Tuesday, February 19, 2008

Policy and Protest

I’ll start with the preface that I know I am fortunate to have health insurance. It isn’t the best insurance out there but it isn’t the worst and relatively speaking, I know I don’t have much right to complain.

But.

Obviously when we’re talking about health insurance you know there’s a “but,” right?

I’ve long since accepted that the glory days of my past insurance life are over, the days when my Daily Chest Physiotherapy was covered, you know, daily, and routine doctor visits didn’t cost hundreds of dollars. I use Express Pay for my many refills and pretend not to notice what the amount due actually is, figuring I’ll just deal with the full blast at tax time. I take what I can get.

Still, it’s impossible for me not to get fired up at the state of healthcare, at the exorbitant cost of heavily marketed blockbuster “me-too” drugs, at the futile feeling that preventative care is the most important thing we can be doing but is still not a priority to many. I will return to this line of thought in one moment, rest assured!

Recently, I had my own minor little indignation. I picked up my refills and a generic prescription for allergies/sinus congestion I’ve had since 1996 cost 10 times what it did last month. Now that was an Express Pay bill I couldn’t ignore! I made many phone calls to the insurance company and the prescription benefit people and actually ended up conferencing both parties since their knowledge of what the other was doing was so woefully inaccurate. I found out that as of January 1, the medication was no longer covered, despite the fact that we pay extra each month for “premium” prescription coverage and despite the fact that drug is listed on the company website as the “preferred drug.”

The real kicker? No other drug in that whole family is now covered. At all. Huh? Now, I realize that of all my meds it’s the least serious one. It’s not like they took away my thyroid medicine or my heavy duty antibiotics or my refined nebulizer medications. The world won’t end. But, as I said to the woman on the phone, it doesn’t make much sense. Keeping my sinuses clear means less gunk spreads to my lungs and lodges there, which in turn means less need for massively expensive antibiotics and even more expensive hospital trips.

Go figure.

Anyway, just as I was stewing away at the arbitrary and exhaustive ban of all medicines relating to sinus congestion, I checked my inbox. It just happened to be full of links and resources relevant to my position here—and yes, it really happened this way, as contrived as the timing may seem.

So, back to my main point here: Information is power. For all of you who feel frustrated, who are nursing your own indignations and outrages, who want to know what’s really going on with your healthcare and what you can do about it, I offer up the following suggestions:

PharmedOut is an independent, publicly funded project whose goal is to empower physicians to recognize and counteract inappropriate pharmaceutical promotion. Last week they released publicly a slideshow called “The Physician-Pharma Relationship." Check out the press release and slideshow here.

Not on the Center for Science in the Public Interest’s e-mail list? Click here to check out the site and sign up to get regular summaries of what’s going on in the world of science and health delivered to your inbox. From disclosing financial conflicts of interest in research studies that affect your life to the latest analysis of FDA policy changes and announcements, the Integrity in Science Watch e-mail is a treasure trove of the kind of information you need to have but can’t always get to easily.

It’s no secret that healthcare is one of the most pressing political issues out there. Election year scrutiny got you thinking? Visit the Partnership To Fight Chronic Disease, a great resource that is a “national coalition of patients, providers, community organizations, business and labor groups and health policy experts, committed to raising awareness of policies and practices that save lives and reduce health costs through more effective prevention and management of chronic disease.”

As for me, I’m planning my next phone call to try and remedy this pill situation. Luckily I’ve got plenty to read while I wait on hold.

7 comments:

Audrey said...

I'll admit I'm confused as to how they can not to cover a whole class of drugs...but I'm no expert. Hmmm...maybe I should be!!! Career idea...

Sorry you have to deal with this Laurie. You are such a great advocate for yourself and others I am optimistic this will sort itself out-but I'm sorry you have to devote time to this. Hopefully others will benefit from your efforts as well.

Anney E. J. Ryan said...

I always figured that you were covered, since you have such a serious illness. I'm embarrassed that I know so little about this. But that's how it is in our country-if everyone was sick, there'd be no issues with healthcare, cos we'd all be fired up. Well now I'm fired up too!

Freadom said...

It would seem quite odd that they'd not cover this med. I know my insurance won't cover birth control, which doesn't make much sense either considering birth control would be much less expensive than the alternative.

But we don't make the rules.

LISA EMRICH said...

Hi Laurie, I'm new to your site and will be returning. I laughed so hard (sorry) about the series of phone calls resulting in the conference call because I've been there.

There was one occasion which my mail-order pharmacy incorrectly filled the quantity of a prescription, sending a 1-month supply but labeled as a 3-month supply. It took almost two dozen phone calls over two weeks between myself, the pharmacy, insurance company, pharmacy benefit manager, and doctor's office before a newly-written script would be approved and filled. Eventually, I was on my cell phone with the pharmacy benefit manager and on my home phone with the pharmacy before the situation was resolved.

Hey, I should blog that story.... Anyway, thank you for sharing.

Barbara K. said...

It is frightening to realize in that in-your-face way how dependent we are on our insurance provider; how illogical and one dimensional their decisions can be; and what little recourse we have.

Thanks for the info about the advocacy group.

card said...

Always try to figured that you were covered, since you have such a serious illness. Embarrassed to know so little about this. But that's how it is in our country for today if everyone was sick, there'd be no issues with health care, cos we'd all be fired up. So keep healthy all the way.

card counting said...

Always try to figured that you were covered, since you have such a serious illness. Embarrassed to know so little about this. But that's how it is in our country for today if everyone was sick, there'd be no issues with health care, cos we'd all be fired up. So keep healthy all the way.

 
Powered by blogger. Customized by PinkDezine.