Okay, so the doctor and I worked together and managed to ask for a pre-authorization on one of my meds. We made sure we got it done in time. We called, we faxed, we mailed. We’ve tried for several years to no avail before this year, still we believe in justice, so we tried again. But again this time the insurance company turned us down. Said that drug was excluded from the Medicare formulary by CMS.
The drug is Fioricet. It’s butalbital, caffeine and acetaminophen (tylenol.) It’s not a narcotic, but it is a barbituate.
It used to be prescribed for migraines until they came up with a more expensive drug for migraines. They say it’s more effective, but when I took it, all I did was throw up and fall down because of my blood pressure. I’d rather my Fioricet.
Amazing how fond you can get of a medication when it really helps you live and thrive. Am I addicted to it? No more than I am to eating lunch to keep myself alive. At least with those awful headaches, once I took Fioricet, there was no more pulling down the blinds cause the light pierced my brain and forced me into bed. No more throwing up. At least by the following morning, the headache was gone. But progress changes things. Like I used to pay $39.00 for a month’s supply. Now it’s $454.00 for the same month’s supply.
Okay. Now Fioricet is one of the few drugs I can take that doesn’t alter my consciousness. If I didn’t have that damn pain (like shingles from my surgery for lung cancer removal 12 years ago where the surgeon unfortunately crushed the nerve because he didn’t want to saw my ribs apart) I would give it up! But I can’t stand the pain, and I can’t try another pill that throws me into shock or makes me hemorrhage. I don’t have the time. I have books I have to finish writing. If we didn’t have global warming I could look forward to being placed on an ice slab and being tossed out to sea with some kind of dignity, like the eskimos used to do for their elders. But we can’t count on ice any longer. Can’t count on dignity either.
So the doctor and I wrote an “exception” letter, saying that the insurance company should make an exception for this drug and include it in the formulary because it increases and maintains the quality of my life. Besides, I’m allergic to all others.
Sounded reasonable to me. But apparently not to them. It was denied.
I think I was rude when, frustrated, I screamed at the customer service person saying, “Two of my past doctors have ordered this, and watched what happened to me whenever we tried a substitute. What happened to the doctor-patient relationship? What do we have 5 doctors who don’t know me, and a phramacist who also doesn’t know me, sitting in a small room making these medical decisions for me?”
Without any hesitation, she said, “No, only one person decides.” She said it as though it should comfort me.
“Who does he work for?” I asked her.
Again she said simply. “He works for us.”
I called my doctor. He had already gotten the denial. He said he’d call and talk to them though he had spent a half hour on the phone with them two days before.
Later, he called me back. “They denied it,” he said.
“Do you get paid for all this paperwork and fighting with insurance companies?” I asked him.
Next step. We have to file an appeal.