Insurance company rant and med prescriptions

[prolesunited]

First off, let me say that I know I'm fortunate to have medical and pharmaceutical coverage at all and that there are others who have it much worse. BUT, I know my situation is quite common and it just makes me want to scream.

I just got diagnosed with asthma, which sucks but it's mostly related to exercise so it's not that aggressive. My doctor prescribes Advair as a preventive inhaler and then something else as a rescue inhaler.

I go to the pharmacy to get it filled. I have coverage based on a formulary. Depending on where a drug is placed, I pay $8 (almost never), $15, or $25 (most often). Since it's name brand, I'm thinking $25.

Here's what the pharmacist tells me. It's not covered AT ALL! I have to go through a "step" program during which we guess what would work best, meanwhile subjecting me to asthma attacks. :wtf:

Since when did we allow the insurance companies start dictating our care! My doctor has asthma and that's what he uses and found to be most effective. Why would pencil pushers be allowed to override his knowledge and experience?

If I want to pay out of pocket, it's $133 per 28 doses! With the other meds I'm taking for allergies and high blood pressure, that would push me over $200 a month! If I don't treat the things, I certainly might end up in the hospital with much worse issues.

They also took one allergy med off the formulary and bumped my nasal spray up to $25. So, now I'm back home to call my insurance company's formulary up online, try to determine what's most cost-effective and go back to the doctor to get him to approve something else.

This is just ridiculous! And tell me again why universal health care is so evil? And how buying drugs overseas is going to kill us?

Like I said, I almost hate to complain as I know I am one of the more fortunate ones. I was only planning to take a half day off work to visit the doctor. Now it's going to take me all day to straighten this out.

[pmbryant]

1. That is atrocious

Appalling that they effectively take the treatment decision out of the hands of your doctor and yourself. I do hope you can get this worked out. It is certainly a huge aggravation.

I've had a related experience with dental coverage (well, it was my partner), whereby they refused to cover an emergency root canal unless we went to one of their specialists. But to do so would have required waiting two weeks, which was simply unacceptable. After I spent a day on the phone failing to get this resolved (with my SO in excruciating pain all the while), we finally bit the bullet and paid for it ourselves.

I wish I could give some more concrete advice or re-assurance, but I don't have any. :-(

Peter

[eyesroll]

2. Oy. Good luck, proles.

I've been on maybe 8 different brands of birth-control pills -- and only one change was for legitimate reasons.

The rest? Insurance -- formularies, generics, etc. Thankfully, I tolerate the generics well, but there was no guarantee of that.

[mac56]

3. How many insurance companies does it take to change a light bulb?

Sorry. You don't get a light bulb until you try this candle first.

[flamingyouth]

4. What are they putting you on - Advair?

The price sounds like it to me.

I'm sorry you got the diagnosis. I really thought you had it, based on your post the other day.

Yeah, they usually want to start you on Serevent and Flovent combined, then when you get so sick you end up with fucking pneumonia, they'll relent and pay for your Advair.

A tip - GlaxoSmithKline is pushing the hell out of Advair, and your doctor will have lots of 14-day samples. Ask for them.

I know, I know, dear, I could rant all day about health care. I pay $200/mo for my own policy and only have 50% drug coverage. Yesterday I had to pay almost $300 for prescriptions. :(

Again, sorry about your asthma diagnosis, but I'm glad you've at least gotten an answer. And, take it from me, you can lead an active life with asthma.:hug:

On edit - check out Costco's pharmacy prices. They will usually beat your local pharmacy by a wide margin.