Wednesday, August 5, 2009

Refills and Romance (there's more connection than you might think)


Here I am at the pharmacy get a refill. Why am I here when I have a blog about romance writing to write? Why didn't I take care of this couple of days ago? I did. At least I tried.


My insurance company wouldn't pay for them on that date though. They said I could have no more for five days.


I had been given a thirty day supply. Thirty days had passed. What was the problem?


The story goes back several months.


I have a chronic medical condition which, fortunately, is well-controlled by medication.


As soon as generic equivalent came on the market, I switched to it and did well for a couple of years. A few months back, when I refilled it, I noticed the pills were a different color. Not to worry, the insert in the bag said. It's still the same medication. But I checked an old bottle. It was a different manufacturer.


Anybody want to guess why the pharmacy would buy from a different manufacturer?


But by law it had to be the same, cheaper or not.


In the first couple of days, I noticed different side effects. I'd been tolerating the drug's side effects for years. Since the difference was that they were milder, I decided to count my blessings. When I had a recurrence of the old problem, I shrugged. It happens.


A few weeks later I had another flare up. Longer and more intense. Diet affects the condition. Okay, no more fudging. No chance taking. I cleaned up my act. The improvement was short-lived. Intervals between flareups grew shorter until there were no good days. Only not-so-good days and not-good-at-all days.


Something was wrong, but it couldn't be the medication. Anyway, I didn't feel like I was on no medication--only that something wasn't working as it should.


I was about halfway through a month's supply when one day cleaning out some papers, I came across an old pharmacy receipt and was reminded that the drug store had changed suppliers. I was about halfway through a thirty day supply.


I called my doctor for advice but he on vacation and wouldn't return for a couple of weeks. I made an appointment for the first day he would return.


I decided to test my theory. I went to a different pharmacy, ascertained that they used a different generic manufacturer and got enough pills to last until I could see the doctor. I knew insurance would not cover them. I paid out of my pocket.


On them I was little better, but the amount of improvement quickly leveled out. When I saw my doctor and told him all that had happened, he gave me a NEW prescription for the BRAND NAME. That was the end of June.


The difference was night and day. Thirty days later, I went back for a refill. That was last Thursday. You know what happened. You see, by the insurance company's lights, I had four pills which I should have taken before I started the new prescription, and they by god, were not going to pay. You see, as far as the insurance company was concerned, BRAND NAME or not, it was the same drug.


So let's talk cost. BRAND is around 300. Generic, 180. That's for 30 days. My copay for BRAND is 60. My copay for generic is 8. Does this look off to anyone besides me?


Now here's the kicker. In Canada where drug prices are regulated, the BRAND name can be bought for less than 250 for a six month supply.


The insurance company had the nerve to tell me I--little Mary Margret Daughtridge, the romance writer*--could keep medical costs down by asking for generic. Me? I think I can do better than that!


There's health care bill before congress now. I have no opinion of it, nor am I inviting political discussion. There are blogs for that kind of thing and this isn't one. But I do wonder, has anyone else had a generic that no matter what anyone says, you know was not the same thing?


*my mention of the life of the romance writer. Okay, I guess there's not that much connection. Except that I write romance and this is about my life. And all this was going on while I was trying to meet a deadline for SEALed With A Ring.


24 comments:

  1. It's a bit of a mystery, isn't it? We use generics all the time at the hospital, and I've never seen much of a difference in the effects, but then, I'm not the one taking them. It is very confusing, however. We switch manufacturers all the time. In the drawer there might be two different versions of the same drug. Giving those to the patient makes them question--and if I've learned one thing in 30 plus years of nursing, it's that people might not know the name of the med, but they do know the color and the shape! Anytime a patient questions me, I go back and double check because nine times out of ten, they're right.

    It's no secret that health care is screwed up--more by drug and insurance companies than anything else. I especially love when you're about to go on vacation but it's not quite time for a refill and your current supply won't last until you get home. At least now the bigger pharmacies are networked together and you can get a refill in another city, but it's still a pain. I certainly hope things improve, but I'm not holding my breath.

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  2. Yikes, MM, that's horrible. I hope you get on the proper medication and don't have any more problems with it. And sometimes as romance writers we need to write about life. I posted one on Mama's Writer's Blog about Making Memories Forever, which is near and dear to my heart.

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  3. Mary, I know that we know our bodies best. After 30+ years of being sick off and on and spiraling out of control after I hit 25, I was tired of being told "Some people are just sickly". My response-depression, then BS. Through trial and error I've discovered I have Celiac. I've been gluten-free for over a year and have never felt better in my entire life. THANK goodness I don't need any medications, because this kind of thing would probably happen to me. And I would have let it go on. (I took a prescription for months before I realized it was slowly killing me.)

    Kudos for taking control. And hey, now you have an experience to use in a scene.

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  4. Wow, MM, so sorry you've been through such an ordeal. A good friend of mine, who has survived two bouts with brain cancer, recently switched to generic seizure medicine and guess what? Major grand mal seizure less than a month into the new meds. He can no longer drive or be alone for any serious amount of time. He knows it was the meds, but now he lives in fear of another big seizure. So, it's not just you. They are different!

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  5. As a Canadian, I am every day grateful for our health care system, but Canadians complain about the cost of meds too! I didn't even realize they were cost-controlled. I've been blessed with good health (knock on wood) and never take meds.

    My Mom, as a senior, only pays a two dollar co-pay for each prescription.

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  6. Hey MM-

    I think this blog was a great look into what else is going on with romance writers! I think most readers realize that you're all "real people," too, but this really goes to show it!

    A little bit before RWA, The New Yorker interviewed Nora Roberts, and she discussed making a living as a romance writer--and I don't think she talked about where she gets insurance, but I doubt her publisher is providing it! So I think this really puts into perspecitve the choices so many of you have made, whether you have a day job or you're writing once you've retired, or you're a stay-at-home mom... and how it can actually have an effect on your lives.

    Thanks!
    Danielle

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  7. I do, MM and my ins. company wouldn't pay for it. The generic left me really sick. So my dr. keeps me in samples every month, bless him.

    I know with my mom's thyroid it can't be changed.

    The good thing is we go to a neighborhood pharmacy, been with them for years, and they do what they can to help, even giving us meds ahead of the 5 days for the ins. then bill the ins. on the correct day.

    Linda

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  8. One thing when meds are switched is the dr. can fight for a prior auth. to get the correct meds. Ours did for my mom's blood pressure meds. He's got a great office mgr who digs in to get what's needed. Although I've offered to make calls on days she can't. :} He doesn't think that's a good idea.

    Linda

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  9. Cheryl,

    Mystery is the right word. I was on a generic for a couple of years that DID work. I don't we understand yet, exactly what makes a medicine effective--mostly, yes, but not completely.

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  10. Terry

    You have a point about writing about life.

    You know, I usually labor over blogs but this one flew onto the paper. I really did write most of it, in the waiting area of the pharmacy.

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  11. Renee,

    Thanks for sharing your experience with celiac. And speaking of using my experience--it's all grist for the mill. In the process of coming to grips with my food sensitivities, I learned a lot about celiac and the subtle, mysterious, and pervasive effects it can have.

    I used what I learned to craft the character of Pickett, heroine of SEALed With A Kiss. Pickett has celiac and is still in the process of coming into her power as an adult, now that the celiac is controlled, and her vitality has returned.

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  12. Donna and Danielle,

    I am self-insured. Insurance, especially if you add in house and car, eats up a large chunk of my income. That's reality.

    But I am looking at dropping the prescription coverage, for which I pay extra, and going to Canada for medicines.

    I'm grateful for Canada's policies. Because of Canada, I have a choice.

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  13. Marie and Linda,

    Thanks for lifting your voices. Generics are not all the same.

    And while I think pharmaceutical companies practically have a license to steal when it come to their brand name prices, we would be naive to think that a medicine could be made cheaper and cheaper and cheaper without seeing some corners cut, and its quality suffer, sooner or later.

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  14. We were watching a news report just the other day about pharmacies legally being able to change a prescribed med to not just a generic without asking, but to a totally different med that is in the same classification! I was absolutely stunned. I have worked in a hospital for over 25 years and have NEVER seen this happen! Pharmacists have to verbally chat with the MD to make even minor changes. I walked away from that news report mumbling that there must be something they weren't telling us; that it just could not be true. Well, you have proven that weird decisions can be made without patient or even MD approval.

    But, like Cheryl, I have never seen a difference with a generic or other manufacturer. Still, it should be the same drug. Very weird.

    And don't even get me started on the health care industry! That is a can of worms best left alone! LOL.

    Hope you feel better soon, MM.

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  15. MM, thank you for sharing your personal challenges. Yes, writers have to deal with real life in addition to everything else.

    I too depend on a lot of Rxes and so far have been able to tolerate generics and had no adverse effects. But I know others, like you, who absolutely can NOT tolerate the generic even though it is supposed to be the exact same drug.

    Cheryl, I'm constantly bumping up against that going on a trip and not having enough drugs left to cover until I get home. QUITE a challenge!

    AC

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  16. Very interesting blog, MM. I've heard stories like yours from others. What a nightmare! It's bad enough Insurance companies tell us what drugs they will pay for--I hate to even think what will happen if someone starts telling us what doctor we must see or even if we are sick enough to see a doctor. Too scary to think about! And I agree with Danielle. It's good to let our fans know that we are human and have the same kind of problems they have.
    I'm glad you are on the right meds and feeling better.
    Amelia

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  17. Oh, Mary Margaret, you ARE my HERO! I'll definitely have to get my hands on Sealed With A Kiss. Unless someone has Celiac they just don't know the full of it. I'm fortunate enough that all of my family has seen the major improvement in my life. I'm no longer walking dead. The vitality is very much a plus, somehow I even had four kids with this disorder. Unfortunately, too many people don't have the support or they won't give up their wheat and remain sickly.

    Thank you for shedding light on this highly misdiagnosed disorder.

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  18. Cindy,

    How to prepare to travel:
    1. Find a cat minder.
    2. Pack suitcases.
    3. Pack cooler with hard to come by foods.
    4. Count pills.

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  19. Sharon said,
    "the other day about pharmacies legally being able to change a prescribed med to not just a generic without asking, but to a totally different med that is in the same classification!"

    Yep, Sharon. I've had them do it. But, at least in NC, it says so on the bottle. You know what you're taking.

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  20. Amelia said
    "I hate to even think what will happen if someone starts telling us what doctor we must see or even if we are sick enough to see a doctor."

    I'm afraid we're already there.

    Nobody tells me who I must see, but the insurance company certainly tells me who is "out of network" meaning they won't pay if I do go to them, and refuses to pay for a specialist even "in network" unless, in THEIR opinion, one is needed.

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  21. Renee,

    I hope you enjoy Kiss. Let me hear from you after you've read it.

    It's such a relatively common problem with a really simple (though not always easy) remedy, and yet it's overlooked and misunderstood.

    I'm glad that you've encountered support in staying gluten free and have recovered your vitality.

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  22. Oh wow! Now I have to read Sealed with a kiss.

    And hi Renee, from another celiac.

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  23. God, what a nightmare. Bad enough we have to pay through the nose for scripts, now they're pulling this? Nightmare.

    Hugs.

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  24. Yes, I would run into that when I was military (until 96). I found out that Uncle Sam would put out a contract and that determined which *brands* were available. I found this out because every couple of months when I'd go in and get my birth control pills filled, it would be different. I had break through bleeding, got pregnant and started doing research. My son is 17.

    And I wasn't given a prescription as such so I wasn't allowed to take it anyplace else to get filled with a brand I prefered out of pocket even.

    I ran into the same thing as you in the military with not being able to get a perscription filled in a conventient manner. Not only wouldn't they let me get a refill prior to them making me move (PCS from Germany to the US) but they also knew that there would be a lapse in protection because I wouldn't be able to get an appointment after moving. Thankfully that time it wasn't a real concern that I'd get pregant but it did mess with my system. I guess you'd call my experience Refills and Lack of Romance!

    I've started turning to more natural things. (not for birth control - that's permanent)

    I was noticing that the generic Sudafed didn't work as well. however that was around the same time as the government made them take out the Phen stuff (not sure of the name). On the otherhand the generic Claritin works better for all of us and its dirt cheap at WalMart compared to the brand name. I can't tell a difference with any other over the counter and I exclusively us generic.

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