i get so frustrated with the red tape and bureaucracy of healthcare. it is such a huge personal issue to me- i feel like i spend my days fighting with doctors, pharmacists, insurance companies, drug manufacturers, social security department, lawyers, senator's office... sometimes i just get tired of pushing and pushing for simple assistance. why can't this be easy and streamlined? for example. i have been on a drug called Lryica for close to 3 years now.
(there's been a recent push for the drug on national tv advertising- it shows some woman painting, and seems to generalize the condition. it's actually quite serious but is sometimes overused by doctors as a "catch all" if they can't figure out what is wrong. you have to be very careful/picky when choosing a doctor to manage this aspect of the disease. people with autoimmune disorders seem to develop this more often than others. they're not sure of the connection.) a
as most of you know in addition to my MS, i developed fibromyalgia, and the two love to compete for who is causing the most destruction in my life. of all the (22) medications i take on a daily basis, Lyrica is one of the most important. it makes the nerve pain tolerable, and helps me keep walking. i originally took Lyrica strictly for my MS, but it's now FDA approved to help fibromylagia sufferers (the first/only fda approved drug for this condition.) you would think this is a good thing, and could only help obtain access to the drug.
last week, i was running low on Lyrica so i called the pharmacy for a refill. it was down to 0 refills, which meant it required doctor authorization. no big deal, CVS (love them) called my neurologist's office for approval to submit the drug. well, my insurance (PA Access- state medicaid/medical assistance) kicked back the refill, requiring pre authorization. so, once again, CVS coordinates with my neurologist to send in the paperwork. my neurologist refuses to submit the paperwork until she "evaluates" my condition. she claims that it has to be "documented" that i am actually suffering from tender pressure points on my body due to Fibromyalgia. (like i could make this stuff up!)
a week has now gone by. i am completely out of this drug, and therefore the physical symptoms that Lyrica usually manages are front and center. in addition, i was having major withdrawal effects. i've felt like a crazy person the past 3 days- intense hot flashes, uncontrollable crying and anxiety, incredible nausea, dizziness and chills, pure exhaustion. my legs were so weak from the pain that they were shaking from taking a simple step. i was even scared to go downstairs b/c i thought i would fall straight down. adding to all of this is the fact that PAC denied my Ambien CR prescription- they will only cover generic Ambien. i have a history with sleeping medications, since i suffer from insomnia quite frequently. it took MANY different attempts with everything from sedatives to sketchy syrup that was used to knock kids out during CT scans. my experience with Ambien is that it makes me hyper- almost heart racing, tossing and turning, itching. so from saturday until last night, i didn't sleep. instead i was a zombie during the day barely making it out to the mailbox to fetch the mail.
in the meantime, CVS is trying desperately to coordinate with my neurologist dept, who are not cooperating. here i am, their patient, a complete mess, and they refuse to sign off on paperwork saying i require the medicine. i was told explicitly that "if i did not come into the office on Friday they would not give me the prescription." i have been their patient for a YEAR. they have prescribed this medication at least 4 times over the course of said year. but still, i have to be "evaluated" and they will then determine if i "quality" for the drug. what was i supposed to do in the meantime? their suggestion is to pay out of pocket for a week's supply of Lyrica, which is $12/day for 4 pills. . it might be another week before all the paperwork is processed- now we're up to approx $84. it infuriates me that they can allow a patient's care to suffer and such a lapse to occur in medication.
now compare this situation with my conversations with my internist this week. i had emailed her, explaining the problem with the sleeping medication, and could we try something else. within a few hours, she had responded with not one, but THREE options- a med called Restoril (which i have taken, it works!), Trazadone (sedative, i tend to avoid it), or meet with a new sleep specialist that just joined their practice (a physician). she then had the nurse fax CVS a Rx for Restoril and even had someone call me to set up the appt with the new doctor. no questions asked, total concern for my health, making me a priority. it's night and day from the staff at the neurology dept, who i feel fight me every step of the way. it's gotten to the point where i am developing anxiety in anticipation of my appointments, and am self conscious about telling the truth about my condition.
our annual girls weekend is coming up next week on the cape, and it's something i look forward to all year. i'm also going to spend a few days with Stacie & Josh in Boston before meeting up with Scottie on thursday. i don't want to be in a slump with all my medication woes, and i don't want to be uncomfortable or exhausted the entire time i am there. i just hope that i can gather some strength for the travel leg of the trip- williamsport to philly, philly to boston, and back again MLKjr day on mon the 21st. by then it will have been 3 weeks- THREE WEEKS- without having the Lyrica problem taken care of. 3 weeks for a bargain out of pocket price of over $300. (which i hope is worst case scenario.) this might sound trite, but this is the ONLY drug that really gives me a benefit. I would think 3 weeks is time enough to work it out.
i'm done venting now. it's late, i'm actually tired, and have a very fat cat curled up against me. who needs a pillow when you have a ball of soft fluff? ha. here's to a better posting next time! ciao!
remember, you can view these postings directly on kit katchat's blog
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