Wednesday, September 16, 2009

musings of a disgruntled narcoleptic.

A few weeks ago, I switched to a new Blue Cross/Blue Shield insurance policy. Because I had been uninsured previously for a few weeks, I was anxious to get some more of my narcolepsy medicine because I had run out. So on September 1st, the day my new insurance policy began, I be-bopped on down to my neighborhood Target pharmacy in order to pick up my prescription. However, the pharmacist had some disappointing news. "You need prior authorization from your physician's office," she informed me. So I called my physician's office. They cheerfully agreed to call Blue Cross and provide authorization. So, a few days later, I checked back with Target. Bad news again. "We spoke with your doctor's office, and they provided authorization, but for some reason when we try to run it through it still says this drug is not accepted. Maybe you could try to call the insurance company and see what the problem is."

A couple days after that, my parents got a letter in the mail from Blue Cross saying that approval had been verified for the drug. Great, I thought. Maybe it just now went through. So I tried again with Target. Still rejected. Finally, yesterday, I called Blue Cross. After a long and confused conversation with a very friendly yet clueless BC/BS representative, we managed to pinpoint the problem that had been confounding every party involved for the past two weeks. Here's the deal: The drug I am taking is called armodafinil, manufactured under the trade name Nuvigil. There is no generic for this drug; only one company makes it. The Huntsville Hospital Sleep Center had given prior authorization to Blue Cross for me to take armodafinil. Target had been trying to run it through as Nuvigil. Between the physician's office, the pharmacist, and the insurance company, not one of them could figure out that these two different drug names, in fact, were the same thing.

Now, this seems like a pretty ridiculous problem. I don't even know to whom I should direct my incredulousness. Okay, perhaps the doctor's office should have provided both names for the drug in their correspondence with the insurance company, I'll admit that. But Blue Cross obviously has a distinct policy regarding this drug because of the fact they specifically required previous authorization for it, so I'm not sure why their system would not recognize the two names of the drug. Also, isn't it a pharmacist's job to know that drugs generally have a compound name as well as a manufactured name? If this was a common problem, would they not have automatically checked both names? I'm wondering how often things like this happen and go unnoticed, or how many patients think that insurance is not covering their medication when it really is. What a dumb problem to have.


Chrstina said...

Thank you!

SarahBeth said...

Perhaps our next FOD project should address this issue?

allison said...

christina: you're welcome. happy birthday.

sarah beth: yes. let's take 250,000 hypothetical dollars and fix the health insurance system in america. six minutes should be enough time, don't you think?

Christian said...

BCBS does that to me on a monthly basis. My Birth control is a fight to get through walmart bc they refuse to give me the generic i take unless its specifically stated that i take that generic and not the other one. I pretty much hate insurance for the fact I can't afford my medications at all anymore. I'm a bit jealous they cover your sleep medication. My policy apparently doesn't cover impotence, fertility, tmj, sexual disorders, and sleep disorders. Great combo of things not covered, right?