Pharmacy fun

Thought you all might enjoy my adventures in trying to procure my ED pills from Kaiser:

URO gave me a scrip for Sildenafil (Viagra) 20mg to take once a day after surgery. The original scrip was for 90 pills. I met with him the week after surgery, to take the catheter out, and then a month later for a follow-up. One both occasions, he asked about erections and said that once I was feeling up to it, I could take up to 100mg a day. He suggested I try 40 or 60mg, and go from there. I tried this on a few occasions, with some success, and managed a nearly full erection on 100mg a couple weeks ago. The wife and I experimented with what worked and had a lot of fun trying.

Cut to a week ago and I realize I will need to refill the scrip soon but that it expressly says that it can't be refilled until April 8th. I start counting pills. I could make it, if I'm not feeling frisky. So, rather than being unprepared, I shoot off an email to the Dr. to explain the predicament.

"No worries," says he, "I've written a new scrip and you can pick it up."

I didn't manage to get to the pharmacy until Friday. The clerk says, "Well, I don't have these here. It'll take me until Sunday to get them. I'll have them then."

"Fine." say I, and take my last pill Sunday evening.

Monday rolls around and I return to the pharmacy, to the very same clerk that helped me on Friday.

"I'm here to pick up my prescription."

She clicks on the computer, looks confused, walks around the shelves behind her, comes back, clicks some more, and looks even more confused.

"It says that this can't be refilled until May 5th."

"That can't be right. This is a new prescription."

"I know. I remember you from Friday."

She walks off to talk to the pharmacist, comes back, asks me how many pills I take, goes back to the pharmacist, comes back and says "We can't fill this."

At this point I start to get irritated and she tries to tell me it's not her, it's the pharmacist.

"Go get the pharmacist."

The pharmacist comes back and goes through the same song and dance about how it can't be filled until May even though the Doctor wrote a new prescription. She asks me, "How many pills do you take?" To which I reply, that the doctor said I could take up to 5 at my discretion. And what I wanted to say is it really any of your business?

"But that's not what it says on the prescription. It says you're only suppose to take 20mg per day. We can't give you any more of these, and I don't even have these here. If I could fill it, I wouldn't be able to get these until maybe Thursday."

"At which point I could have refilled the original prescription!"

We did this little song and dance for quite some time and she said she would have to contact my doctor, which, of course, she should have done on Friday! I left when it became clear I wasn't getting anywhere and sent my doctor an email. He's "amended" the scrip so there is no more "confusion", but who knows how long it will take to fill.

As much as I like most of the people at Kaiser, the bureaucracy is such a pain in the...

Well, I'm fortunate that this isn't an issue but....my prescription plan won't let anyone have more than something like 12 at a time, no more often than once in 30 days....and still pay $3 a pill for it. It's "not in the formulary"...which means that they aren't considered necessary drugs. If I'd needed them, I'd be moving into the gray market.

halbert said...
Well, I'm fortunate that this isn't an issue but....my prescription plan won't let anyone have more than something like 12 at a time, no more often than once in 30 days....and still pay $3 a pill for it. It's "not in the formulary"...which means that they aren't considered necessary drugs. If I'd needed them, I'd be moving into the gray market.

Someone please explain to me how this is different than a woman having Breast cancer , where the insurance companies are required to pay for reconstruction. It's necessary. Just like erections. I made that comment to my surgeons NP at my last visit, and she said that it's an issue that is being worked on by legislators, but is a way off.

Halbert, my coverage is similar to yours, non formulary, and I'm limited to 6 pills every 24 days. But somehow my doc got them to approve 30 pills every 30 days, and I got a letter from the insurance company saying I was approved for regular refills through end of this year.

The first scrip, my copay was $40, then starting with the first refill they told me that it was an error and the copay going forward is $90 FO 30 pills.
Less frustrating than the alternative, I guess.

Our insurance does not cover any ED drugs. But it covers the ED doctor visits 100%. Go figure

When I saw my urologist last week there was a sign on the inside of the examining room door that said that as a convenience for patients the office would be able to fill scrips for certain often-prescribed drugs. The sign had a list of six or seven drugs that were available there in the office and sildenafil was at the top of the list. Last time I checked the cash price was about a dollar a pill. Now that I have gone bionic I am probably out of the market but my uro, at least, seems to be trying to fight the wall of bullshit that the drug companies, pharmacies, and insurance companies have "erected" around ED drugs.

And now for the rest of the story...

When my wife filled the original prescription, the day after surgery, she wasn't in the mood to argue with the clerk about why it wasn't covered under our plan, and paid cash for the prescription. Works out to about $2 a pill. I never got around to arguing with anyone about it and was prepared to pay the cash price again when I went to fill this latest prescription.

I got a call today from the pharmacy manager -- excuse me, the NEW pharmacy manager, as of last week -- and he was trying to explain to me why they had trouble filling the prescription.

"Your plan doesn't cover anything more than one pill per day, so that's why the system prevented the refill."

"But I'm not paying my co-pay price. I'm paying the cash price."

Long silence.

"Oh...well that's...I'm so sorry."

He is clearing up the mess and has promised to have my prescription by the end of the day. Furthermore, he is initiating paperwork to try and cover one pill a day under my plan, so that I only have to pay the cash price for usage above and beyond that limit.