May 8, 2006
Someone needs to do something, perhaps you can help.
The new Medicare Drug plan is a disaster! Most people seem to think that it's a result of all the old people on Medicare being empty headed but that is not so. Here is what really happens:
You pick a plan that seems great since it has the drugs that you use or an equivalent on its formulary list and you enroll. I enrolled in Mutual of Omaha. They use Caremark for drugs. Now you get a prescription from your physician, which requires an office call. You get that and submit it but weeks later you find out that your physician has to get prior approval. You are told that prior approval requires only a simple phone call from him but later you discover that isn't true either. What he must do in cases when the drug is expensive even though you have been taking it for years is start you on a lower cost different treatment for a while and if that doesn't help, try another still lower cost drug and only if that doesn't work and if he provides copies of your medical records you may get the drug. But that's only if they haven't removed it form the formulary list by that time.
In my case I have suffered from GERD for several years and have had medical treatment for it. My Gastroenterologist (sp?) had prescribed Prevacid, which I had been using for several years. I was told that I would have to take it for the rest of my life when the doctor prescribed it.
The Plan I accepted in January did not have Prevacid but it had Nexium, which I assumed would be equivalent. I went to my Physican, who said that Protonix would be better than Nexium. I got my prescription and mailed it in. Weeks later we called since I had received nothing. First we were told that my prescription was lost since my wife and I both mailed in prescriptions in the same envelope. We assumed that pharmacist would read the prescription. Anyway, it turned out that the prescription wasn't lost, they just wanted some time so they could remove Protonix from the formulary list. In order to get the time they needed they required that my physician try something else first as well as fax my records. After several phone calls about the faxes which somehow never get through according to the drug company, they finally mailed me a letter stating that Protonix was no longer on the formulary list and would not be provided.
All during this time, I'm suffering from chest pain, trying everything I can of OTC medications and swigging the pink stuff. Only managed to stay out of the ER by taking left over ulcer medication from an earlier doctor visit.
Finally we realize their game so after another office call, we have a prescription for Nexium and thanks to our blessed physician a bag of samples to maybe hold me over until the Nexium arrives. Guess what, it turns out to be a repeat of the same sorry story, they have removed Nexium from the formulary list. My physician told my wife that they had as many as 19 rejections in one day from such companies and they were no longer trying to work with them, as they couldn't afford it.
Now I have dropped that plan, which by the way was from a well known and reputable insurance company, and am going through the waiting period of one month after enrolling in another well known and reputable insurance company's plan before they will provide service. This time I enrolled in Humana. I can only hope this plan is better than the first. It is now May and it looks like I will not have my much needed medicine until sometime in June, maybe.
Here is what should be changed:
The provided should only be able to remove drugs from the formulary list if the FDA says they are unsafe.
The physician's prescription should be sufficient to bypass the cheaper drug trial plan. Generics would be okay if the physician approves.
The physician should not be required to copy and submit patient records. They are already overloaded.
The patient should be able to get a prescription for more than one month's supply thereby being able to use the mail-in service and save money for all concerned. All the expensive drugs have a 30-day limitation.
The one-month waiting period before you can submit a prescription is also a serious drawback as that means probably a two-month wait before you can get drugs.
2017 Beam Rd.
Columbus, IN 47201