When Prescription Healthcare Goes Bad

Insurance companies and drug companies used to be the hot topic of the day until the housing market became shaky. So with all of the focus on foreclosures and mortgage rates, I thought it would be a wonderful idea to rehash the growing problem with insurance and drug companies. Let's face it, just because it's not being talked about in the mainstream media doesn't mean that it has gone away.

Case in point; recently I ventured to my local pharmacy to fill a prescription for a new brand of birth control pills. After I joyfully dropped off the prescription and handed over my insurance information, I gladly strolled through the isles of the store purchasing some much needed items while I waited. After returning 30-minutes later for the pickup, I was given a harsh slap in the face; Cigna, my insurance carrier would not cover the regular amount and so instead of paying the normal $20 fee I would have to pay $50. At first I was taken aback and thought the pharmacist may have filled a three month supply since the prescription was only for three months, but I was quickly corrected in my thoughts.

The only explanation the pharmacist could give was that the brand was so new that the insurance company would only cover the regular amount, thus leaving me with the $50 fee instead of only $20. I immediately told them I couldn't afford that and didn't want the pills. The fact was that I probably could have afforded it, but why should I have to when we pay so much for insurance already? I was furious and so I paid for the items I had found and left.

Normally this situation would not have irked me so much, but the fact that my OB/GYN prescribed the new brand to me for a reason didn't help. I couldn't wrap my head around why my insurance company wouldn't pay as much for the new brand that was clearly working for me better than the older one, but instead would pay a lot more for a pregnancy. Thinking of this then led me to remember the incident I had when I had a miscarriage in 2005. Again, Cigna wouldn't pay for something but that time it was something I definitely had to have; a Rhogam shot. Since my blood type is negative, when I have children or a miscarriage I must get this shot, but the insurance company did not care. The problem with that situation was the doctor was not getting reimbursed by the insurance companies for the shot, so they were forced to write prescriptions and have the patients get them filled but then would administer it for them.

Even though the shot was being administered by the doctor, the insurance company saw it as a "self administered" shot and not needed so I was forced to pay almost $150 and got no reimbursement from them. The extreme mental anguish that a person goes through during a miscarriage is bad enough, but when you add in the fact that your insurance company is throwing you under the bus, it makes things even worse. At the time I could afford the out of pocket payment and I knew I had to have the medicine, so it was a no-brainer. But it got me thinking as to what would have happened had I not had the money to pay for it?

This leads me back to the recent situation with the new birth control pills. Again I found myself asking the question "What would I do if I couldn't afford to pay for this?" Yes, there are other birth control options, but I feel that it shouldn't come down to this kind of contemplation. To me it's fairly straightforward; it's cheaper for the insurance company to pay for birth control than pay for a pregnancy, delivery, and then care for the baby. Apparently this is why I am not a CEO for Cigna or any other insurance company in the United States. My feeble little consumer brain can't fathom the reasons why an insurance company will take a person's weekly payments and then refuse to cover a prescription because it's new or even not cover one at all that is clearly needed.

I know my problem is miniscule compared to other people across the United States that are in a constant fight with their insurance company. But where do these companies draw the line and how can they say yes to one person and no to another? When I had the situation with the Rhogam shot, I actually asked the Cigna representative why they would cover insulin and not Rhogam is they are both seen as "self administered", even though my shot was not. The representative actually refused to answer the question because I do not take insulin and it was apparently none of my business. This was not what the person on the phone had said, but they did refuse to give me an answer.

So here we are as Americans, working longer work weeks than most people across the world, spending less time with our families, and giving more money to the insurance and drug companies; but for what reason? Oh yes, for them to line their pockets and make 100% more profit than last quarter. So what I am saying is that the bottom line with health care in the US is a grim future. Nobody wants to fix the problem and hold these companies accountable for their decisions, yet we all want to complain when it happens to us or someone we know. I don't have the answers, nor do I pretend to act like I do. Unfortunately I leave these problems up to the powers that be and hope that someone will come along and tackle this situation head on with guns blazing. Until then, my advise is to do what you can, pay what you must, and bend over to take it in the rear like the rest of us.