RERUNS, SURVIVAL, AND DRUG PRICES

ANOTHER YEAR ROLLS AROUND

Yesterday was my 12th anniversary on this blog.

I have written more than 12,000 posts and have just under 30,000 photographs in the media library. I have been a very busy lady.

I try to add new material daily. These days, I post more photographs than written stuff because writing is more of a brain drain. I’ve got other issues to deal with.

You don’t get a lot of perks from aging but I have decided it’s okay to say “I don’t feel like doing that” — whatever “that” might be. At 75, I write when I feel like it and if I don’t feel like it, I don’t write. What with more than 12,000 posts in the hopper, I’m not bashful about re-posting something. Even when reissuing a post, I give it an edit, change pictures, and try to make sure the dates are right. Blogging isn’t always my top priority. Survival looms larger.

I’m fighting for basic medications — mostly for blood pressure and heart-related issues. Having to fight for your life is exhausting. I don’t know if I should scream or weep.

If I don’t take the right medications, my heart will stop beating. You might think that would be sufficient reason to get the drugs I need, but you would be wrong.

I have been with MassAdvantage for just over a month. I have had to fight them for every medication — ALL of which are generic. The people — their “customer disservice” group — I talk to at MassAdvantage don’t understand anything. I explain and they say: “We are very sorry for the inconvenience.”

Inconvenience?

If I don’t take these meds, I’ll die. From my standpoint, this would be a huge inconvenience but maybe not for them. I’m not sure what they mean by “inconvenience.” Is this their way of not ever having to say “I’m sorry”? Or “We will fix this”?

I have a rebuilt heart plus a pacemaker. I’m maxed out on medications. I’m also missing a stomach due to massive ulceration. Serious medical issues result from this combination. Forget the spinal arthritis — that’s minor compared to the other stuff. There are a lot of medicines I can’t take or which don’t work because of the missing stomach. Add that to the medicines I have to take or I’ll die, then finding ones that are generic (and theoretically affordable) isn’t easy. There’s no wiggle room for me.

So after this kind of awful, long day, I’m too tired to write. Instead, I search through my posts to find something interesting, give it an edit, new photographs, then publish it. Today, I’m writing because I need to blow off steam. It’s a day later and I’m still furious. I can’t begin to tell you how sorry I am to have left BlueCross. Garry and I were with them for four years and I never — not once — had to fight them to get a drug I needed. 

So, as I enter my 13th year of Serendipity, I’m not going to write a new post every day. I’m sorry if that’s a disappointment. Writing posts isn’t always at the top of my “to do” list. 

This battle to get necessary medicine is a fight with which many of us are familiar. If you have a serious chronic condition, the absurdity of drug prices in the U.S. is terrifying. You can’t qualify for “extra help” from Medicaid unless you are so poor you’re living in a crate.

I apologize for the inconvenience. Oh, wait! That is exactly what MassAdvantage said after denying me Procardia (generic). Which I need to survive. If I die from not getting the meds I need, will they consider that just one more “inconvenience”?

After this long battle with three different levels of customer disservice, they said: “Okay, we have put it on the formulary — that will be $89 for three months.” Of that $89, they are paying nothing. They are providing not a penny of insurance backup. And here’s the best part.

Their price is almost $20 ABOVE list price. No, I’m not kidding.

It’s not just politicians who who have no shame. As far as they are concerned, this is all they need to do. They apparently think I need their permission to take a medication.

If you have a prescription from a doctor, you don’t need anyone else’s permission. MassAdvantage apparently has not gotten this message.

Moreover? In four years of working with BlueCross, I never had to fight for medicines I needed. Not once in four years. I never had to fight with anyone in their customer service department for any reason. Yet, a mere month and a few days of “working” with MassAdvantage? I’ve had to fight for every single medication.

They have exceeded my worst fears. It’s not just politicians who have no sense of shame. Drug companies and insurers are worse because they are playing directly with our lives — and they don’t care.

 



Categories: Anecdote, Arthritis, Customer Service, Health, Heart, Medicare, medication

Tags: , , , , ,

35 replies

  1. Congrats on your wonderful blog, Marilyn. It’s the perfect place to tell it like it is, so that we can see that we’re not alone i this crazy world. Hope you can get all of your meds at resonable prices… It seems that healthcare is getting worse than ever for so many of us. Keep the faith and keep shouting out the realities! Hugs & prayers, ❤ xo

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    • I called Medicare and complained and they looked at their “product” and said “I would never recommend this plan to anyone.” THEN I disenrolled and rejoined (as of March 1) BlueCross. Talk about you get what you pay for!

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  2. First, congratulations on the 12th anniversary of your blog. Second, I’m sorry about the hoops you have to jump through to get the prescription drugs necessary to keep you alive. It’s unfathomable to me that in this country it’s so costly and so hard to get life-saving drugs. This is the wealthiest country in the world, yet so many people, especially the elderly, have to choose between paying for their prescriptions and paying for food or heat. That is ridiculous.

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    • I ditched them and rejoined BlueCross. I didn’t realize I could, but if you are a member of an Advantage plan, you have until March 31st to bow out and join a different plan. I was trying to give them a chance to get it together, but they called me this morning and told me that a drug that has been on the market for more than 60 (yes 60) years had been put on their formulary as a Tier 4 drug! That was IT for me. Meanwhile, I helped them get a solid black mark from Medicare, — which they most richly deserve.

      We pay more for drugs in the U.S. than in any other country I know of. Why we have not fixed this is beyond comprehension. I will never understand it. Meanwhile, my job is to survive and I was pretty sure a year on this plan and I’d be dead before it was over.

      Liked by 1 person

  3. Congrats on 12 years of Blogging Marilyn. I’m sorry but you have the worst system of which I know. The drug prices are more than three times of what I pay in Pakistan. I can get whatever the doctor prescribes and if the drug is not manufactured locally, they import it for you and even then these aren’t as expensive as the drugs made in USA.

    Liked by 1 person

    • We do have a horrible medical apparatus. I hesitate to call it a system since there’s nothing systematic about it. It’s just a mess and I’m not seeing any hope of it getting better in my lifetime. The older I get, the more betrayed I feel. it’s not a good way to feel about ones country or medical establishment.

      Liked by 1 person

    • I was just thinking the same thing. The medicines have a cap on the prices in this side of the world. In India too there is a maximum price, which I never realised is a blessing in disguise. And I always thought that the States being a welfare state has schemes.
      You stay well Marilyn, your health is much more important and congratulations on the twelve years.

      Liked by 1 person

      • I spent some time on the phone with Medicare and basically, although there are rules in place, if an organization fails to follow them, nothing happens. So they do what they please. If laws are not enforced, they don’t mean much — and that seems to be what’s going on all over this country. Many of our laws were observed because our citizens believed in doing the right thing. But somewhere along our path, we seem to have lost that. if people refuse to behave reasonably, eventually life becomes chaotic.

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        • How very true! They seem to be only titular and since most people are unanswerable they do as they please!

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          • A failure to set up laws where there is an actual punishment for failing to obey it. Right now, most laws that don’t pertain to murder, robbery, some kinds of vandalism — these are laws that are enforceed. Other things, many things, including copyright, voting, civil rights — even rape — are essentially penalty-free or the requirements to get them enforced are absurd and make them effectively unenforceable. I suppose we believed a law would be obeyed because that’s how society works. You CAN’T enforce every law. Some things are taken for granted, assumed as “understood.” That had been true, but is not true anymore.

            The result really IS chaos.

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  4. I’m so sorry Marilyn. I know you hoped that this change of providers would work out cheaper and with at least as good service as you got from Blue Cross.
    I hope you can work things out.

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  5. I have Blue Cross Blue Shield of Illinois as a supplement plan and Wellcare for Part D. So far, so good. I used a medicare advisor (no cost) to help me find the right plans. Otherwise, I would have chosen a different Part D. She was very good at finding the right choices.
    John had Blue Cross Blue Shield when he first came here, about 6 months. He had no problems with it. I was steered away from Medicare advantage plans by the advisor. She told me it would not work well in my case.

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    • That’s a very good plan. BCBS is really the best group and as a supplement, they usually will pay for pretty much everything. Advantage plans are more affordable and have a few perks compared to straight Medicare. But if you have expensive medications — insulin, for example — you are much better off with a straight Medicare and a supplement. As we move into next year — if MassAdvantage doesn’t kill me first — I will reconsider my options. We don’t have nearly as many choices here as we would if we lived in a different county. Worcester county doesn’t have enough doctors or hospitals while Boston and near-Boston is LOADED with every facility you could think of.

      Believe it or not, UMass is the best of the group, which is why I though the plan might be okay. Stupid me. Will I never learn to never believe the sales department?

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      • I went to an advisor recommended by a friend other wise I might have been sucked in by a sales pitch.

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        • I just assumed that my own hospital and doctors would work for me. it wasn’t the sale pitch. It was that they are a group that is local and focused on “local people.” It made sense. But, of course, sensible has nothing to do with medical care in this country. At least we’ll get Garry a new cochlear set up and THEN we’ll rethink the whole thing.

          Liked by 1 person

          • The only ones I had a problem with were Walgreens not understanding I switched insurance and trying several times to use last year’s company. It’s was as if people don’t change insurance the first of the year.

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  6. Terrible. I hope you can get your meds asap

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    • It’s AWFUL. I just have to survive a year with these morons. I’m so sorry I believed they would do a decent job. I knew it might be a little bumpy in the beginning — new group and all that — but I never imagined it would be THIS bad. We really really REALLY need a decent healthcare system in this country. I doubt I’ll live to see it, but I keep hoping.

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  7. Very well written rant Marilyn. I think perhaps it’s time you escalated to either your political representative or the state’s official who oversees health insurance (the insurance commissioner)? It’s one thing for the apparently new customer service folks to be still in a state of learning curve since the plan is a very new one, but you should not be their guinea pig for experimenting with their formulary. Is the physician who prescribe your meds a participating member of their plans? I would engage him or her to take up your battle. He should carry more weight as a prescriber telling them “my patient will die if you do not allow this medicine.” Also NPR’s website runs stories about people vs insurers and / or hospitals. Some may be funneled from Kaiser Health News. They may be interested in your experience and able to urge a satisfactory outcome for you. So maybe it is time to call for the heavy artillery and get the press involved? At least the plan covered Garry’s cochlear implant, or was that BCBS? Good luck to you!

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    • The irony is that ALL my doctors are part of this hospital’s network because (ta da) — this is the only full service hospital in the entire county. The one rep who used to help with this stuff got un-elected in the “trump bump” — so I have no idea who anyone is anymore. If the medications were not life-and-death stuff, I could cope better, but these aren’t “feel better” drugs. These are “stay alive” meds for heart disease. What is WRONG with these people?

      This is the one plan that WILL cover Garry cochlear stuff, so that’s the good news, but it’s a mess for me. I’ll work it out. Somehow, I always do. I usually don’t even know HOW I work it out.

      Liked by 1 person

      • That stinks for you. Drug manufacturers sometimes have “patient assistance” programs and there are also deeply discounted options out there. Here’s a page with 2 versions of Procardia: https://www.patientassistance.com/B6195-procardia.html This one seems to offer a 55% discount on Procardia https://www.patientassistance.com/B6195-procardia.html so that knocks the Medicare Advantage price down from $89 by quite a bit. There are other discount programs out there on the interwebs. Hope you get some help quickly so you can get back to your “real” life.

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        • I will check out the links.

          I am so disappointed that this has been such a fiasco. I thought because this was a local group based out of our only major hospital in this county — and all my doctors already part of it — while there might be a rough start, they’d work it out. I am giving them a few days to address my grievances. I’m not expecting them to actually do anything, but I want to give them a chance. In the meantime, I’ve got coupons for the drugs they won’t cover which will give me time. BUT I’m not expecting them to do the right thing, I have been noticing how very rarely I see any organized group do the right thing, no matter how bad things get. We seem to have lost our sense of right and wrong and having lost it, I doubt we will find it again. I would very much like to be wrong about this.

          Garry is even more pissed off than I am. This has to be the first time he wishes he was still working. Unfortunately, he has been retired for almost 20 years. The people he knew are also retired and many have died. Time caught up with us.

          I will check out the Procardia link first because the actual original drug has a lot more options than the generic version, including a 30 mg tablet that I could take which would be a big improvement for me.

          I really hate this endless fight to keep alive. I’m tired. It seems I have been in this battle for at least 20 years. I’d like some time to just hang with the birds. Take some pictures. Pretend the world hasn’t gone completely wacko.

          THANK YOU. I really appreciate the help more than I can express.

          Liked by 1 person

          • Marilyn, you’re welcome and I just read your latest post wherein Medicare allowed you to disenroll from this scam of a plan. CONGRATS to you. I am so sorry for all of the tsuris and mishegas your experience entailed. One last suggestion – I suggest you let the AARP know about this scam of a plan. (I am not a member but assume that this is one sort of thing they would monitor.) Congrats again and get some well-earned rest and maybe do some delicious Chinese cooking – chopping up the ingredients while imagining chopping up that plan, itself, might feel fine.

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  8. Great rant Marilyn very eloquently said and it’s good that you have an outlet for it. I really feel for you. I assume you live in USA which seems to be one of the worst places to be if you are ill besides third world countries. Congratulations on your wonderful blogging achievements. 🙂

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    • Thank you. We have the worst medical “system” here. It’s not a system. It’s just a mishmash of insurance companies making decisions about health without caring what the results of these decisions will be. It’s shameful. Now I just have to survive this year and live to change insurers again.

      These endless battles with insurance companies are draining and humiliating. Good thing I can write or I might possibly explode!

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      • Sounds so awful, I’ve seen a film about someone suing an insurance comoany. I pay a fortune in private health in Australia but I feel it’s worth it as we have used it a lot and they are very good at paying up

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        • People sue them. If they win, the insurer promptly declares bankruptcy, pays nothing to anyone, and slides into a new company under a new name.

          When Johnson pushed Medicare and Medicaid through congress after Kennedy was assassinated, we actually believed that this problem had been solved. Wrong. OH so VERY wrong! I just have to survive a year with these idiots.

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