Fun With Medical Insurance: How Medco saves money by bureacratizing and slowly filling my script.

[NNadir]

I would say that the only chronic condition that I've had for my entire adult life is insomnia.

There are two kinds of insomniacs, those who don't give a rat's ass about not sleeping and those who experience a lot of grief because of the condition.

I'm the second type.

It is true that you can get a lot of work done if you're an insomniac, but it also can involve a lot of difficulty.

Over the years, in order to manage having day jobs and also working in fields where I had to cross a huge number of time zones, sometimes traveling through many time zones in a week - during the week of my son's first birthday I spent Sunday and Monday in California, Tuesday on a quick stop in New Jersey and then hopped on plane, Wednesday, and Thursday in Norway, Friday on the plane and Saturday back in New Jersey entertaining guests at a party - I've sought medical treatment for my insomnia. I received it.

Needless to say, my biological time clock was FUBAR.

Around the time I started heading to Europe a lot I started taking Ambien regularly.

Over the years, I've been more or less concerned about addiction to Ambien, but here's what my doctor said to me, and he has a point: "Don't be such a catholic about medication. I hope this never happens, but if you had cancer, and we're in huge pain, you would want me to give you morphine for your pain, addiction or not, wouldn't you?"

Having watched two people die from cancer - my parents - I had to agree. He said it wasn't my fault that I was a chronic insomniac, and that I was, in fact, "suffering" because of it, and he was right there too.

Ambien (Zolipidem) works to treat insomnia, but not perfectly. In fact, the drug is designed to have a very short half-life, and if you sleep lightly you will wake up and either need another one, or stay up the rest of the night.

There are hair raising stories about the business end of Ambien - about which I could tell more than I care to do here - but a few years ago, zolipdem had gone off patent and become a generic, around the time it started, probably because of tolerance, to work less and less well.

For reasons that are obvious if you know medicinal chemistry, and for reasons that are very much involved with business and money considerations, Sanofi Aventis, which had taken back the Ambien license from Searle/Pharmacia/Pfizer developed a controlled release formulation, now marketed at Ambien CR.

It is, in fact, much better than regular Ambien, and much better than the now available generic Zolipidem. So I have a prescription for it, and have used it for years with fairly good results.

Recently my insurance plan changed so that I was stuck with Medco, about which I knew very little. I went to get the prescription I have had for years filled. Back came a message to me and my doctor asking if I have ever used generic zolipdem. Yes, in fact. Generic zaleplon? So on and so on.

I went to doctor recently for another matter - he's a good man and I consider him a friend - and we discussed all of the byzantine discussions and forms required by Medco to get any non-generic prescription filled. He said, "what they do is they try to wear you down." He then filled out the forms requested by Medco - which had never hired a physician to examine me and was totally unaware of my medical history and sent it in. They approved it for one refill at a local pharmacy and then informed me that I would need to get it directly from them via mail order or else pay full price, $5.50 per pill.

OK, more forms for my doctor to fill out. He gave me a written script to mail them. Back it came in the mail, as my supply dwindled. Then an email saying that my doctor had to call them to discuss the prescription. My doctor called. I emailed them back, angrily. They remarked that since I was getting my prescription filled at a different pharmacy - which was, um, theirs I needed new authorization.

Finally came approval, along with an email saying that um, it takes them 5 to 7 business days to fill a prescription.

I'm now on my fourth sleepless night, and today, we will have a health care bill giving more power to these guys.

I'll live. But what, as my doctor noted, this was, um, cancer and not insomnia? What then?

I love my President. I think he's doing a damn fine job, giving the job's inherent difficulty. I am proud of our Democratic congress. It's not easy herding cats.

But I hope this bill will not be the last bill. We have to take medicine out of the hands of stupid MBA's with no ethical universe.

Note that by failing to treat me, Medco is saving for this instance about 50 bucks. Multiply that by everyone who had Medco prescription plans, and all of the medications they take, and you have a sense of how much money is involved. Hundreds of millions of dollars, if not more.

Have a nice evening tonight, and get some sleep. I won't.

[havocmom]

1. Thanks for posting. Too many cheerleaders just don't understand the problems with Health CARE

when insurance companies drive the bus we get thrown under.

[CountAllVotes]

2. can't your doctor fax in a 90-day supply?

I have Medco too. At present I pay $25.00 for a prescription that costs close to $1,000.00 for a 90-day supply.

No bitching here!

You have to know how to use Medco properly. If you don't it is indeed a nightmare I agree.

[NNadir]

3. We've done faxes, email, phone calls, everything. My experience is they suck.

[Liberal Veteran]

4. My experience has been fine.

There are about 6 different medications I take (I have HIV and migraines)and the only delay I ever had getting my meds filled was when I was taking growth hormone which required a prior authorization.

[NNadir]

6. My favorite part of the movie Mr. Incredible was the retired superhero working as an insurance...

adjuster.

He had big problems with his boss (voiced with the perfect voice of Wallace Shawn) because he cared about his insurees.

You may have Mr. Incredible at Medco. I don't. My physician tells me - and I think he might know - that he thinks they're horrible. His nurses say they're horrible. Maybe we all have to deal with the voice of Wallace Shawn and you got lucky.

But I'm glad you're getting treated well, even though I suspect I'm hardly alone.

[grilled onions]

5. I Actually Joined Medco

I was getting NO drug help and I never qualified for any of the drug programs for one reason or another. I started with their middle of the road plan only to end up in that dreaded doughnut hole half way through the year because of new meds I did not plan on when I signed up. This year I signed up for the highest plan because that one at least covers some generics once I hit the hole. I won't even make it until half way through the year this time because of more new meds including a pain patch which is over $200 a month. We can only be prepared so far but none of us has a crystal ball to know what we will need as the next year arrives.
They make it sound so easy(especially those that feel a medical savings account is the answer). I have had to deal with hospitals stays,a nursing home(while waiting for a hospital bed to empty)home care with nurse and PT.
I don't see how "they" can make it sound so simplistic.
Those of us who are in this medical merry-go-round for life with chronic illness know we will require more then a prescription or two in a years time. There are many who know others who stretch those pills by taking half the dose,juggling utility bills or waiting far too long before they make that doctor visit. We need help and we need it now. People should not lose everything they have to pay those hospital bills or costly MRI's. People should not have to jump hoops trying to figure out what each plan covers or more to the fact what they DON'T cover.
It is sad that we have such selfish people in this country who do not see what a quagmire our medical system is in.

[Odin2005]

7. Health Insurance is like a umbrella that dissolves in the rain.

[NNadir]

8. I like that locution. n/t