Dealing Drugs

Marty had a UTI a couple of weeks ago. Over the last few years I have learned that urinary tract infections are no joke and if not quickly treated they make people really sick, especially those with compromised systems like Marty.

The strokes, the results of the strokes, poor muscle control, makes Marty very susceptible to this malady, so every four weeks, like clockwork, our friendly neighborhood nurse rolls by to get some clean pee to check for infection.  On her last check there was a bug, a bug which was different than normal, I can’t remember what it was called.

Patty, the nurse, called Friday and told me the test showed a moderate number of bacteria in her urine, so we immediately started her on a broad spectrum antibiotic.  I knew at the time it probably wouldn’t do the trick.  The last few times Marty popped a UTI it has been a bug that is not sensitive to any oral antibiotics she can take without turning red and puffing up like a toad and becoming mortally ill, all bad results.

To make it a little more complicated my annual  ski trip with our kids and grandkids was scheduled to depart the following Thursday to Deer Valley Utah.  I knew at the time if Marty had to be in the hospital my kiddos were going to ski without me, the bestest skier in the crowd. 

Monday morning nurse Patty calls and says the Levaquin Marty has been taking would not do the trick and she gave me two or three other options asking if Marty could take those.  I didn’t know and we punted to Great and Wise to figure out whether we were spending time in the big house with IV antibiotics or I was gliding gracefully down the pristine Wasatch mountains.
 

Around lunch we got a call from one of our very favorite nurse type people at Great and Wise's office. She said there was one and only one antibiotic dear Marty could take orally, only one antibiotic standing between the hospital and home for Marty, Zyvox.  My response, hot damn that’s a good thing.  Jessica says it’s expensive, I say that’s why God invented insurance, call it in.

Mid afternoon I got an email and phone call from Walgreens saying Marty’s insurance was requiring the dreaded “prior authorization”.  Now you would think Great and Wise’s prescription was “prior authorization” but it’s not.  They needed paper work before they would pay.   

I talked to the lovely Jessica more than once Monday and she essentially did back flips for our scrip plan, OptumRX and United Health obtained through AARP.  We ended the day at 5 with Jessica reassuring me she would stay on this and call me first thing in the morning….Tuesday.

Tuesday came, Marty appeared still appeared to feel fine to this point, so I wasn’t in too big a hurry, aside from the fact that I knew she was growing bacteria inside her bladder, not a good thing.  Jessica, true to her word called and updated me saying United wanted more information and she was on it.  The insurance folks promised to make a decision by end of day, remenber we are still growing bacteria while we fiddle away the day.
 

I then get a call from the insurance company saying they hadn’t heard from our doctor and they were waiting on them to respond.  Obviously not true, I just got off the phone with the doctor's office.  This is where I didn’t do a good thing, I got mad, not a good idea when you are asking people to do stuff.  In my defense you can call me anything you want but you will get a negative reaction from me if you diss my wife, my kids, my dog or Marty’s doctor.  I don’t react well.
 

Suffice it to say the call ended with me wanting to know when I would hear from OptumRX.  In about 30 minutes I heard, I got a recorded call, they had denied the use of the Zyvox.  Peachy, they made a decision based on some manual, they made a decision that would put Marty in the hospital, expose her to CDiff, flu, MRSA and other lovely things.  They made a decision that would cost Medicare $10000 for the hospital, brilliant.
 

I wasn’t finished with this whole deal and to their credit neither was Great and Wise and his office, they persisted and made a mission of fixing this.

In the meantime, I started doing some research about Zyvox and started pricing it at other drug dealers, also known as pharmacies.  Lo and behold, I find me a coupon, a coupon from a web site called GoodRX.  The cash price for 14 Zyvox doses ran $2500 at Walgreens.  This coupon said I could get 28 for $238 from CVS…I scored.

Never one to assume the veracity of what is found on the internet I called CVS and sure enough, it was a real deal and they would honor it, but they only had 7 doses.  I think, not a problem they can get the other 7 the next day, we can start Marty on the antibiotic in time for me to make sure she wasn’t going to go all blowfish on me and I could catch my flight to the mountains.

Great and Wise sent the scrip to CVS, I drove over with Marty and said is this real.  A nice young man said sure, he got the meds, looked at my coupon and said, Oppsie Daisy (he really didn’t say that), this scrip is for 14 and the coupon is for 28, 14 pills will be $700. 

 

You all would be so proud, I was cool, I’m thinking well that’s stupid but I can get Great and Wise to change the scrip to 28 and just hold this drug in case of a zombie apocalypse.  The dude looks at me, whips out his phone and does some calculation and said, wait, I can do 7 for $70.  It felt a little like buying drugs from a dealer but I said sure and about 30 minutes and $70 later I walked out with the pills, thumbing my nose at United Health Care and thanking my lucky stars for GoodRx.

Long story short Marty took the meds without any reaction, of course CVS did not get the other 7 pills the next day or even the next because they forgot to order it.  I found myself sitting in the locker room in Deer Valley Utah calling other CVSs in Waco to see if they had Zyvox.  I found the meds, sent our trusty Nykkie over to get it and the rest is history, Marty took the meds and she is infection clear.  We got it done.
 

When I got back and checked on what they charged us for the last 7 pills I found out it was only $9.  That made no sense but I wasn’t going to look that gift horse in the mouth.  Turns out United finally approved the meds.  I found out in a letter we received the day after Marty finished her course of antibiotics.  I had a letter waiting for me denying the claim and another approving the claim.  It was a cluster.

I am grateful for the outcome but I have to say this is a critical problem for patients, for doctors and even for pharmacists.  This is not an Obamacare issue, it is not a Trump care issue, it is a structural issue, it is an issue with a profit motivated entity rationing healthcare by denying reasonable treatment from a really good doctor.  It is an issue.
 

I don’t know the answer to the problem except to shine a light on it and turn all of you guys on to things like Good Rx which saved our bacon because Marty would have been in the hospital dropping about $10,000 if we had waited for the snail mail approval of something that should have been approved immediately.

Bottom line, it is crazy that any insurance company would choose a hospitalization over a medicine being used for something other than its primary design intent.  Bottom line, I was lucky to hit on an internet search and find a legitimate coupon.  Bottom line, I have a great support system between the offices of Great and Wise and flexible care givers that allow me the opportunity to fall in some snow.
 

The real bottom line, Marty is fine, until the next time and we will once again do what we need to do….just like you do.