Anne suffers from clinical depression and has been on several different anti-depressants before finding one that worked well in the form of Effexor. She’s been taking it for the past 6 months or so and it really does seem to help, but this past Saturday when she tried to get the prescription refilled at the pharmacy she was told that a policy change now required her to have a pre-authorization before our insurance would pay for it. We’ve been getting this prescription filled at that pharmacy for the entire time she’s been on it and this is the first time our insurance had given has a hard time about it. Effexor is one of those drugs you can’t afford to just quit cold turkey so we went back up to the pharmacy and I bought a week’s worth of pills for her to the tune of $64 for 14 pills. Yeah, it’s not a cheap medication as the full prescription would’ve set us back $256 or so.
Needless to say, I was really pissed off. And I was especially pissed because my insurance company—Blue Care Network—just raised my rates again the previous week. The pharmacy said they’d put in a call to the BCN who would call our Doctor and ask her to submit a form and then they’d call the pharmacy back and clear the prescription and we’d get reimbursed for the week we paid for minus the copay. On Wednesday we heard from the Doctor’s office, but we still hadn’t heard anything from BCN or the pharmacy on Thursday so I called BCN and learned that they use a third-party “pharmacy benefit manager” company called MedImpact. According to BCN they approved the pre-authroization and forwarded it onto MedImpact and that we should hear from the pharmacy on Friday, but if we didn’t we should call MedImpact. We didn’t, of course, and a call to the pharmacy indicated that nothing had come through yet. So I got on the horn and called MedImpact and was told that their system was indicating that BCN still had the paperwork which they had submitted to them on the Wednesday. Next call was to BCN where I was again told that they had given it their approval and had definitely sent it back to MedImpact, but perhaps MedImpact hadn’t loaded it into their system yet. BCN assured me, though, that it would definitely show up in MedImpact’s system by Saturday without fail.
So today is Saturday and guess what. The pharmacy still hasn’t heard from MedImpact and BCN’s offices are closed on Saturday. MedImpact does have Saturday hours, though, and I just got off the phone with them after trying my best to keep my anger under control. Again I was told that the system at MedImpact was still showing no new updates from BCN. At the moment the authorization is stuck in limbo someplace between Blue Care Network and MedImpact and Anne is once again out of pills. I asked to speak with a supervisor or manager or someone who might be able to expedite this issue and find out who the hell has dropped the ball as my wife’s health is at stake here. After a few minutes on hold the young lady came back and said that they could do a five day override for now and that I’d need to call BCN come Monday.
You bet your sweet bippy I’ll be calling them on Monday. Someone’s likely to be walking funny after I get done with them too.
As it turns out, the policy change that brought all this fun running around into play isn’t really the fault of Blue Care Network. Rather the FDA put the new policy into place after some recent studies which implicate several anti-depressant drugs in actually causing an increase in suicidal thoughts in kids and teenagers taking them. The FDA is also going to run a study to see if the same might be true for adults. As a result all prescriptions are under greater scrutiny and the fact that Anne is taking a dose that’s twice the maximum amount they make, in part because of her weight, was exactly the sort of thing that fell under this new rule from the FDA. So it’s not really BCN’s fault that we have to jump through hoops, but that doesn’t excuse them for not handling the claim processing in an efficient and timely manner. We were told it shouldn’t take more than three days and we’re now headed into the second week of trying to get this resolved and I’m not at all happy about it. To top it all off I now want to have her Doctor look into if Anne’s at risk for the health risks Effexor appears to carry with it and, if so, what other treatments might be considered as a replacement for it.
It’s getting to the point that I don’t think I can take the stress involved in trying to keep my family healthy.