She’s Lucky I Don’t Have A Weapon…

So, my husband’s insurance has changed–we have a new prescription provider, CVS Caremark. I thought I hated Express Scripts THE MOST, but now Caremark has taken over the #1 spot. I went to get my Delzicol (extremely vital med I take for my Ulcerative Colitis), with my new prescription card in-tow, naively thinking that I would shell out $75 and walk out with a 30 day supply. WRONG. Never, ever assume anything when it comes to attaining your medical care. Turns out, Caremark (the irony that “care” is included in this name…ha) will require an appeal by the prescribing doctor, stating why Delzicol is used and not some other prescription. Now, I get it–Delzicol is an expensive, patented brand-name drug with no generic substitute, and if it’s not necessary to pay these inflated prices then Caremark doesn’t want to pay them. But I was told it will take a minimum of 72 hours for the appeal to be processed, and I can’t even begin this process until I get a hold of my doctor on Monday (it’s after 5pm Friday). I NEED MY DRUGS NOW. I can’t go all weekend without them, I can’t even skip a dose or my ass starts bleeding. So…I realized I had a prescription on file for another (less effective but supposedly equivalent) drug, called Asacol HD. And guess what?! Asacol HD is also a patented brand-name drug that requires an appeal from my doctor in order to get coverage. So I’m left with: pay out-of-pocket for a weekend’s worth of meds OR go without meds. Of course we paid out-of-pocket…EIGHTY TWO DOLLARS…$82 mother*cking dollars for 2.5 days worth of Delzicol. OMFG. If you ever feel sorry for yourselves, just please be glad that you don’t have a chronic life-long disease that is sucking the life out of your body and your pocket book–just please count that among your blessings.

Oh, but it gets better. Today I had to call my GI to see about 1. getting some samples of something to tide me over until I can get a prescription of Delzicol and 2. Getting them to appeal the Delzicol. You see, it was actually prescribed by my former GI in Las Vegas, so Walgreens sent his office the notice to appeal for the Delzicol, but it’s really not his job at this point. So I called up my current GI’s office (which is small and full of old ladies) and the first lady asked me what I needed, so I started to explain and she cut me off and forwarded me to a woman who I assume must be either and RN or an MA (most likely an RN, because oddly most of the Dr.’s offices in this town still rely on RN’s and haven’t switched to MA’s). We’ll call her OB (short for ‘old b*tch’). I begin to tell OB about my medication drama and she keeps f*ing cutting me off–very rudely. I’m not being long-winded either. I try to tell her about the Delzicol and she says “So then we must have gotten the paperwork sent to us by the pharmacy already”…NO, b*tch, you DIDN’T because it wasn’t prescribed by you, it was prescribed by my former GI and new GI approved me to continue. Then she says “Wait a minute, I have here that the doc prescribed you Asacol HD, so why are you taking Delzicol”….well B*TCH, that is because I wanted to switch to Asacol HD because it’s easier to swallow than the Delzicol, but unfortunately I had blood and mucus coming out of my ass so obviously it wasn’t working, and I switched back to Delzicol, which immediately stopped the blood/mucus–the doc already knows this. Then OB says “Ok, so we’ll just send the appeal to them and you should be able to get your meds” and I said No, that the Caremark people told me the quickest way to submit an appeal is over the phone, and they had given me a phone number, to which she replies “Well I DON’T UNDERSTAND, I do this EVERY day and it always works so I don’t understand, blah blah rant rant…”…and I cut her off to say “Well I don’t understand either, all I know is what they told me. But if you’ve worked with Caremark before then I trust you know how to get it handled”. And then, I asked her if she has any samples of anything I can use until the appeal goes through, and she named off a couple, including Lialda–which I’ve taken before with success. I mention to OB that I’d like to try the Lialda, and I also mention that it’s actually covered by Caremark without an appeal, to which she replies “Well then why don’t you just take that if your insurance covers it, because it’s ALL THE SAME THING, it’s all Mesalamine”…OMFG why are nurses SO STUPID?! These meds are NOT all the same, they are in different preparations and release differently in the body–most recently I have not done well with the extended release meds (such as Asacol HD), and Lialda is an extended release med. Just because I took it 2 years ago and it worked doesn’t mean it will work NOW. And NO THEY ARE NOT ALL THE SAME, you stupid stupid ignorant *&^%$#!–if they were truly all the same, then we’d all just take the motherf*cking generic and not bother ourselves with calling your sorry ass to make an appeal. Right?! Right. Geezus. So, after I made it VERY clear that I still wanted her to appeal for the Delzicol, she said “Oh by the way, the hospital called to say that you didn’t show up for your most recent Remicade infusion, so I assume you’re going to call and do that this week”…well, no actually, I’m NOT, because I just talked to the doc on the phone the other day to discuss pushing out or possibly permanently suspending the Remicade, because I’m currently under control and trying to get pregnant. And he approved. And THIS is why I so urgently need to get my meds–so I can maintain remission WITHOUT the Remicade. Do. You. Understand. Me.? She said she’ll leave the Lialda samples at the front desk. Click.

There’s more. I called Caremark yesterday because it occurred to me that they may not give me the sweet ass deal on Bravelle that Express Scripts was giving me ($75 all-you-can-eat, first time Dr. Angel ordered 10 viles but this last time he ordered 20 viles and either way it only cost me $75 dollars, whoop whoop!) I got a really nice guy named…Bobby? I think. So anyways, first Bobby looked up Bravelle and found that it’s not covered. And I said “Ok, well do you have a biological equivalent that is approved?” And Bobby asked me what kind of med it is, so I explained is a reproductive medication, called Follicle Stimulating Hormone, or FSH. Bobby put me on hold for a few while he looked it up, and came back with: Pregnyl and Human Chorionic Gonadatropin (he couldn’t say the words so I asked him to spell them)…well, those are both HCG shots, not FSH. So Bobby put me on hold some more and dug deeper. What he found was that Bravelle IS covered WITHOUT an appeal required, and I could hypothetically get 20 viles from a retail or specialty pharmacy for $300–for two refills–and then I’d have to go through the CVS mail order pharmacy. And I said “God willing Bobby, I won’t need more than two refills”. It’s more expensive than Express Scripts, BUT $300 for $3000 worth of meds is nothing to complain about. So, at least there’s that–BUT it’s only hearsay at this point.

Mr. MLACS will joke sometimes when someone pisses him off (usually while driving) that if he had “one bullet a day” that person would’ve gotten it. So I do it too now, when people piss me off I’ll turn to Mr. MLACS and say “one bullet a day” and he giggles. So I leave you with this: Today, OB is lucky that this is just a joke, and I don’t even know how to shoot a gun. I’ma go pick up my damn samples and she best hope I don’t see her sorry ass when I do. *spits on the ground, mean mugging*

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16 thoughts on “She’s Lucky I Don’t Have A Weapon…

  1. Oooh, bless your heart. What an ordeal!!! I have been there when you can’t get the meds you absolutely need because of uncooperative people. I love this “one bullet a day” joke you and hubby have. I bet some days you wish you had more than one. LOL! I know I would!

  2. God, so frustrating, I’m sorry. You’d think that people in that kind of job would have compassion for what your going through medically, but instead they often just seem to be on power trips. I hope you don’t have to deal with her again.

    • Unfortunately, it seems OB is the “keeper” around here and if you want to score you gotta get through her. I surely hope that this particular situation doesn’t arise again, but with my luck it probably will. Lord, give me the strength… XO

    • I totes saw her…and I was nothing but polite. I kind of hate myself for being such a puss–on the other hand, I have to go through her to get what I want/need, so maybe a more passive-aggressive form of revenge is the way to go here… XO

  3. I do love your posts hun, it’s your way with words! What a catastrophe though man, seriously. You held it together super well. I would have gone all medieval on her ass big time. Here’s hoping you never have to deal with that crap again. Hugs xx

    • Thanks for not minding the excessive use of profanity–I worry that I’ll offend people, but then I think “well, if you can’t be yourself in an anonymous blog, then wtf is the point” and I just replace certain letters with asterisks to appear modest. XO

  4. OMG!! That’s ridiculous!!! I wish I could say I’m surprised, but I so totally am not. I think it’s outrageous that people are having to pay or copay so much money anyway – which, let’s face it, is ALL about the profit margin for the big pharmaceutical companies. Care indeed. AS IF.

  5. I’m so sorry you had to deal with all of this. There should really be a rule- you don’t have to deal with bullshit when you are going through fertility treatments. That should just be a written rule somewhere. I hate explaining stuff to people that don’t want to understand. It’s awful. I also like the ‘one bullet a day’ thing too, although people would think I’m serious so I couldn’t say that out loud to others. We have several guns and a membership to a gun range. Since I also have my permit to carry I won’t go around staying stuff like that. Maybe just to my husband perhaps? Thinking about you friend- Things just HAVE to get better.

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