The Ninth Area, War, at the Pharmacy
I’m asking for war counsel from my readers.
Today, I got a call from a local chain pharmacy that has been filling the prescriptions of a close relative for several years. It was one of their automated calls that I’ve gotten used to receiving which informs the patient that a prescription has been filled and is ready for pick up. I want to make it clear that I am NOT asking for advice on how to remedy or treat the condition of my dear one by either allopathic or more natural remedies. I am, for now, convinced that this medication is necessary to sustain the health of my kin.
Here is the decision I must make: Do I pick up the medication from a pharmacy that has made outlandishly clear their intentional deceit and mistreatment of me and my kin? Or, do I attempt to get the prescription filled elsewhere? The decision is not as easy as it might seem. And, the white people involved with this mess at this pharmacy know that. Creating this dilemma was their intention. I will organize the background of this dilemma into two parts: 1) the truth told to me by these white people, and 2) The Deceit.
THE TRUTHFUL PARTS
Drug A, the one waiting at the pharmacy right now, required an appeal to our insurance.
Filling another prescription, call it drug B, that my relative needs each month, required an appeal to our insurance about three months ago.
This pharmacy couldn’t get Drug B at the beginning of this month from their manufacturer.
Insurance appeals usually take no more than 5 business days if the letter from the prescribing doctor stating its medical necessity and the reason that a less expensive drug could not be used is submitted.
—When, standing at the pharmacy window on a Friday afternoon, I asked for the doctor’s letter that had been submitted three months ago to get drug B so that I could take it to another pharmacy that had some of the drug in its shelf stock. I was told by a young white woman that the person who handles the pharmacy’s appeals and who had access to that letter, Tony, was gone for the day. I asked to speak with whoever was in charge at the time. After each request, the young white woman left the window for a few minutes only to return to tell me that neither the appeals specialist, Tony, nor any manager who could help me was working. She said I’d have to come back on Monday to get the information I needed. That was a lie. How do I know? Because, when I was insistent on speaking with whoever was in charge at the time, even if that meant the store manager on duty, I was asked to move to the consultation window. The appeals specialist, Tony, whom I recognized by his name badge, appeared. He announced that he was, indeed, the person who handled my kin’s appeal and, yes, all appeals. He began asking me for identifying information. Remember, this was the person I was told three times was not in the building. And, he’s the person who probably told the young white person to do it. She seemed to enjoy telling me that lie, too. He, then, gave me a copy of a document issued when the appeal was approved. I thanked him but asked for my letter as well. He said I didn’t need it; that the approval number on the document he handed me was all another pharmacy needed to get the prescription covered if they had the drug in stock. He would not give me the letter. There was no shouting, cursing or name-calling. This white man did not even turn red. I then phoned 10-12 other pharmacies and found one that had drug B in stock and was able to get it filled with the document given to me by the uncooperative white man, Tony.
—A week later, I requested that a third drug, let’s call it drug C, be refilled. My kin had been taking drug C for several years and had never required an insurance appeal. When I called to check on the status of drug A, I was told that this drug C, too, now required a special appeal. When I asked what reason the insurance gave, I was told that the the insurance said they did not cover that drug. Incredulous, I asked if the request had mistakenly been submitted as brand name instead of as generic as prescribed. I was assured by three different pharmacy staff, all white persons who were bordering on rude and dismissive, that it had been submitted and rejected as a generic drug. They were lying. How do I know? Because, when I asked the pharmacist who is called “Asian,” who works his butt off by himself late at night, if it is unusual for a drug to need an appeal when it is listed as covered on the insurance formulary, he double-checked and found that someone in the pharmacy had checked the “brand-name” box. He unchecked it and filled the prescription for drug C that night.
—In the same conversation earlier that day with the white folks , I was asking for a status update for the drug in question, drug A— since it had been more than a week since the latest date an answer should have been received on the required appeal. I had submitted the prescription for drug A with the required doctor’s letter but the pharmacy staff person who submits all insurance appeals told me he never got the letter after it was received by another pharmacy staff person. That was a lie. How do I know this? Because, I told Tony that I now question both the competence and honesty of the staff at that pharmacy and that I would be pursuing this matter with the officials in charge of the pharmacy, the store, and the corporation and would present a list of irregularities with dates, times and names. I, then, picked up all of the original written prescriptions for my kin from the late night staff. The outcome was the automated call that the prescription had been filled two days later. This would have been impossible had the doctor’s letter not been submitted to the insurance by the pharmacy.
So, now, the dilemma. How in the world did the pharmacy fill a prescription that they no longer have in their possession? And, since they processed an appeal with the insurance for the drug this month, if I now take a copy of the letter to another pharmacy to start the appeals process again, the insurance is likely to say that they already paid for it over at this pharmacy staffed with people playing life-or-death chicken with me over my loved one’s needed medications. Yet, how can I even trust that this pharmacy didn’t put something harmful in the bottle that is waiting? We have enough of a supply of the drug A in alternate liquid form to last another two weeks.
What would you do?