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Insurance forcing a pharmacy change

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Chronic Pain
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Posted 10/28/2008 7:07 PM (GMT 0)
I am so angry, but there's nothing I can do. I'm on the COBRA coverage through the hospital that laid me off last year (so you can guess how I feel about them!) and I just got a letter in the mail today that they are forcing everyone in their group plan to use the hospital's pharmacy starting December 1. There's some convuluted exception if it's after hours (as they're only open M-F until 4:30pm) and you can get 15 days, but have to pay a $35 co-pay, then must get the remainder of the script through them. Now you all know that won't work with pain meds.

I just called the insurance company to verify and they said yep, there's no choice. I can't afford other coverage, and the COBRA will end in a few months and I'll end up on Medicaid, so right now it's better coverage than government, but my pharmacy is one of the rare pieces of my pain management that works for me. I like the people, they treat me well, and they're close by. The hospital if 45 minutes away, and winter is about to start. Plus there's gas prices and my unemployment just ran out. They say then they'll mail them to me. I've always been afraid of the mail order stuff, wondering if it would arrive on time, get lost at Christmas, etc.

People who don't rely on their meds for serious chronic conditions don't understand the fear this stirs up for us! It feels like I'm being forced to switch from a doctor that I like - heck, I'd be wiling to switch doctors; I like my pharmacists better!

GRRRRR..... mad smhair

PaLady
Posted 10/28/2008 7:40 PM (GMT 0)
Ouch! That sucks. I will be in the same boat come January when I am forced to change my insurance. I am being forced into a High deductible health plan that will demand I pay the first 3k$ of my healthcare. For me, that means I will have to come up with that within the first three months of the year!

Well, good luck with the switch and let us know how the mail order thing works for you.

Take care,
Sarrah
Posted 10/28/2008 7:51 PM (GMT 0)
3K in 3 months? OUCH!!

We need reasonably priced healthcare in this country!

PaLady ------> zipping lips so as to not get political
Posted 10/28/2008 11:02 PM (GMT 0)
I have been on medicaid and it has been ok..it really has been good...as long as you have a pharmacy that will fight for you and good doctors..that makes all the difference...as I had to go on Public aid back years ago when my husband got disabled never dreaming I would have to use it but now I have to and now I am having to apply for Social Security that I never would have dreamed of either...life is not always fair but really it is not all that bad and I have been there for 8 years on it...pain4you
Posted 10/29/2008 12:10 AM (GMT 0)
PaLady I'm sorry of your plight to change your pharmacy. I know if I had to change forcibly change something I wouldn't like it either. As for me, my pharmacy is the pits. They get everything wrong, but still it is familiar and I do know some of the people too. But like pain4you says, it may not be so bad after all Keep a positive thought and perhaps you will be one of the lucky ones. I do sincerely hope things work out for you. Having to drive forty five minutes in the winter weather is a drudge too and I do feel for you

Lindaloo
Posted 10/29/2008 2:47 AM (GMT 0)
Ohhh, that is so frustrating! I absolutely agree with you - it's different for those of us who rely upon prescriptions that are already very restricted and require lots of hoop jumping. What does this mean for your pain med contracts? It just frustrates me that someone in an office somewhere can make medical decisions that have a profound impact on our health and tell the doctors who actually SEE and TREAT us what they can and cannot do or prescribe. ARGH! I feel your pain on this one!

Maybe your doctor can go to bat for you? This just seems like a monopoly of sorts.

Ry
Posted 10/29/2008 2:57 AM (GMT 0)
Thanks, Ry!
Well, it is a monopoly of sorts, but each employer makes the contract with the health insurance company and they can vary the details any way they want, especially if there's not a union. It's not that I can't get the meds I'm prescribed, it's the process and who I get them through. I either have to pick them up directly at the hospital or have them mailed. And all my scripts are scattered throughout the month as far as due dates. Nothing my doctor can do about it, as it's the insurance plan that's changed.

I'll only be able to afford that plan until June (or as long as my cousin can keep paying) and then I'll have to switch all over again. It is the hospital trying to make more money, though. When I told my CVS about this today, they said the other large local hospital has required this for their employees for years.

It just seems to get worse for us, doesn't it? I think so much of this feels like losing control, one more piece at a time. Like losing our health wasn't enough? And ability to work, earn a living, etc.? Even the smallest loss now feels like a major one. I know you all understand.

Thanks for letting me vent!! smhair

PaLady

Post Edited (PAlady) : 10/28/2008 9:11:32 PM (GMT-6)

Posted 10/29/2008 4:14 AM (GMT 0)
PALady,
So sorry to hear about your troubles.
My company's insurance plan switched to requiring mail order 3 years ago. One bit of advice, if I might: make sure there is a tracking number assigned to any mail order meds. I have to pay $14 per shipment to get one assigned to mine, but I learned the hard way that it's well worth it when meds started going missing in the mail.

There was no way to prove where they "got lost" since the meds were journeying from halfway across the country (it sounds like at least yours won't have to travel long distance), so the police refused to file a report as I could not prove that they ever actually were lost in the city where I live, or even that they ever left the mail order facility. No police report means no replacement script per my contract with the PM clinic. My PM re-filled me anyways once he found out (I was scared to even ask, but it was 90 days worth of medication, so I finally got up the courage after a few weeks) but it was major trouble for him having done so. The mail order pharmacy was willing to eat the cost of the missing meds, but it was a huge hassle for me & my doc.
The second time they lost a med, at least it wasn't a controlled substance so I just got a new script, but after that time I make sure I get a tracking number assigned to every single shipment. No need to have even more problems.

Other than the tracking issue, there aren't any problems that I've had with mail order. Now the drugs can be tracked the entire time & - wonder of wonders - they don't get "lost" anymore. It is seemingly too tempting to too many people to handle an untraceable package clearly labeled as medication & that shakes from the sound of the pills. Once you take away the tracking issue, mail order is even better than going to the pharmacy. I get 3 months at a time & get phone call reminders when it's time to refill (usually 3 weeks before I run out).

Hopefully you'll have a decent experience with the mail order. Maybe it will even be a chance to save a little extra on gas? Just trying to find the silver lining. You're right though, more and more of these choices are made for us.

Hang in there. Who knows what could happen between now & June, right? I was about to lose my job a couple months back because of all the days I missed from work this year (almost half of them), but then another admin was caught in a major lie & somehow deceit trumps chronic absenteeism on the list of undesirable traits so I got to keep my job (for now). I've gotten some new projects since then & am now getting to somewhat redefine my work. Things are still super hard, but I just keep remembering that sometimes when it seems like we're down to the last thread -- about to lose home & car & job & healthcare & everything else too -- that miraculously we are spared the absolute worst of it.

I know you've been through a lot, but you are an inspiration to many of us & an incredible wellspring of information. I am sure many others join me in wishing for even some small little things to work to your benefit (or even better, some really, really huge things :) ;and, know that I will be keeping you & your cousin in my prayers as always.

peace,
frances
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