So why then do these people feel as though they know more about medicine and medical conditions than the physicians who hold real degrees, or the clients who are served by their company? I have often wondered where the responsibility lay when medications are changed to generics or other medications even when insurance companies felt they shouldn’t have to pay for what the doctor ordered.  For a very long time I believed the mail order pharmacies were the ones changing things to suit their pocketbooks, but I recently learned that it was the upper echelons of white collar big business who were deciding the medical care the blue collar workers should receive. 

My husband works for Kirby West (you know the vacuum cleaner company).  He has been there for 25 years, and is paid less than what many others with less seniority there are paid.  He has been lied to about raises and tution reimbursement for training the company required, and he has been “treated” medically by the company over his own physician.  A medication he requires for an esophogeal condition was changed to what they called the “generic” version, even though there was no generic out at the time.  The refused to pay for the prescription fill for the medication ordered, even though it was written to be dispensed ONLY as written.  He managed to get through, not without problems, but he did survive until a generic came out.

I  thought what they were doing to him was horrible, but they would not budge on their stand. I didn’nt think it could get much worse until they did something to me that caused me a great deal worse physical maladies than my husband had when he was without his medication.

When CVS merged with Pharmacare, I suddenly found myself required to get a 90 day supply of ALL maintenance prescriptions.  I had done this already with most, but not with triplicate prescriptions.  Triplicate prescription are very closely monitered as they are Schedule II medications with a high potential for abuse.  These prescriptions cannot be called in, faxed or have refills written on them.  You must obtain a NEW Rx for every fill.  So every 90 days I would call my doctors office, wait for the Rx to be written, go and pick it up and mail it in to the pharmacy.  Because of turn around time, I would end up being without medication for 3 or 4 days every 90 days.  I talked to the pharmaceutical company several times, and they had said they woudl check into an overide on this medication so I could go back to getting a local pharmacy to fill it.  I think their promise lasted only until I was off the phone as I never heard anything about that again.

23 days ago, on June 4, I called my doctors office to get a refill on my Adderall XR prescription.  (in case you haven’t guess it, or didn’t know, this is a triplicate Rx). I had to wait for three days for the doctor to write the prescription for me to pick up.  On his half day of working, Friday, I had my mother pick up the Rx while she was in the building his office is in.  She brought it to me, and I promptly placed it in an envelope with a check for payment, posted it with a brand new stamp and she took it to the post office for mailing.  I have MS which has decreased my ability to get out and do these things on my own in recent years, so having a mother who is able and willing to run these errands is a wonderful thing.

The following Wednesday I logged into my CVS/Pharmacare account to check on the status and see when it would be delivered.  There was no record of any Rx having been recieved. 

I spent the next week on the phone with CVS/Pharmacare customer service, my doctor’s office and Mike Hall at my husband’s work.  I was getting nowhere.  CVS/Pharmacare said they never recieved the Rx (which I was inclined to believe as the check had not cleared my bank and I am certain that would be their first priority). My doctor’s office did not want to write another Rx with one out missing in some unknown place (and I don’t blame them at all, that is no safer than requiring a triplicate Rx be mailed 1200 miles to a pharmacy to be filled). 

The days drug on, and I called each and every day to check on the Rx and see if it had arrived.  Some of the phone representatives did make notes on the account, while others didn’t, so the entire occurence became very confused.  I finally demanded to speak to a supervisor, and she was actually helpful to me.  She even gave me her extension # so I could contact her in the future about what all was bing done. 

When I had been completely out of medication for 4 days, the supervisor informed me that an overide could be put in so a 15 day supply could be filled locally.  My doctor agreed to write the Rx for the 15 day supply, and it seemed that perhaps I would not have to remain symptomatic much longer (abrupt removal of Adderall is contraindicated). 

Donna, the supervisor and only helpful person I had spoken to at CVS/Caremark, called and informed me that Scott & Fetzer, a Warren Buffet company, refused to let the overide go through.  They did not feel I needed the 15 day supply, and that I could wait until a new Rx could be written. I am not sure if they knew how symptomatic I had become because the medicine had been stopped suddenly, but I was fairly certain they did not care about me or my health. 

I had called out to Kirby West, a Scott & Fetzer Company, and spoken to the person I was told could handle this problem.  He made a rather cutting remark asking if we couldn’t just pay retail for the medicine (which would be about $400 dollars), and then became irate when I told him (perhaps not in the nicest way) that we might could do that had my husband been given the raise he was promised.  I did my best to regain my composure as I sat there holding the phone, rocking back and forth due to the pain I was experiencing and trying to keep my head clear enough to carry on an inteligible conversation.  I explained the situation, and he agreed to see what he could do.

Two hours later he called and told me that an overide had been approved. My husband took the Rx to the pharmacy with all belief they would be able to fill the Rx.  The overide was denied.  Scott & Fetzer had blocked it from going through. 

In a desperate attempt to help me out, my husband  purchased as many pills as he could afford so that I would not be in the physical condition I was in, about 5 days worth of pills for just under $100. 

This incident went on and on for the next several days.  Yesterday, when at another doctors office (wonderful thing about MS is you get to meet a LOT of different doctors), I asked what could be done regarding these kinds of occurences.  He didn’t have an answer, but did say there were committees working on the problem.  Committees tells me not much will be done, but at least the problem has been identified.  This isn’t doing me much good at the moment, but at least it is something.

I tried to get ahold of legal representation to try and change the policies, or at least make some kind of difference so others would not go through what i am going through.  Not one lawyer would even talk to me, other than to tell me they were not interested, they represented insurance companies, or that they would not want to go against a company owned by the second richest man in the world. So much for representation for ALL people. 

This morning I began making my usual round of phone calls: first I called my doctors office.  THey were supposed to call CVS/Pharmacare. A CVS/Pharmacare representative told me they could not contact the doctor about this matter, the doctor would have to call them.  As of this morning they had left 9 messages, no return call.

Second I called CVS/Pharmacare.  The Irish in me was already beginning to show when I dialed the phone.  I decided to bypass the middleman, especially since they were just getting things more confused, and asked for a supervisor right off.  A young man got on the phone and told me that an Adderall XR Rx had been shipped out.  He didn’t have an explanation for how they filled a Rx that had expired on the 11th of June, or why no one had let me know that this Rx had shown up on the 23rd, even though I had been calling about it.  He just told me it was filled and left the building about 30 minutes prior.  Of course he also had no expanation as to why my doctors office had gotten no reponse after 9 phone calls either. 

So now I am just waiting, hoping the 2nd day UPS will get here by next week (strange they had the Rx since the 23rd, chose to mail it on Friday the 27th, when it couldn’t possibly be 2nd day delivery since it was a weekend).  I still want to find a lawyer, but I don’t think there are any around here that would be willing to take a risk and set a precedent.

For now I will just continue to hope and wait, and try to get my health back after all of this. Well that is until the next time that is, since doctors have no control over their patients treatment when it comes to pharmaceutical insurance and the insurance companies!