Friday, February 27, 2009

Darn Prescriptions!

Today was the first time using our new Rx coverage. I was walking into the Pharmacy just happy as can be since we are no longer forking out a near mortgage payment for COBRA coverage each month. I was expecting to pay $10 for our supply of insulin (2 vials) that lasts us at least two months. (Thank you tiny basal rates!) Then I realized I must be dreaming. ...nothing with insurance is THAT easy. My happy thoughts quickly turned into Uh-oh's as I realized our new policy requires us to get any "recurrent" refills from mail order. I hate that. I dont do insulin by mail! We have had too many bad vials! (Hello, its 120 degrees in the summer!) So, walking in I'm already irritated and feeling controlled by this new evil insurance plan!

This one time will be okay I reassured myself.....I know they allow the first initial RX to be filled at the Pharmacy because I made all benefit elections after spending enormous amounts of time studying each and every tiny detail. "Thats right, the first RX is allowed here in the local Pharmacy" says the clerk. Then, it all started to get a little too frustrating for me. She just sounded more and more CRAZY as I stood at the counter in disbelief. "Thats $76.03" says that silly Pharmacy clerk! Right about now is when my blood starts to boil and I become a bit irrational after having just left my day job dealing with this same CRAP all day from insurance companies. Ok, I ask.......why would it be $76.03? Is it not a "preferred" brand of insulin? "Hmmmmm she says. Let me see" "Um, No.....thats just your cost" she tells me. So, at this point, I start to giggle in an evil, freakish, watch- out- because I'm gonna BLOW kind of way. Yeah....even Maddison walked away. She's seen it go down like this before :) Long story short, we had ZERO insulin at home and I needed to do a site change with a low reservoir. No time to argue. I asked for a print out with the NDC number and planned to call the insurance right away once I calmed down at home. Add $76.03 to my expenses this week.

Now the adrenaline rush has me crashing to a nice 53 when I pull into the drive way. GREAT. It feels like my blood pressure skyrockets right along with it. I can only imagine what I may have missed in electing our coverage. What the hell did I do? Did I miss something this HUGE? I'm frantically trying to recover my computer print out from when I made these new benefit elections online. Ah ha! Found it! Long story appears we are on a BASE Rx plan, not the PREMIUM RX plan I elected. How the hell did this happen!!?? I can tell you, it wasn't my error and if SOMEONE doesn't change this election to what it should be when I elected it online we will be in SERIOUS FINANCIAL DESPAIR!!! Thats right. This "Base RX" covers only generics at $5 copays. Anyone ever seen a GENERIC INSULIN? HOW ABOUT GENERIC TEST STRIPS?

The breakdown:
Insulin= $76.03 per month
Test strips for Maddison @ 400 per month = $87 (yes this is a "preferred" brand)
Test Strips for ME @ 400 per month = $87

Total: about $300 per month (car payment perhaps?)

By comparison, we used to pay $10 for insulin and $10 for test strips. OUCH. I never knew how good our insurance WAS!! And, Ah yes.....this base RX says you pay 40% of retail cost for any brand name RX, not to exceed $200. How nice. Now, why isn't there generic insulin? I dont know how this happened, but someone made an error somewhere....this is NOT the plan I chose! More insurance drama that I will have to fight. How completely, and entirely frustrating! Can't anything just ever work out the way it should without me having to go an extra 10,000 miles to get it there?


Beth said...

call me - we can give you some supplies until you get it straightened out! I just refilled insulin and have 3 months worth of Novolog (which would be a lot more like a year's worth for you 2).

Anonymous said...

I'm not a fan of APlus Medical (see the CWD site for more info on them) but they may just be the answer to your problems. In any event, I hope that you can get this all straightened out!!

~Caspi (from CWD)

Scott K. Johnson said...

Major suckage.