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Friday, August 20, 2010

Dropping Drugs

So I went with my son and sat in on his 2 minute dermatologist visit. I think it took longer for the doctor to shake our hands than it did for him to examine the boy. His diagnosis was to keep the same treatment up, antibiotic once a day and Epiduo in the evening. Personally I thought the boy wasn't making such great progress. The boy and doctor disagreed. It didn't matter I still asked again, as I do every visit, about Accutane, which was promptly ignored.

For the record, I know all about Accutane. I was on it, twice. It was the only medication that ever worked for me. I had been through it all, tetracycline to the point I'm now allergic to it, various other antibiotics, hot ice wrapped in gauze scoured over my face twice a week, cortisone shots in my face, scapels and other assorted metal instruments of torture, you name it I underwent it. Nothing worked, except for Accutane. You probably see all those ambulance-chasing lawyers on tv telling you to call them if you took it because you could be at risk for some deadly illness but you know what, I'd take it again. It made my life livable.

Funny thing is my son's doctor prescribed it to me when we first moved here. Maybe he's a little more gun shy now what with all the lawsuits and all, so he's opting to keep him on the same treatment with a four month follow up visit. He handed me a "free" Epiduo coupon. In exchange, my son has to participate in a survey with the drug company for the next month. At first I wasn't going to even use it because I still had three refills left on the last prescription that would only cost me $35 because of the discount card that I had gotten last time. I figured we'd use those three up and then go for the "free" tube.

When I went to renew at Kroger the pharmacist called me to let me know that Anthem will no longer allow Epiduo to be refilled. What?! He said I needed to get the doctor to fill out some forms saying he tried x,y,z and that they didn't work so this is the medicine my son needs. Well the doctor didn't try x,y,z because this medicine worked. I reminded the pharmacist that I still had 3 $35 refills left so this shouldn't be a problem. He informed me that Epiduo would not refill them because Anthem would not allow them to use them as the primary. These drug companies will only give you a discount if you have insurance. Wouldn't it make more sense to give a discount to people who had no insurance? Now I was getting really pissed off. I freaking pay mega premiums with a $2,500 deductible for each of us. On top of that I have another $200 prescription deductible, for each of us, and then only get 40% off so it's not like I'm living high off the hog off Anthem.

The pharmacist laid out my options. 1) Contact the doctor and have him fill out the forms and wait up to three weeks for a decision. His experience is that Anthem wouldn't budge. 2) Exclude Anthem and pay for it myself. How much? $276.00! What?! No, that's not an option. It's the freaking size of a Clearasil tube! Ok, Anthem sucks for dropping it but so does the drug company for charging so much. I gave him option 3) I'll go on-line, register the boy, fill out the survey, and get the free code. He didn't know if that would work or not since the boy was already on the medicine. I took a chance, went back to Kroger, handed him the materials and waited for the results. Option 3 worked. We got a tube of the golden Epiduo. I handed it to the boy and told him to use it sparingly since I don't know what's going to happen when he finishes it. I imagine I'll go up to the doctor's office and let him know what Anthem is pulling, hoping he'll throw a sample or something our way. Geez, my son would have to work 40 hours just to pay for a freaking tube. Crazy.

I'm really dismayed about this. You would think Anthem would have had the courtesy to at least send me a letter informing me they would no longer allow this drug, since we've used it three times already. The pharmacist said Anthem's been doing this, just willy nilly deciding to drop a medication. I say bullshit. Is this their preemptive response to the upcoming health care changes? Are they stopping covering certain medicines before they're forced to pay for it? Is this only the beginning? What's next -- dropping certain procedures, tests, specialist visits? I gotta tell you, I'm not liking where this is heading. I have a bad feeling if you're not getting your health benefits by being in a union, you're gonna be screwed.

5 comments:

  1. You make a good point here. How smart you were to go online and get the free coupon. What a rip off to those paying high premiums-like you are. Maybe you can go back online and get another coupon for a different member of your family and give it to your son next time too.

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  2. Cheryl the doctor gave me the coupon. He was the one who was giving me the discount cards too. In order to use the free coupon you had to have a valid prescription and register so I couldn't put it under my name.

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  3. I've noticed the prices for some of our prescriptions have gone up. First it was just a dollar and then it was three more dollars. A total of a $4 increase for the generic that used to cost me just $3 something.
    Somethings up, I'm in agreement with you.

    (PS - this is why I REALLY like seeing an acupuncturist!)

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  4. I don't think this has anything to do with the health care initiative. Anthem has done this to me on various drugs since 2004. First it was a drug I was taking for my stomach, then it was an anti-inflammatory. In both cases I had been on the drugs a while but Anthem made my doctors go back and start all over with different drugs. In 2009 (before health care) they did the same thing to me over my blood pressure medication. I have been through nine different blood pressure medicines, thanks to insurance.

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  5. I would hope then that the healthcare bill will have provisions to protect the consumer from insurance companies' dropping working medications, instead of putting in provisions that have nothing to do with healthcare, such as the 1099 forms. I won't hold my breath.

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