The Trouble with Health Care – Part 2

Last time I talked a little about some alternative treatments to just chemo, radiation, or surgery for cancer.  This week, I want to explore some of the trials getting the drugs we need for my wife’s home care since insurance forces hospitals to send people home sometimes before they should.  Case in point, when they sent my wife home the Thursday before Christmas but she could not handle the problems she was having and wound up back in the hospital the Thursday after Christmas.

When you do get to see a doctor or get treatment for your illness at a clinic or hospital, most likely they will send you home with one or more prescriptions for additional medicines you will need to take over the next several days at the very least or even longer in some cases.  However, going to your local drug store of choice may not be as easy as it sounds.

First, you have to find a drug store that will accept your insurance.  Some drug stores accept nearly all insurance plans, but most do not.  Where we work, our insurance plan covers something called Express Scripts.  For years we were able to go to our local Walgreen’s drug store.  Then Walgreen’s and our insurance had a disagreement over their contract and Walgreen’s stopped accepted Express Scripts.  Another local drug store picked up Express Scripts and we just transferred our business to them.  All was good until I tried to get the drugs that the hospital doctors prescribed for my wife.

On the Thursday before Christmas, the hospital discharged my wife to go home to recuperate.  They included three prescriptions.  The first was one for nausea.  The drug store we went said they would fill only part of the prescription, not the whole thing.  Instead of getting the 48 pills she was suppose to get to take 1 every 6 hours which would last 12 days, they decided they would only give us 12 pills at a time, enough for 3 days.  I would have to go back every 3 days to get the prescription refilled.  First, that is inconvenient when I am trying to care for someone at home.  Second, it gives the drug store an opportunity to charge a separate co-pay for each refill rather than just a single co-pay for the entire prescription.

The second prescription was a drug for pain and is commonly prescribed.  They did however, need to enter my driver’s license in with the order because it is a prescription drug that is sometimes abused.  When they tried to enter my driver’s license, their computer system rejected it.  In fact, they tried several times on several different cash registers and it was rejected on all of them.  Now I know my driver’s license is valid, but try to explain that to a technician who is more concerned that I may be a drug abuser trying to get a pain medicine to take for fun.

Maybe that is why they did not want to fill the prescription for the third medicine, which was also a pain medicine.  However, this medicine does not come in pill form.  Rather it is a patch.  (It is sort of like the patches for people who try to stop smoking.)  The patch is suppose to be good for 72 hours and is a slow release of pain medicine.  I suppose people can abuse these patches too by applying multiple patches on themselves at one time.  Anyway, they said they did not have any.  So I asked the natural question, ‘Can you check any of your other local stores to see if they have it?’  I was told, ‘No.’

Now while I have no proof other than the word of a very close pharmacist, that such a reaction is common when a pharmacist does not want to fill a prescription.  The secret is that a pharmacist does not have to fill every prescription submitted to them.  If they have any doubts about the interaction of a set of medicines, they can turn down the prescription.  If they feel someone might be abusing the drug in question, they can turn down the prescription.  In fact, if they do not turn down a prescription that for either of these two reasons, they could get into trouble and could lose their license to practice.

Unfortunately, there are rings of drug abusers who get prescription scripts for pain medicine from real or even questionable doctors, especially doctors from out of state or questionable pain clinics and try to get pharmacies to fill them.  Often one or two will try a series of pharmacies in an area and if they get the prescription, they report back to their buddies in the ring and soon the pharmacy is getting dozens of prescriptions for the same pain medicine from the same doctor or clinic.  The real tip-off is when the doctor or clinic is from of state and each person claims that they are in the area on vacation and ran out of their pain medicine.

If the pharmacy gets into trouble for filling these dubious prescriptions, the pharmacy immediately throws the pharmacist under the bus and the pharmacist loses, not just their license, but their job.  So is it any wonder that pharmacists will error on the side of caution?  However, in my case, the script was not from a pain clinic or a doctor from out of state, it was from the local hospital.

So I heard that Walgreen’s was not accepting Express Scripts again so I went there.  They said they had the drug I needed, but that even though they were now accepting Express Scripts again, they were not accepting Express Scripts from our organization.

Finally, I was able to get the prescription filled at a local food store surprisingly enough.

The problem is this.  Why go after the pharmacist in these cases?  Why not go after the doctor prescribing these pain medicines if the doctor or clinic is not legit?  Can doctors from hospitals for example apply a seal to their script (sort of like a notary) to validate the script so that the pharmacist knows they can trust it?  Apparently, the fact that the script was on hospital paper may not be enough.  Without this type of system people in real pain cannot get the medicines they need and people who just want to get high by abusing pain medicines will have a more difficult time getting these drugs.  It would seem like a simple way to validate legitimate scripts and would make our health care system a little more efficient.   Second, this game about who accepts and who does not accept your insurance coverage has to stop.  A caregiver does not have time to run around town looking for a pharmacy that will accept the script while the person they are suppose to be home caring for alone and in pain.

Well, that’s enough for this time.  C’ya next time.

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