Babygirl has been managing her pill sorter for some time now. Generally, she's pretty good at it. She lets me know when she is running low on things, but yesterday for some reason I asked her to check on her supply of translplant medications. She'd asked me to call in the one that has to be filled at the local pharmacy, but I couldn't recall getting any medications from the specialty pharmacy that sends her 90 day supplies of the pricy ones.
Sure enough, one of them was pretty close to gone. She just sorted two weeks' worth, and there are a few still in the bottle, so we have time enough to get them ordered. Another one was about to start on the last bottle. The pharmacy usually can get them to us in three to four days, so no problem.
I put in the call, and the chaos began.
"That will be two medications, with $15 co-payments each, for a 30 day supply, okay?"
Um....not really! "Why just 30 days? We always get a 90 day supply. And why do we have a co-payment? We haven't had to ever pay you for these medications before! Not that $15 is so much, but what changed all of a sudden?" I know insurance companies sometimes change the rules, but to change two rules simultaneously seemed, well, just off.
I spent thirty minutes on the phone with a very patient and kind pharmacy representative who did her best to try to figure out what had changed and why. When all was said and done, she really didn't know, but mentioned something about a 'cap' on the amount of medication, and read me back from the insurance coverage that this was, indeed, what the price and amount was supposed to be.
Well, we're three weeks away from out of medication on one dose, so here's my credit card number and go ahead and ship just THAT one, okay?
We've been using this mail-order specialty pharmacy for transplant medications since right after Babygirl's Medicare ended 2 1/2 years ago. We were told, if I recall correctly, that we HAD to use it for these medications or face fairly astronomical monthly co-payments at the local pharmacy. We've been using them without a single glitch ever since, and I have nothing bad to say about them - they've been convenient, easy to contact, and unfailingly courteous. But.
There is no way to tell someone who doesn't have a chronically ill child (or a personal catestrophic illness) just exactly how gut-clenchingly terrifying the word "CAP" is. The implications are staggering, nauseating, insomnia-inducing, palpitating, adrenal-squeezing: That moment when you realize the ship is going down and there is nothing you can do to stop it.
It implies that your coverage is running out. And without that coverage, bad things - VERY bad things - will happen to your child.
It was a good thing we were having chicken soup for dinner. (Cock-a-leekie soup, actually, but no one seems to believe me when I say that, and it makes people laugh. But it's very good soup.) It's very calming.
During lunch today I called the pharmacy benefits department of our insurance. They looked over the policy, and assured me that the mail-order people have it right: We can only get a 30 day supply for a $15 co-pay. "Since when?" I ask. "Since always," they reply. They seem to believe that the pharmacy has been working in error for 2 1/2 years, gifting us with co-payment-free medications to the tune of nearly $1500 in missed revenue without noticing. Furthermore, they tell me, I should be getting these at my local pharmacy because the monthly co-payment THERE is only $10.
I was so mystified by this absolute crock of crap that I totally forgot to discuss the work 'cap', but under the ACA (while it stands, and God bless us, it still stands) there ARE no caps, so I'm going to let that sleeping dog lie and hope my adrenal glands and my gastric lining recover.
Meanwhile......Babygirl turned 18 on the first of this month. I can't help but wonder if THAT tripped some trigger somewhere.
DeeDee
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