Sick again, part 4: Bureaucracy Hell
This is a photo of the 3 sharps containers I currently possess. AbbVie, the drug manufacturer, sent me 2 for some goddamn reason. And Caremark, the specialty pharmacy, also sent me one. Everything about the process of obtaining specialty meds is a nonsensical bureaucratic nightmare and I thought this photo of my absurd number of sharps containers exemplified that pretty well.
It took 28 days between when my doctor and I decided I needed to be on Humira and when I actually got my hands on it. I keep thinking how lucky it is that I’m not sick worse than I am. Do you understand how much an untreated Crohn’s flare can escalate over the course of a month?
It took 28 days of my very best efforts as a person with a pretty damn high level of competency in navigating the American healthcare system, to get my meds. I cannot imagine what this is like for anyone who is newly diagnosed and not yet experienced in this shit. Or even just for anyone who isn’t a complete fucking nerd about healthcare.
The first barrier was that my insurance company requested a prior authorization - that is, a bunch of paperwork my doctor had to fill out to convince them that I actually need the medication before they will approve it. My insurance company has every motive in the world to prevent me from getting access to this med; it will cost them $5,000 a month.
The prior auth ate up about 2 weeks. Then came wrestling with the specialty pharmacy, which for my insurance is Caremark. Getting my first dose of Humira to actually arrive at my local pharmacy took....about 6 or 7 calls with customer service?
At one point, I thought everything was all set, because when I logged into my Caremark account online, I saw an order for Humira that said it was expected to ship the next day. When the next day came and went and nothing had changed, I called them. The customer service rep said something something insurance, ICD-10 codes, and had to put me on hold to call my doctor.
Folks, if there is a problem with your order, your specialty pharmacy will not proactively reach out to you to make you aware of it. It’s on you to stay on their asses about it.
When she came back 30 minutes later, she said it was all set, and told me it would arrive on the 30th. I was happy and hung up and walked away from my phone for 2 seconds and when I came back I had a robot voicemail from Caremark telling me I had to call them.
When I called back I had to go through a phone tree to tell them why I was calling, (a little hard when you actually have no idea why you’re calling), and when I got a human I was put on hold for awhile more and when she came back she said she couldn’t figure out why I had gotten that voicemail because everything was fine with my order.
There were several days where stuff like this happened over the course of those 2 weeks.
I should have had a copay, but when I picked it up from the local CVS that Caremark shipped it to, they just.....didn’t charge me. I pointed out that I was supposed to have a copay but the pharmacist didn’t know what to do about it. I mean, there are worse problems to have, but I’m still half convinced that Caremark is going to send me to collections over that $5 someday.
There are just....layers and layers of absurdity to the process. There exists both a caremark.com and a cvsspecialty.com and I had to make an account on both but they have all the same data. Why????
I assume that refilling an existing prescription will be much easier than getting it for the first time. But here’s the fucking kicker - next month will probably be just as hard as this month, because it will be technically a new Rx, because the dosage is higher in the first month.
And if I change jobs or my employer decides to stop contracting with my current insurance company, I’ll have to do it all again, this time with the added stress of knowing that if it takes me too long to wade through this sea of shit and I’m late on a dose, I might build up antibodies and become immune to the medication forever!!!!!! 🙃
