Fifteen Thousand What?

 

The specialist physician has suggested a 30 to 60-day trial period for an FDA approved medication appropriate for a moderate to severe case of rheumatoid arthritis.

Although it isn't the medication we had discussed at the last appointment, the doctor believes this daily oral medication is a better fit for my patient profile than the weekly injectables with pricey advertisements by a golf pro.

I ask the doctor how to spell the name of the medication. 

He rattles off the letters which fit together oddly in the English language like many names of medications.

In the moment, without any research, without having heard the name of this medication before, I trust what I judge to be the physician's high IQ and superior medical knowledge. I agree to try the oddly named pills.

He retrieves a collection of a half dozen identical medication boxes each fat with its own folded disclosure insert. My backpack purse's capacity was stretched to the limit with four of the boxes plus a separate, slick, marketing pamphlet.

After a couple of medications that were intolerable or ill-fitted to my patient profile, I was trusting, but skeptical. As a result, my new rule was to wait 30 days, taking the medication with fidelity, and then given satisfactory fit, call to investigate insurance coverage and copay information.

So far, so good. 

Read the pamphlet and the folded, fat, product insert. Took the pills. 

Fast-forward, thirty days of taking the pills, drinking the water, prioritizing sleep, targeting step count for each day, and on and on...

I have reached my artificial deadline of thirty days. It's time to call the insurance company, call the prescription company, call the specialty pharmacy, and inquire about coverage and copay for the new medication.

This is just a quick call, right? 

If you have a condition with chronicity, in other words, a chronic condition, you may already understand the specialty pharmacy interaction. 

Call the insurance company and wait 36 minutes only to hear, "We can't help you with that, but we do have to approve this medication. Go ahead and call the prescription plan for coverage and copay information."

Call the prescription plan and hear the warning about extended hold times. Oh boy. Can't wait. Then I finally hear, "Thank you. We need to note the account but cannot help you with these questions. You have to call the specialty pharmacy for this medication."

Call the specialty pharmacy and hear their warning about extended hold times. Oh boy. Can hardly wait! Then, I finally hear, "Yes we can give you a 90-day supply of that medication and your portion is...just one second...it's coming up...my system is a little slow...oh yes, it's $15,989 for a 90-day supply." 

"and...how would you like to take care of that?"

Let that sink in.