Monday June 08th 2009, 3:08 pm
Filed under: Crohn's flare,Politics

Remember when the employee of Caremark, the prescription distributor my insurance company contracts with, told me they weren’t sure they wanted the liability of selling me my prescribed Humira?  At a time it looked like nothing else would keep me alive?  I wanted to say to them, all drugs have side effects and if you can’t handle that simple fact of life, what on earth are you doing in this business?  And why do you have any say whatsoever?  You’re just a supplier. My insurance has (FINALLY!) approved that Humira.  It is approved by the FDA for the disease I have.  Send me the flippin’ med, fer cryin’ out loud, since it’s one I cannot pick up at a drugstore and cannot do anything about on my own.

And we all know how that one went. Nada, despite frantic phone calls from us, from my doctor, even from that Caremark employee’s secretary responding to me by walking around the floor trying to find where that woman went so she would finally take my call again and do the right thing.

And then my readers saved the day by bombarding them with messages till they not only caved when the weekend was over, but they actually grovelled.  Which was a little too satisfying for my own good.

So. On the Sunday of Memorial Day weekend, as I’ve written here, I was in Urgent Care again in great pain with a new flare, and one of the things the doctor I saw did was to prescribe me Zofran.

When my Crohn’s flares, I barf.  I never did once during all my pregnancies and I used to pride myself on having an iron stomach. Shows you what I knew.  So.  It is somewhat unusual for Crohn’s to cause barfing, and I can assure anybody that thank you, I’d prefer to be normal on that one.  But all the iron-stomach thinking and determination I’ve tried gets me nowhere these days: in the hospital, they had to keep me on two different high-powered IV anti-nausea meds at a time pretty constantly.

I could draw you graphic pictures of what I do on Phenargan, the entry-level med. Let’s not.

Based on all that, the Urgent Care doctor prescribed me Zofran instead, and rightfully so.

Which the insurance company denied. And not only denied, but since it was a holiday weekend, they had nobody on staff to even begin to appeal it to to get me through the long weekend. The doctor filling in for my Dr. R. reiterated to them a few days later my need for that med; with my very low blood pressure, barfing is an emergency and I need to have access to it.

I got a letter Saturday. Not from Blue Cross, my insurer, but from Caremark, who, like I say, they contract with, and who my local pharmacy had to get the okay from.  And I quote:

“The request was denied for the following reason:

The patient is not receiving moderate to severely emetogenic chemotherapy, total body irradiation or fractionated abdominal irradiation. The patient is not less than 18 years of age with a diagnosis of gastroenteritis and dehydration.”

I don’t have cancer so go ahead and barf. Nice.

And we wonder why the insurance companies don’t want the accountability that would be a natural part of the competition of having people having a choice of a government plan vs. them?  Right now, their only accountability is done legislative piece by piece, state by state, as outraged people get the one part of medical neglect they’ve been subjected to fixed by the demand of the law, while other parts wait for someone to suffer loudly enough.

My friend and hero Marnie took on a quarter million dollars in medical debt to adopt her kids, because at the time insurance companies were allowed to deny coverage to babies till they’d proven they were healthy their first month and forever if they weren’t.  That loophole was so egregious as to spark a Federal law outlawing it, too late for her.

We need a better system.  We need the will to do it. I’m not one demanding a single payer, but I do say, and loudly, that the insurance companies MUST be held accountable.  And the only way to do that, short of lawsuits that drive up healthcare costs and enrich the lawyers, is if they have true competition, which they do not now.  You know why they’re fighting so hard against the government providing an optional plan.  They’d have to change.

26 Comments so far
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Growling right along with you. And sending anti-nausea vibes as best I can.

Comment by Diana Troldahl 06.08.09 @ 4:19 pm

I so agree. Everyone, please register to vote if you haven’t, then vote. Encourage your friends. If we the people don’t speak up, we will see more and more of these horrible injustices as our population ages and our insurance companies become as bold as wall street.

Comment by Judy 06.08.09 @ 4:31 pm

I once took my two (at the time) young children to a “town meeting” with our representative just so I could wait (and wait and wait) my turn and endure the dirty looks of many people there, including the ORGANIZER of said town meeting (how dare I bring young children? well, because I’m a constituent, that’s why!!) so I could ask him to please, please not forget those of us who do have health care, but it sucks. Yes, get the uninsured insured; but also? Why is it legal that my health care sends all prenatal care to the deductible and it’s not paid for outright? Well-baby visits are paid for; we each get an annual exam; but the BEST PREVENTATIVE MEDICINE, the BEST WAY to ensure a healthy delivery and baby, the BEST WAY to prevent premature births–ie, good prenatal care–is not covered. And while we do have the money for the deductible, how many people don’t? How many mothers might have to make the choice between skipping an important test or not filling the vitamin prescription that month, and paying something else?

(The rep’s staffer, by the way, was very nice and helpful, and when it was finally my turn to speak, I looked right at that eye-rolling organizer and said I knew my kids were getting antsy, but MY group–mothers with young children–deserved to be heard too.)

Good luck getting your medicine, and there is a special circle in hell for health insurance despots.

Comment by amy 06.08.09 @ 4:40 pm

One of my doctors has asked me to be very careful about medications I receive in the mail. She says she’s prescribed drugs for patients only to find out later that the patient is taking something completely different. So now I pay careful attention to the labels. The name of the drug on the label never is the name of the drug she mentioned. So I check to see whether it’s the generic form.

I do appreciate having a drug benefit, but drug companies dictating to doctors is not so good.

Comment by RobinM 06.08.09 @ 4:52 pm

That’s a very good point. As for my Zofran, the local pharmacy tried to fill it for me and it was denied.

I’d told the Urgent Care doctor I was sure I still had a few pills at home in case there was a problem. I did have the bottle I was thinking of–but once I got home and looked up the generic name written on the bottle, left over from January, it wasn’t an anti-nausea drug at all and I was out of luck.

And thank you Amy for standing up for expectant moms everywhere. I like your style.

Comment by AlisonH 06.08.09 @ 5:04 pm

Can you file a complaint against them with the Better Business Bureau? They’re not doctors, they’re not pharmacists. If your doctor prescribes it, and says you need it, especially with your medical history…

Or, be really nasty. Get copies of your medical records, pertaining to your need to higher level anti-nauseau meds, and send them to Caremark, along with your doctor’s appeal. 🙂 I bet that’s pages and pages and pages!!!!

Comment by Serena 06.08.09 @ 5:09 pm

This is a tired song. Caremark needs to learn a new one. I will pray that you feel better soon.

Comment by Sonya 06.08.09 @ 5:51 pm

I would deliver the results of their denial to them…literally…

Comment by Betsy 06.08.09 @ 6:11 pm

Oh yes yes yes. It must change. What we’ve got now is a crying shame and a travesty.

Comment by Jocelyn 06.08.09 @ 6:25 pm

Contact your Senator and get them to intercede on your behalf. You’d be surprised how much they can do, even though technically they don’t have any power over the company.

Comment by Barbara-Kay 06.08.09 @ 7:28 pm

I don’t know what I could say that would add anything to what has already been said. I am completely disgusted with health insurance firms, and have my own little story of delays and denials.

I am inordinately lucky. These days I get my meds from V.A. Anything my private doctor suggests they have agreed. Everyone should be so lucky, and I think Single Pay is the way to go!

Okay, enough with the outrage. Let’s change the tone with humor:

There was a young lady named Carol,
Who loved to play cards for apparel,
Her opponent’s straight flush
Made the little girl blush,
And Carol went home in a barrel!



It was autumn, and the Indians on the remote reservation asked their new chief if the winter was going to be cold or mild. Since he was an Indian chief in a modern society, he had never been taught the old secrets, and when he looked at the sky, he couldn’t tell what the weather was going to be. Nevertheless, to be on the safe side, he replied to his tribe that the winter was indeed going to be cold. He told them that the members of the village should collect wood to be prepared.

Being a practical leader, after several days, the chief had an idea. He went to the phone booth, called the National Weather Service, and asked, “Is the coming winter going to be cold?” “It looks like this winter is going to be quite cold, indeed,” the weather man responded. So the chief went back to his people and told them to collect even more wood in order to be prepared.

One week later, the chief called the National Weather Service again. “Is it going to be a very cold winter?” he asked. The man at the National Weather Service replied, “Yes. It’s going to be a very cold winter.” Again, the chief went back to his people. This time, he told them to make sure and collect every scrap of wood they could find.

Two weeks later, he went back to the phone booth, and called the National Weather Service one more time. “Are you absolutely sure that the winter is going to be very cold?” he asked. “Absolutely!” the man replied. “It looks like it’s going to be one of the coldest winters ever!” “How can you be so sure?” the chief asked. The weather man replied, “Because the Indians are collecting firewood like crazy.”

Comment by Don Meyer 06.08.09 @ 8:41 pm

Obscene. Just obscene.

(and you said an f-word! Never thought I’d see the day… 😉

Comment by Lene 06.08.09 @ 8:51 pm

I am so sorry you’re having to deal with such utter nonsense. I learned with my illness that All illnesses can effect each person differently. I do not wish illness on the decision makers, but the understanding that accompanies illness might be helpful considering their line of work:)

Comment by TripletMom 06.08.09 @ 9:32 pm

Good grief! Well, let’s see, how dare we expect everyone to have a heart and a brain at the same time. Knuckleheads.
I’m so sorry you have to deal with malarkey like that.

Comment by Toni Smoky-Mountains 06.09.09 @ 4:10 am

I have a good idea…go barf on the desks of the people who are denying your drugs!

Comment by Jody M 06.09.09 @ 4:29 am

I feel your pain. I have to go through hours of calls, being put on hold, being switched to yet another customer care person, explaining AGAIN what my problem is- every time I refill my antinausea meds. Last time I was on the phone for over 3 hours in a 7 hour time period. It got to the point where I went “a little pregnant” on one man, telling him that I’d be hospitalized within 48 hours if I didn’t get the drugs(which is true. Once I start yacking I can’t stop). That finally made him move.

And phenergan. Oh man, the stories I have from that drug. Yicky. Vivid nightmares, talking in my sleep, halucinations…horrible.

I’m thinking of you, Alison. Be well.

Comment by sunflowerfairy 06.09.09 @ 7:12 am

Patient advocates. Aren’t they supposed to help with stuff like this? Since I don’t know how the laws differ by state, I’ll just pray…

Comment by Channon 06.09.09 @ 7:21 am

We’ve had our troubles with insurance too, it’s soooooo frustrating. Here’s hoping you get your situation straightened out and have your medication soon.

Comment by Eileen 06.09.09 @ 9:57 am

Sorry about the Crohn’s and the evil insurance co. I throw up when my Crohn’s is flaring also. I think it has to do with having a stricture and stuff doesn’t want to go down so it has to go somewhere, know what I mean? Yech. TMI, right.

Comment by Marianne 06.09.09 @ 10:07 am

I’m growling right with you. Daizzy’s in on it too 😉 She loves a good reason to growl with me 😉

Comment by Alicia 06.09.09 @ 10:46 am

I’m spluttering here at my desk.
I can’t believe (wait, shit, yes I can, but I’m so offended by it I’m trying not to) that the INSURANCE company’s Med delivery company has the gall to disapprove a drug because THEY’ve decided they know better than the doctor what you need!!!!

And to think, I sometimes thought the stories over on “your pharmacist may hate you” were made up.

I’m sending good energy your way (and trying really hard not to think evil thoughts in Caremark’s direction).

Comment by Helen 06.09.09 @ 10:46 am

What really bothers me is that the insurance people are essentially, without ever seeing you, making a diagnosis. And I would bet that they are not qualified in any way to do that. What right do they have to decide that your doctor is off the mark in prescribing the drug to you, especially under those circumstances AND if it’s not an off-label prescription?

Fie, indeed. And I second the suggestion about calling your congresscrittur. I think I’d be sixthing or so providing proof positive of your need for that particular medication.

If you don’t start keeping food in, you have to get IV nutrients, and THAT is well more expensive than the meds, I would bet (speaking from when I worked in a hospital pharmacy when back in school and occasionally had to help mix the stuff).

Comment by Margo Lynn 06.09.09 @ 12:27 pm

Absolutely. With the way the current drug insurers work, one never knows from one day to the next whether a Rx will be covered. My mother takes two pills for dementia. My brother just called me this weekend to say that the one pill which was $114 for a 3 month supply is now $366. And that is for meds that are covered.If more than a few folks take them, the insurance company just stops covering that medication.

Comment by sherry in idaho 06.09.09 @ 2:12 pm

If ever there was a change we needed, health care is it

I’m having my own little “go ’rounds” with the whole health care system right now and it makes me so angry I could just SPIT!

(see, once some insurance company denies you coverage for whatever specius reason, you basically can’t get coverage except for one of these little pathetic things that barely cover anything anyway!)

Comment by Bev 06.10.09 @ 8:57 am

Oh how I hate drug plans, let me count the ways….

The real problemis that it is drug insurance. and the insurance business is a scam. They are betting nothing will happen(so they can keep your premiums and do nothing) and you are betting something will happen(so your premiums keep you rome muchhigher bills). The problemis that the game is rigged. In the favourof the insurance companies. They change the rules midstream. They make getting something so damn difficult that you giveup. Etc.

Wrong. Just wrong.

Comment by Carol 06.10.09 @ 11:34 am

I vote with Betsy. Barf on their desks.

Comment by Kristine 06.11.09 @ 1:27 pm

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