Boy Was I Wrong!

This is a true story. I realized last month that I was on the last bottles of a couple of my critical heart medicines and that they both needed new prescriptions. I called my cardiologist’s office and after a brief conversation with the nurse, she assured me that both prescriptions had been electronically-transmitted to my mail-order pharmacy. I thought: “I’m glad I noticed them in time, and don’t have to worry about that matter until next year when the prescriptions need renewing again.” Boy, was I wrong! What has transpired since stretches the definition of incredible.

A couple of weeks ago – I got a robo-call from my mail order pharmacy stating that one or more of the prescriptions in my recent order could not be filled because they needed additional information from my doctor. I hate robo-calls, but most of the time I can just ignore them. But this was potentially a life-or-death situation, so it required action. I called the mail order pharmacy (MOP for short). After figuring out how to get past the dozens of robo-guesses as to why I was calling, I figured out the correct response to get connected to a real person: “REPRESENTATIVE”, I yelled into the phone. I know it’s just a computer, but it is a good release of tension to yell at it. Another of my favorite yells into the phone is: “I WILL NOT PRESS ‘1’ FOR ENGLISH! THIS IS AMERICA! WE SPEAK ENGLISH! I WANT TO TALK TO SOMEONE! This usually works because the computer is programmed to interpret such a response as a call from an old dial phone (do any still exist?), and after repeating this yell a couple of times, I almost always get connected to an English-speaking representative, bypassing all the questions and avoiding having to enter account numbers, social security numbers, ad infinitum. And Marsha is entertained. Unfortunately, I was not presented with that question by MOP.

MOP’s representatives are very nice. “Thank you for calling [insert your mail-order pharmacy’s name]!” How may I assist you today?!!!” After a very long conversation, being placed on hold while the representative called my cardiologist’s office and resolving the question about Coreg CR, I was assured that all was well again, and that my prescription would be mailed the next day. Great! Or not?

A week ago – I get another robo-call. Exasperated, I call back. “REPRESENTATIVE!!!” This time I’m told that my Coreg CR is incomplete because it needs a new prescription! And oh, by the way, the other of the two prescriptions in the order, eplerenone, needs a new prescription also! After another very long call, they put me on hold, called the doctor again and got “new” prescriptions. Now at this point, I’m not feeling “Great!” anymore. I’ll feel great when the medicines arrive. Fortunately, I started working on this with plenty of pills still in the bottle. Yes, I have prior experience with MOPs.

Monday – another robo-call. I call back. Melissa: “We’ve received the eplerenone prescription but not the Coreg CR prescription. We left a message with your cardiologist’s office. I’ll keep your file open until this is resolved.”

Tuesday – phone-mail message from Melissa: “Mr. Higginbotham, we still haven’t been able to contact your cardiologist and we’re cancelling your order. Please call your cardiologist’s office and have them contact us.” Now by this time, I’m really tired of dealing with MOP, and am becoming resigned to my impending death by cardiac arrest. I decide to let it rest for a day before I call back, due in part to my bad disposition at the time and also thinking that maybe, just maybe, a miracle would happen and it would get resolved somehow.

Wednesday (yesterday) – I take a tranquilizer (not really) and call MOP. I had been very uncharacteristically polite through all this so far. Yesterday I decided to vent a bit. I explained that the robo-calls were so vague as to be totally unhelpful and that I always had to call back to understand what they were trying to communicate and why didn’t they leave the name of the drug they were related to? I was told that it was due to HIPA laws. I shouldn’t have asked as I already have enough grievances against the federal government. So I then asked the status of my Coreg CR prescription and was first told that they were still waiting on the doctor, but then “REPRESENTATIVE!” changed his mind and said that it had been mailed the day before. I’ll know which answer was correct when and if I finally have the package in hand.

Today – My head is about to blow off! I got another robo-call a few minutes ago. “One of the medicines in your order of August 27 cannot be taken at the same time as another of your medicines. Please call us.” I did. To the best of my ability here is the incredible, word-for-word transcript.

Me: “REPRESENTATIVE!!!!!”

MOP: Mr. Higginbottum [sic], thank you for calling [insert your mail-order pharmacy’s name]!” How may I assist you today?!!!

Me: Well, I just received a message that one of my medicines has an interaction with another of my medicines, and that you need authorization from my doctor, and that you had been unable to get in touch with him. Which medicine is it?

MOP: Let me look at your file. (pause) The, and I’m going to spell the name, e p l e r e n o n e needs a new prescription from your doctor and he has not responded.

Me: What! This has been going on since last month and I thought it had been resolved several times before!! The message said that there is an interaction between two medicines I’m taking.

MOP: No, I don’t see anything about an interaction – we still need a prescription.

Me: Then why did the message say anything about an interaction? This is really frustrating! I have spoken with other representatives twice this week, and I was told that everything was resolved.

MOP: I’m sorry Mr. Higginbotham that you were told there was an interaction.

Me: (I don’t recall what I said at this point, but it apparently got results.)

MOP: Let me scroll down some in your file. (pause) Oh yes, there is a note here that eplerenone cannot be taken with ramipril. Are you taking ramipril?

Me: Yes, but I’ve been taking the two together for years. They were both prescribed by my cardiologist.

MOP: The note says “Need to verify that eplerenone can be taken with ramipril prescribed by another prescriber.”

Me: But it wasn’t prescribed by another prescriber. Both were prescribed by my cardiologist. Check the prescriber listed on the ramipril record.

MOP: (pause) Yes, I see that even though the note says “different prescriber”, that both were prescribed by Dr. W.

Me: So this is resolved then, right?

MOP: No, the information we have is that eplerenone cannot be taken with ramipril. We need to get your doctor’s OK.

Me: (I could not resist laughing out loud at this point.) But I’ve been taking both since 2005! And you have new prescriptions for both from the same doctor, Dr. W!! What further authorization do you need? Are you going to ask him if he REALLY intended to write them?!!!

MOP: (At this point, representative’s demeanor gets a little more excited. I can’t tell if she was offended by my laughing at her (and I was) and raising my voice, or by the thought that the entire conversation was being recorded for her supervisor to listen to later.) So you’ve been taking both since 2005?

Me: Yes.

MOP: (long pause) I’m going to mark this issue closed and fill the prescription.

Me: Thank you so very much!!!! Have a nice day.

Now again, I’ll believe this issue has been resolved when I have the package in hand. And based on many obvious contradictions by my mail-order pharmacy over the last several weeks, and my years of experience with my cardiologist’s office, I am 99.9% sure that all these errors were cause by MOP. So I don’t feel bad about revealing that MOP is CVS Caremark. And if you can believe it they are better than Aetna’s mail-order pharmacy. I think the best is Medco. This is a glaring example of one of the major problems with our medical system. The fundamental problem is that employers have been inserted between patients and their care providers. Employers are incentivized by tax advantages to offer group health coverage. (Our government at work again) Employers are also incentivized to negotiate for the best premium rates. For that reason, we rarely get choices of insurers. So when we have a grievance with the insurer or their contractors, we have little leverage – it’s not like we can easily switch insurance companies.

If I should die with the next year, from any cause, will someone please sue CVS Caremark for me for wrongful death?