As I read of the continuing furor over “ObamaCare” I recently experienced an set of circumstances that illustrate, yet again, why the current system of so-called “private” insurance in the US is completely broken.
Despite carefully preparing for our trip from Ann Arbor to San Diego, I managed to omit two medications from my travel bag. One was a blood pressure medication, the other my daily cholesterol pill. Both are generics and both should be non-controversial and dirt cheap. We’re not talking about narcotics or potentially dangerous medications. Not the sort of thing that anyone would be falsely demanding of a pharmacist. So I had no idea of the difficulties I would encounter as I tried to repair what was admittedly my goof upon my arrival in San Diego.
After settling in our lovely boutique hotel, the Keating, in the Gaslamp District I quickly located a nearby shopping mall and headed for the CVS Pharmacy therein. The Pharmacist was sympathetic but insisted on contacting my home pharmacy to verify that I had a valid prescription for the two medications. As it happened, my blood pressure prescription was current and there was no problem filling it for the duration of my trip. My cholesterol med, on the other hand, was “expired”–I had been renewing it for three months at a time and had just used the last of that round of renewals, so technically I wasn’t entitled to get any more until the physician wrote a new scrip. The Pharmacist noted that I could do without this med for a day and she would contact my doctor the following day.
When I returned to the pharmacy the next evening, the Pharmacist sadly informed me that my doctor had not returned her call, so no cholesterol meds for me. At that moment, it dawned on me that my doctor did have an “after-hours” number, so I tried that and sure enough the answering service had the doctor on the line within a couple of minutes. She called the pharmacist immediately. So I gave the pharmacist an hour or so and then returned to the store. She looked at me and said, “Yes, I did get call to my voicemail but I haven’t had time to listen to it.” So no meds yet. Soon she reported that yes, there was an appropriate authorization but it would take her some time to get it together.
An hour later, I made my fifth trip to CVS in search of my anti-cholesterol medication. The pharmacist wanted my prescription health plan card and I found two different copies in my wallet, both of which were no longer valid. We then recalled that when I retired, my prescription coverage was provided by my wife’s plan because I was too young for the University’s retirement plan to provide subsidized coverage. The reason I didn’t have a current card was that the University had provided an incorrect address for me to the pharmaceutical insurance provider, so they had mailed my card to the wrong address. Despite receiving a corrected address about three months ago, they still hadn’t managed to get me a new card.
But fortunately my wife could provide her information and sure enough that number did include my insurance coverage. But we weren’t home free yet. Yes, I am covered, but no not for these pills because my prior prescription had been provided too recently. In other words, if you recall, I couldn’t use the prescription on record at my pharmacy because it was “expired” but neither could I get a new prescription because it was too soon.
Fortunately the medication was generic and I can afford to pay without insurance. So after a $12 payment, my five pills were procured and I was, at last, on my way back to my room with my anti-cholesterol medication.
In our country, a maze of government red tape, insurance company interference, and stupid regulation resulted in a phenomenal waste of time for all concerned. Forget about my petty needs to control my blood pressure (somewhat countervailed by the handling of these issues) and cholesterol. My home pharmacy, the San Diego pharmacist, my physician, the insurance company’s costs and you will see how a few generic pills probably cost these various entities a total of several hundred dollars.
Just about any place else in the industrialized world, this situation would have been handled quickly and with little cost to anyone. The pharmacist has reasonable discretion, most people have government controlled plans that allow quick information to be located based on something akin to a social security number, and the absence of regulation results in dramatically lower costs. This is a microcosm of what is wrong in our country, why health care costs so much. It won’t end until we wake up and realize that our crazy-quilt system of providing coverage is costing us dearly–sapping vital resource we could be using to for so many other projects and depriving many people of adequate care.