We are. And our doctor is cool, and she can probably just call in a new, generic script on Monday, and sure maybe he will have to make an appointment with her, and pay another $30 co-pay, and take an afternoon off work to get it all situated, and that’s fine because he can do that. But what about the people who can’t? What about the people who have no idea there are other options? What about the people who can’t take an afternoon off work, or that extra $30 co-pay will set them back for the week? What about those people? Who is thinking of those people? Not big pharma. Not United Healthcare. Not Optum Rx. Not anyone like that.

My husband was frustrated, sure. But he will get the problem resolved. But there are people who can’t get their situation resolved. There are people who need much more important medication everyday. Life-saving medication. And it is taking months to get things like this resolved. And months can mean death for some of these people.

I’m probably not saying anything you don’t already know, that is if you’re even a little bit “woke” as the kids say. But just in case you didn’t know, this is the kind of thing that is happening. And it’s happening to people like us. It’s happening to the working middle-class. The upper-middle-class. It’s happening to the lower-middle-class. And it’s certainly happening to the people below that. And no one is benefitting from it, but Big Pharma.

I’m sorry if you’re any of those people. I’m sorry if you’re walking through this right now. Ask your doctor for help. Ask your friendly, neighborhood pharmacist. They want to help. They get it. And please, for the love of all that is holy, find out the politicians in your area, and nationally, who are working to make things easier on the health insurance companies and big pharma, and vote them the hell out, y’all. We have to fight for people that can’t go at it alone.

End rant.

M.

Mental Healthcare

/ Missy Goodnight / Leave a comment

In the saga that is my mental health and working with my health insurance, I have some good news to report: My insurance company approved my new anti-depressant, and they paid the copay for the new medicine (because there is no generic version of this particular pill yet) and they approved and paid for my DNA swab test to see which medicines work best for me (in the tune of $5,000, which they negotiated down to $1000, $100 of which I’m responsible for.) So, they paid for most of this. Which leads me to questioning this absurd system we have.

I reside snuggly in the middle-class. In fact, by some accounts I’m considered “upper middle class” which boggles my damn mind. Like, what?! We are a one-income family, with the majority of our health insurance premiums covered by my husband’s company. We pay premiums, and they are too expensive if you ask me, still, when we get sick and go to the doctor our co-pay is rarely over $30, that includes my mental health co-pay. I see my therapist two times a month, and my mental health nurse practitioner once a month. Which means I’m spending $90 a month just to “see” people. Still, I feel like I can’t complain, because some people who desperately need to have the sort of help I get, simply can’t afford it or they don’t have access to it. See Veterans and the working class.

Enter my new pill: Trintellix. It’s a revamp of an older pill, and has yet to be made available through a generic prescription. I won’t pretend to know why that is, but my suspicion leads me to think that they like to milk the market dry before they “invent” an alternative. But that’s not the point. The point is that I received a letter from my insurance company telling me that I’d been approved for a one-month supply and they had graciously picked up the $500 price tag for the new pill. I was excited, because I’ve been on samples for three weeks now and they seem to be working well. So I went to the pharmacy to have them fill it. That’s when they told me I still owed $80 out of pocket. Ho hum.

But wait! There’s more! The pharmacist told me that I could use this little card that the doctor gave me and it “might” save me more. So I sat on the phone at the CVS in Target (you didn’t think I get my prescriptions filled anywhere else, did you?) and finagled this card thing with these lovely people at Trintellix. All in all it wasn’t too hard, and they really were nice and helpful, even after I’d put my birthday in wrong and had to call back. But that isn’t the point either.

Ahhhh. I’m tired by now right? This has been a one month ordeal. Waiting on four different groups of people (therapist, insurance, CVS, Trintellix) to work together to get me these damn pills. Meanwhile, I’m running out of samples. Meanwhile, I’ve weaned off my Lexapro. Meanwhile, meanwhile, meanwhile.

This is a small, very small snippet of the healthcare racket that we have here in this country. Very small. Now I won’t completely downgrade it, because it is mental health and mental health is very important, but I can’t imagine what people with diseases like cancer or AIDS or persistent heart problems go through. It’s got to be nuts. Meanwhile, we want to talk a mad game about mental healthcare, and making it affordable and easy to get, but then we get jacked around like this. I’m persistent. And I know my rights. And I don’t care if something costs $20,000, I’m going to ask my insurance to pay for it, but some people aren’t like me. They won’t self-advocate. And then what?

All I’m saying is, I think the cost, the hassle, the stigma, and the accessibility are totally screwing people who need good, quality mental health care. Who need answers. Who just want to know there is help out there. There are people who don’t have insurance and still need mental health care. There are people who have insurance, but can’t afford the co-pay to get mental health care. And that’s just one aspect of their overall health. We have to change things, y’all. We have to.

Anyway, thanks for reading my story today. Thanks for supporting those of us with mental health issues. Thanks for talking about it, accepting it, helping us when you can. It’s really important that we have people in our lives who care and who listen. Because for some, they aren’t getting it anywhere else.

Take care of yourself first. Then others.

M.