Sunday, February 16, 2014

Insurance Companies

My daughter takes a very expensive medication – like $500 a month.  When she got her own insurance, the company refused to pay for it.  Their logic was that there were less expensive drugs out there that she could try.  They told her that for them to pay for this expensive drug then she would have to try these less expensive options.

This sounds reasonable except that this will make the third time she went through the process.  The first time was when the doctor initially prescribed the meds for her.  The second time was when I switched insurance companies (to the same one she has now).  It is in her records that she has done this before but they were insistent. 

Since she can’t afford the drug without insurance, she had to jump through the hoops they demanded.  The first drug – did nothing.  The subsequent three drugs she had allergic reactions to.  The first allergic reaction she had a hard time breathing and broke out in hives.  The other two she broke out in hives.  At one point the pharmacy didn’t want to give her a prescription because she had an allergic reaction to one of the other drugs. 

I made her call me and talk to me while she took one of the prescriptions because I was worried she would stop breathing and not have anyone there to help her. 

It is ridiculous that the insurance company had any say in which prescription the doctor gave to her.  She has been on this medication for ten plus years and it works.  Why mess with that?  Especially when she had already tried other medications that didn’t work or that she was allergic to – this seems wasteful as she now has four prescriptions she has to discard because they didn’t work.  It isn’t saving money if she can’t use them. 

It is ridiculous to change a person’s medication when what they are taking is working successfully.  Isn’t that the point of taking medication – finding what works and sticking to it?  I know it is a lot of money but that is something to take up with the pharmaceutical company not the patient – especially when there was documentation that other medication hadn’t worked.  

2 comments:

  1. Hi Eileen. If she's tried the less expensive drugs already that should be sufficient. She just needs her doctor to document that on the insurance paperwork and they should approve the drug. That's been my experience at lease.

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  2. Unfortunately it wasn't the case here - it was documented but the insurance said that she had to go through it again. It is a good thing she didn't have a more severe reaction - if she had we would have been talking to a lawyer. I don't like to threaten to sue but when it comes to health and risks I am VERY conservative.

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