Prevacid and the Perils of Pauline

This is what is happening to my friend Pauline in the US, in her own words. That makes it the first guest post!

AHHH...the insurance debacle.

I got a  call today from the CareSource guy who manages my case and he said they denied the Prevacid again.  Well, I lost it, for me anyway, then felt guilty afterwards. 

Why did they deny it?  Did they get the doctors letter?  Did they read it?

Step Program from woodworkingdownunder.com/freedollhouseplans

The reasons they state for not approving Prevacid are that the generic is the same drug as the brand name and a step program of trying other drugs is needed. Now I am on the 90 day trial of the 2nd manufacturer, but it upset my stomach on day one, so am not taking anything for my acid reflux. I'm just sitting till my waiting period has expired and so I am wasting money by not taking the same medication that I tried in 2007 when it did not work.

This is what I need to do again:
I need to use drugs from two different generic manufacturers again.
The Doctor needs to send the chart and history (he has done that).
He has written a letter. All the things they need, we've done.  I asked, doesn't Caresource read anything?  They're sending me the same denial letter over and over again!  The two other med manufacturers are Dr Ruddy and Sandcrest.  Does the insurance company read anything or do they just deny and put everyone off?  I think they don't care about the people - just about making money.  This will be my third letter stating the same reasons!

Sometimes it's like a merry-go-round

The rep said well, I wouldn't say they just worry about the cost not the people.  I said "Well, what does this look like?  I don't mean to take it out on you but this has been ongoing for about 9 months or more. I'm not taking any acid reflux meds and probably developing ulcers because of the stress".   

They just want us to give up on getting this med and I'm sure the majority of patients do.  And if the generic made me feel okay, I'd take it but....my tummy says no way.
 

My CareSource Navigator said that if I get this approved, make sure that the Dr pre authorizes it..because prevacid and nexium are the two hardest to get.  They're the most expensive. 

The pulmonologist said we (patients) should all rally against this.  How do you do that?  There's so much to rally against...what do you start with?  Doctors that drop you, meds they prescribe for you that are denied, moving your scheduled appointments to another later date, going to only the poorer hospital, switching your generic meds constantly...with different manufacturers?  Is that safe? 

Not a drug rally. This was environmental

So, what do I do now?  He said to call the doctor's office: they got a copy of this denial letter and have them call the Peer to Peer group in the CVS Pharmacy.  HMMMM..can I call the Peer to Peer group myself?  Nope.  Lucky for them.  He said they aren't even allowed to call them anymore.  Sherry at Dr X's office has to call so I called and left her a message.  No hurry..wonder when she will start blocking my caller id.  LOL 

I feel bad being kind of nasty with the rep but it rubbed me the wrong way.  Even Dr X said,  this letter is all we can do..the last step.  I hope it works. Anyone need some nails cause I've been spitting them out since 10 am? 

I think (KNOW) now that I am fighting for principle.  I could easily change to something else but I know prevacid doesn't upset the stomach like the others...so why try number 3, 4 and 5? 

Really, I thought..according to the insurance and medical companies, that the generics are all made the same as the name brand.  So???

Generic is not the same .. I don't care what they say. Its a nightmare here to get your name brand meds.  I don't think the generics are made to match the name brand. For sure the fillers and delivery system may be different and probably made in factories with poorer quality control. Look at the Ranbaxy settlement for one example of substandard drugs.

It's stupid.  My care source navigator told me that she tells her patients if they get do get approval on nexium or prevacid...never let it drop cause it's like gold.  What a waste of time, paperwork, medication and my health. My husband used to call this "thinning the herd".

I have 2 friends who have had success on this name brand drug and no luck with the generics. I wonder if they are the only ones? It's too bad that so many with RA need to take additional drugs to protect their stomachs from damage by NSAIDS.

Too Many Decisions

It was a week for blog-reading. I find it a great way to find out how other people cope. One of them, called I Can't Decide by Chronic Rants struck a chord with me and reminded me of another article I saw in the summer called Life, Interrupted.  In Suleika's blog from Life, Interrupted, and also in what Chronic Rants says the sheer number of decisions and effort that goes into decisions is a serious problem. There are so many choices to make and so many consequences to them that you can just get worn out.

                               www.yourgoldwatch.blogspot.ca

For both of them decisions about health care and future possibilities are almost overwhelming.  In Suleika's case, though struck with a life-threatening illness, she is still covered by her parent's health insurance because of the Affordable Care Act.  However the number of bills and complexities of insurance coverage are so difficult to handle that her mom has had to quit her full time job so she can handle the financial and insurance details, while Suleika concentrates on getting better, at least for the next two years.

For Chronic Rants the situation sounds even more confusing with numerous choices and possibilities and no easy route to solid information and the best decision. Having to spend that amount of time and energy just to maintain the basics of treatment leaves you unable to get better.

Their situation reminds me of my search for a diagnosis early in my disease. The symptoms were overwhelming, and at the same time I had kids, a job and family. Trying to juggle all of the responsibilities kept me from making the best health choices.

This is a problem that we all wish that we could  help to solve and highlights an issue all too common with chronic disease. 

                                       webkaye.wordpress.com

This problem is known as "decision fatigue".  There are studies about it that show that the more problems we have to worry about and make decisions about in a day, the harder it is to make good decisions or any decision at all.  

I have taken some information about this from a political article in Bloomberg by Ezra Klein where he quotes from a book called “Poor Economics,” by Abhijit Banerjee and Esther Duflo.

So while you are struggling with all of the issues of chronic disease give yourself some sympathy for the burden of all of the work you have to do just to stay afloat. When you realize that some of the best coping mechanisms with chronic illness are money and a good education it gets pretty discouraging, and that may account for the scorn some well-off politicians use when they blame poor people for making bad choices. 

                                      www beadingdaily.com


Dealing with all of these decisions is like making sense out of a complex puzzle over and over every day. It takes a lot of energy just to do the basics, and it's vital to our well-being.

When it comes to finding a way to get help with health decisions getting expert advice is vital.  How to find the experts is yet another problem.

In theory a set routine ought to be helpful if only in lessening the sheer number of choices you make every day.

If there were an easy solution to this we would all be better off. Please leave ideas in the comment section.