Beacon Runners 2013

It’s that time of year again.  The 9th season of the Beacon Runners is about to get started.

For the initiated- I started the Beacon Runners in 2005 as a way to encourage my patients to start exercising.  It’s grown over the years…

Anyone is welcome to join- man, woman, child, dog.  All abilities are welcome- we’ve got an appropriate level for you, I promise.
The goal of the program is to complete a 5K race in May.
Group workouts are Saturdays at 9AM at the Red Hook Brewery and Tuesdays at 6PM at Jenness Beach.
See you there!
insurance insanity

Watch an Insurance Company Try To Drive Me Insane- Algebra Edition

Wow.  Express Scripts/Medco must really HATE people who have herpes.  This is the second post in a row about trying to get proper treatment for this condition.  This time I wrote a prescription for acyclovir, a generic anti-viral.  The correct dose for suppression of herpes is 400mg twice a day.  That’s what I wrote for.

Of course, they asked me to fill out a prior approval form for it.  Now, please note, acyclovir is CHEAP.  It’s like, $30 a month cash.  It’s the cheapest option for treatment.  But, again, like a good little soldier, I filled out their form.  And got back this:

Ok.  First of all, who the HELL figures out dosages like this?  80,000 mg of acyclovir every three months?  What????  So, I did a couple of quick calculations in my head.

400 mg x twice a day = 800 mg/day.  800 mg/day x 90 days = 72,000 mg.

So, this is what I sent back to them.

It’ll be interesting to see what they say.  
80,000 mg per 90 days = 888 mg/day.  Acyclovir comes in 200, 400 and 800 mg tablets.  How do they expect anyone to take 888 mg/day?
insurance insanity

Watch an Insurance Company Try to Drive Me Insane, Again

As you may or may not know, Express Scripts and Medco merged last year.  What are Express Scripts and Medco?  They are what’s known as Pharmacy Benefits Management companies (PBMs).  Basically, they are a third party that processes prescription claims.  They are the ones who create the charming prior approval forms that I’m always complaining about.

Anyway, two of the largest companies, Express Scripts and Medco, merged. They made sure to reassure customers that they would continue to “receive the high-quality care you expect.”  Well, my expectations were pretty damn low, and I’m happy to report that the newly merged company has more than met them.

Oh, I hope you enjoy my new Post-It notes that I’ve used to block out identifying information.  They eloquently express my feelings.

This saga started on January 8, when I received a PA form for valacyclovir, an anti-viral medication that is generic.

On January 10, I received a letter from Medco, stating that the PA was not even needed.  Please note, THE PATIENT HAD ALREADY PICKED UP THE MEDICATION ON JANUARY 8, THE SAME DAY I WAS MADE TO FILL OUT THE DAMN FORM IN THE FIRST PLACE.
Then the patient’s pharmacy (CVS) called me asking, “Where the hell is the PA for this patient’s medication?” despite the fact that they HAD ALREADY DISPENSED THE MEDICATION TO HER!
I faxed them the form form back saying that no PA was needed and faxed a copy of the letter to them.  They apparently didn’t really care, because they sent me another request for a PA on February 5.
I faxed them a copy of the letter again.
Then, today, I received another PA from Express Scripts for the medication!  Two months into this saga.  Like a good little soldier, I filled it out again.
After I filled it out today (since I received it today), I got this fax, sent today but dated yesterday.

Apparently, they are unable to approve the medication that they have already approved.  Why not? Because apparently my evil twin withdrew the PA request.  So, Medco tells me it’s not needed, Express scripts tells me it is, and hours of time are wasted.

Read what Express Scripts had to say in their press release about the merger:

“Our merger is exactly what the country needs now,” said George Paz, chairman and chief executive officer, Express Scripts. “It represents the next chapter of our mission to lower costs, drive out waste in healthcare and improve patient health. We remain focused on formulary management, channel management and closing gaps in care, which will allow us to further improve the health of people with chronic and complex medical conditions.

Yup.  Tell me another one.

I can’t wait to see what’s waiting on the fax for me on Monday.