Saturday, January 23, 2016

On Insurance, Computer Systems, and Pharmacies

I must take my medicine. This liquid cortisol infused subcutaneously into my body is not a luxury. It is a critical requirement in order to sustain my life. To obtain this liquid life, I work closely with my pharmacy.

Before we moved to Malaysia, my insurance forced me to a different pharmacy as the only way I could obtain six month supply of my medicine. I hated the new pharmacy because I felt like only a number in their system. This was highlighted when my prescription for "CORTEF ONLY, no substitutions!" was delivered as a bottle of "Generic Hydrocortisone" marked with "MFG: Qualitest." The pills ended up being the Greenstone generic mislabeled in a Qualitest bottle, but that raised even more flags.

When we returned from Malaysia, I attempted to fill my new script for Solu-Cortef for my cortisol pump through the same pharmacy. After receiving no update, I stopped by in person to check on the status ten days after the script was originally received. It was a few days before Christmas 2014 and I wanted to get an update before everything slowed down for the holidays.
"Out of stock." 
"What?! Ok, um... when are you going to get it in stock?" 
"Oh, we don't know." 
"And you didn't even THINK to call me? To update me? To let me know that there was an issue? This isn't some unimportant medicine! This is literally what sustains my life!"
I left that awful pharmacy in tears, shocked at how they let this important information sit for ten days and only informed me because I asked. I arrived at my former pharmacy in tears. I talked about how I needed this medicine to live, how that larger pharmacy mishandled the script, and how I was desperate to find someone who was willing to tell me more than "Out of stock. Sorry. No update." My former pharmacy listened and promised me they would research what happened.

I learned that the computer system used by most pharmacies is set to minimize costs. Before it orders a medicine, it does a search to see if the generic version of that medicine exists. I attempted to order Solu-Cortef, the brand name manufactured by Pfizer. The computer system found that the generic A-Hydrocort existed and attempted to order that. A-Hydrocort, not Solu-Cortef, was the medicine out of stock with no anticipation of the next delivery date.

The backorder reasons for A-Hydrocort just fill me with all sort of warm fuzzies!
</sarcasm>

My local Walgreens ordered Solu-Cortef for me.

We then discovered another quirk with insurance and computer systems. There are two types of Solu-Cortef with two separate NDC codes. I use act-o-vials for emergencies and the pure powder for the pump. The pH levels between the two are slightly different and the powder works better for sub-q infusion.

2 mL, Act-O-Vial Solu-Cortef NDC: 0009-0011-03
Powder Solu-Cortef NDC: 0009-0825-01
I explained this to the pharmacy staff. They would type in the proper NDC, but the system would swap the NDC to deliver the Act-o-vials. Through contact with my online community, I learned that this is a fairly common mix up across all pharmacies. For some reason the computer system thinks it's helping out the patient by giving them the "easier" medicine. No thank you. We type in a specific NDC for a specific reason.

Eventually, my pharmacy discovered they could outsmart the ever "helpful" system by manually placing my order every month. No auto-refill for me! Also, as they got to know me better, they kept a few extra vials on hand just for me. This a not common medicine, but they understood how vital this little vial was for my life.

I was not just a number to them.

I was an actual human.

I transferred all of my prescriptions back to their care. I trusted them. I enjoyed chatting with them. It got to the point where I could walk up towards the counter and they would greet me by name and already have my scripts pulled. They'd even open the bag for me because I always physically check my medicine at the counter before I pay for it.

When chronically ill, the pharmacy is a critical part of your support team. Get to know them. Have them as your ally. It doesn't necessarily have to be a Walgreens, but find a place that you can trust.

Meme found courtesy of Chronic Perseverance.
And to my local Walgreens, I am going to miss you. Your care and support helped me remain Clearly Alive. I hope to find another pharmacy as awesome as y'all in Nevada.

What has been your experience with your local pharmacy? I'd love to hear from y'all!

Saturday, January 9, 2016

The Next Chapter - Part Three

The Road Not Taken

by Robert Frost 


Picture taken during a road trip. December 2015.
Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.
Good-bye Texas.