In a post from last October, the eccentricities of navigating the medical system were described. The same story repeated itself today and is as follows…On Friday afternoon, my rheumatologist prescribes a new biological medication – Humira. I indicated that my insurance would only work through a specialty pharmacy when dealing with biological medications. In the computer, he “sends” it to them. Within the hour the local pharmacy calls and says that the prescription was received and would need prior authorization from the doctor. Why did the local pharmacy call? This is on Friday at 5:00 p.m. so the weekend puts everything on hold. In the meantime, out come the prednisone steroids to knock down inflammation (along with fun side effects which are not pertinent to this story). A call on Monday to the specialty pharmacy in another state is made and they indicate that they did not receive the prescription and would contact the doctor. A call to the doctor only results in a message being left and no return call. A call to the local pharmacy later in the day is made and the pharmacist states that they do have the script but that she would contact the specialty pharmacy in another state (same company but they never seem to talk) and the doctor to let them know that the script must be sent to the specialty pharmacy. She mumbles something about prior authorization being needed by the doctor before the insurance would approve it. Within the hour I receive a cell phone text message from the local pharmacy indicating that my script was ready for pick up. I called and spoke to a technician. She says that a Humira autoinject pen is ready and would cost $4,000! At this point I wanted to scream! But I calmed down and will wait another day suspecting that the doctor will get it right on Tuesday by faxing the script to the correct pharmacy and getting prior authorization from the insurance company. My insurance company approved Enbrel and Cimzia and I can’t imagine that they would not do the same for Humria (it’s about the same cost). In the end, it will all be good and I’ll get to start the new treatment. In the meantime, I’ll have “fun” riding the carousel.
Photo Credit: http://www.flickr.com/photos/joeshlabotnik/