This showed up in a post on the internet… we, in healthcare, are all about caring for pts.. especially Pharmacists… who apparently determines if a Rx is medically necessary by geography.
My wonderful Obamacare insurance plan (Being sarcastic, it is terrible) creates a situation where the closest urologist that participates in my plan is two counties away. I am given a script for pain meds (Kidney stones again. Perhaps from the large doses of chemo). !st problem, I need to go for a scan and sonogram to determine if they could pass on their own. If not, as has been the case before due to size, I would need minor surgery. With a 5k deductible I am pretty much screwed. 2nd problem. I called my pain doctor and was told it would be OK to fill the rx and take. I went to the local drug stores and was turned away because the doctor is not in the county I live. This “system”they came up with is wrong both logistically and morally on so many levels.
Filed under: General Problems
Yes it is wrong on so many levels, and I am sorry you are having difficulty getting your pain medications filled. As Steve almost daily reports, the DEA wants pharmacists to be the enforces of drug laws, and pharmacies, especially corporate ones, have implemented programs to guard against potential hefty DEA fines.
I suggest you call the customer service number for your pharmacy benefits plan on a week day during normal business hours and explain your situation to them. Ask if they can offer any assistance, and if they might intervene on your behalf with a contracted pharmacy. It is in the insurance company’s best interest that you get the medication you need; otherwise, they will be paying for more expensive hospital care.
I have no idea of your particular situation, but I would guess that for a higher premium payment you could have chosen a plan with much less than a $ 5000.00 deductible. In my state, which is not ACA friendly, there were multiple choices with a wide range of premiums and benefit options. The more expensive options offered a larger network of providers even though only one insurer chose to serve the entire state. If you are part of an employer group plan, with that high of a deductible, you probably have a partially employer funded health savings account that would defray some of your out of pocket expenses.
The Affordable Care Act is not the Free Care Act. Health care is very expensive in this country compared to the rest of the developed world. That’s the way most people want it as a “free market” system and not a single payer system. I can’t imagine what insurance would cost you if not for the ACA if you could get insurance at all.
That pharmacy is practicing ridiculous discrimination. I dont know where you live but it sounds like FL and I send you my condolences.for a state where one seems.to be guilty for having real pain, but I digress. Where I live in IN it is very common for someone to have to go to Indianapolis for care which may be an hour or more away, some to Chicago. I’d say 99% of pharmacists I know around my city dont bat an eye much, and if they choose and get the verification.
And i empathize with the poster as I am a chronic stone former with 2 surgeries in the past…my thoughts and prayers you find relief soon.