How a specialty pharmacy denies a physician his medication

Holy crap.

My medication did not arrive today.

How can this possible be happening?  Do they not know this medication is not optional?

Let me recap.  I called over a week ago for a refill.  I am only allowed (by my insurance) to use the (non-local) specialty pharmacy that they own for this medication.  They told me my medication would arrive yesterday, which was the day after I’d use my last pill.  Even though that was cutting it close, that was their plan.  The meds did not arrive and I received instead a cryptic message I was lucky to catch and return.

The specialty pharmacy – the only one I am permitted to use – had my medication on backorder.  And didn’t tell me until the day it was to arrive.  When it was absolutely impossible to do anything about it.  The person at the pharmacy swore it would be delivered today.

She lied.

I just got off the phone with them.  After being put on hold for 10 minutes, they came back and said they don’t know what happened.  It will now be here Thursday.

I explained to them that this medication is not for fun.  I must take it.  They apologized for my inconvenience.  I told them I wanted to go to my local pharmacy and get it.  They told me to call my insurance prescription plan.

I did.  Now I know the nice woman at the end of that line isn’t to blame.  But I hate them all now.  She again apologized for the inconvenience.

Anyway, she suggested I get my doctor to call in an “emergency script” for a few days’ meds and then go to the local pharmacy and ask them to call the insurance company (while I wait) and fight with them to get it covered even though it’s not the specialty pharmacy I’m supposed to use.  I explained that (1) it’s 9:30 at night and my doctor is not available, (2) I have to work tomorrow and can’t stand at the pharmacy in the middle of the day while they “fight” with the insurance company, and (3) it’s all moot anyway because I’m now two days without meds and there is nothing they can do to fix that.

Nor do I believe what any of them say anymore.

I can’t believe how frustrated and helpless I feel.  I am playing by the rules.  I’ve missed no payments, no visits, no deadlines.  They are keeping me from my necessary treatment by forcing me to use a pharmacy that runs out of meds, lies about it, does not inform me, and then does not have a solution.

This is not an “inconvenience.”  I’m being hurt – literally.  They are denying me the medication I need to stay healthy.  Them.  Denying me.  It’s not an inconvenience.  It’s an assault.

Aaron E. Carroll is an associate professor of Pediatrics at Indiana University School of Medicine who blogs at The Incidental Economist.

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