…how much I hate the fucking US medical care “system”?
A week and a half ago when my elbows were extremely bad, I went to the urgent care specialist as I blogged about already. They gave me a pretty strong narcotic (“ultracet”) to kill the pain, but it made me sick to my stomach, so I only took it once.
A week later I went to my doctor. By then my elbows had calmed down because I stopped doing the stretches. He gave me a prescription for Celebrex, which is a non-steroidal anti-inflammatory drug (NSAID) which doesn’t disqualify one from flying. I didn’t want to start a new drug just before going flying this weekend, so I didn’t bring it in to get filled until yesterday.
But of course, because the medical care system in this country is run by crazed monkeys (or as they call themselves, “insurance companies”), the drug store called me to say that the crazed monkies won’t approve the prescription unless they get a “pre-authorization” form from my doctor. “I thought the prescription *was* the authorization?” I said. “Oh yes, but for this one they need a pre-authorization.” Here is is, 24 hours later, and the doctor filled out the pre-authorization request but hasn’t heard from the crazed monkies yet.
Let me get this straight – a doctor I’ve never seen before can write a scrip for a strong narcotic and the drug store fills it in 2 hours flat, but when my own doctor writes a scrip for a simple, not very strong and non-dangerous NSAID, the insurance companies hold up filling it for days? What a fucked up system.
It’s all about money. What you ran into is known in the trade as a “managed prior-authorization program”. It’s something offered by prescription benefit management companies to allow their clients to control drug costs. The real purpose is to discourage MDs from prescribing expensive drugs where a cheaper alternative might be effective. Celebrex is expensive, I’m guessing that the narcotic isn’t, or is seldom used long-term as a maintenance drug. Managed prior authorization is a compromise between full coverage (and higher premiums) and no coverage (drug is off formulary, and member pays full price). I know this won’t make you feel any better, but I wanted you to know what was going on.
Some time ago, I was taking Wellbutrin, an antidepressant. My insurance coverage changed underneath me, and the new company wouldn’t cover the Wellbutrin until they checked with my doctor.
It turned out that Wellbutrin is also used as an aid to giving up smoking. It was OK to take it if I was depressed, but not if I were trying to give up the weed.
Once the doctor said I wasn’t trying to give up smoking, the coverage came through just fine.
One would think an insurance carrier would consider giving up smoking would be a Good Thing, considering the price of chemo drugs.
Ph.