Epinephrine vs. CVS Caremark

For the last ten days, I have been trying to get medications for my next round of treatment from my god-awfully incompetent prescription insurance and their specialty and mail order pharmacies. Let me tell you, in the five months since I last dealt with CVS Caremark, they haven’t improved. Here are some highlights:

My doctor faxed the prescription. Two of the medications need prior authorization, the other two don’t. Thus, two come from CVS Caremark’s specialty pharmacy while the other two come from their mail order pharmacy. The two pharmacies do not talk to each other. Separate on-line systems with separate patient log-in information. Separate call centers. Neither pharmacy has any idea what the other one is doing or knows. Thus, I have to place twice the calls when nothing at all happens with both sets of meds.

Call 1 – CVS Specialty. They confirm that they have the order and even have the prior authorization info from my doctor, but are waiting on insurance information.

Call 2 – CVS Specialty. They inform me that my insurance has denied the claim. This is odd, because I should have just enough coverage left for this order, and then I’ll be out. I ask for more details. The call center agent tells me that my Aetna PPO has denied the claim. I tell him I have never had an Aetna PPO, I have CVS Caremark insurance. He tells me that the claim was submitted to Jennifer Haines’ Aetna PPO plan. I have already told him my name, it is not Jennifer Haines. I reconfirm this with him. Despite this, he proceeds to read off Jennifer’s plan number to me. Awesome. I reiterate, for at least the 5th time, that it isn’t my information. He gets the correct info entered (in theory) and says they’ll submit to my insurance next.

Call 3 – CVS Mail Order. They have my prescriptions, but need information from my doctor. No, wait, they already have the information from my doctor. The prescriptions should ship soon.

Call 4 – CVS Specialty. They inform me that insurance has approved the claim, but I can not yet order the medications because, “they’re not in the system yet.” What the fuck does that mean? The call center rep can’t explain.

Call 5 – CVS Mail Order. Still not in the system. Should be in the system in the next day or two and will ship then. Sorry for the delay, don’t know why it’s happening.

Call 6 – CVS Specialty. Still not in the system. Try calling again tomorrow.

Call 7 – CVS Mail Order. Not in the system. Wait, yes, they are in the system. But, unsure if pharmacy has enough in stock to meet the order. What in the fuck? This is a mail order pharmacy and these are common drugs. Also, I communicate that I’m concerned about the prometrium, because it’s a gel capsule and our temperatures are supposed to hit -22F. I’m worried it will freeze in transit and be destroyed. They transfer me to a pharmacy tech, who can’t tell me anything, but transfers me to a pharmacist. He agrees that it will probably be an issue, but “we can’t do anything about it.” I can either pay for expedited shipping or wait for the meds to arrive and file a claim if they’re ruined. There’s customer service for you.

Call 8 – CVS Specialty. In the system! Ordered! Shipped! Shipped without telling me, and by the way, adult signature is required, so now I have to make last minute arrangements to work from home so I can get the package.

While in the hospital, I lost enough blood that no one could find my blood pressure or pulse on either arm. When the doctor arrived, he gave me epinephrine, which stabilized me so that I could be taken to surgery. Sometime later, when I could talk again, I told my husband that he should have just leaned over and said “CVS Caremark” to me. Hearing their name is enough to get my blood pressure up without any medication at all!

And So It Begins

I headed back to the RE’s office last week. While I have no intention of trying again until March or April, I’ve missed so much time from work that I wanted to get the appointment in before I returned to the office and would have to leave early to take it.

I’ve said it before and will say it again: I have the utmost respect for my RE, her knowledge, and her skill in this field. I feel confident that my treatment plan reflects the most up-to-date science, and that my input is consistently considered. I would highly recommend her to anyone else.

I have less confidence in some of the information that comes from the (otherwise wonderful) nursing staff. Case in point: DH and I both had communicable disease screening done last June/July. The nurse I’m communicating with told me that we’ll both need to be retested.

Now, I had several blood transfusions due to hemorrhage after delivering the girls, so I don’t mind being retested, although it’s been far less than a year and I’ll have to pay out of pocket. But I couldn’t understand why DH would need more testing. We don’t have  MFI, so we get to try to get pregnant the quasi-old fashioned way: drugs, ultrasounds, and sex. DH will be going nowhere near the RE’s office, and will therefore pose a risk to no one but me. Thus, I asked why he needed to be tested.

The nurse informed me that it’s an FDA requirement, because “he might expose you [me] to something.”

At first, I was righteously indignant at the FDA. In the first place, they have no business in my sex life. In the second place, do they really think that the only way I’ll be “exposed” is if I have treatment? They are protecting me from exactly nothing. Finally, why in the bloody hell should the government force me to pay for testing just because I need injections and ultrasounds to get/stay pregnant?

But after being indignant for a while, I went searching for the actual government regulation. Because I’m a) curious, and b) stuck at home in pain with nothing better to do. You know what I found? 21 CFR 1271.90 (2), which is the regulation that requires testing for “human cells, tissues, and cellular and tissue-based products” (aka sperm/egg/gamete donations) specifically exempts “Reproductive cells or tissue donated by a sexually intimate partner of the recipient for reproductive use”. In other words, DH should not need to be tested. (Should anyone be aware of other relevant regulations, please let me know. In all my searching this was the only thing I could find.)

Thus, the bullshittery of frustration, bad information, incompetence (wait until my next post about good ‘ol CVS Caremark), and frustration has begun again. Happy f-ing New Year.

Bear With Me

It’s now been a month since we said goodbye. I have lingering complications that have left me in more pain than I could have imagined. If they don’t resolve on their own, I’ll be facing surgery at the start of January. I’ve been told that surgical recovery is two weeks of true agony when heavy narcotics are needed, then six weeks of pain. This terrifies me because I left the hospital on 800 mg of ibuprofen every 6 hours, 650 mg of Tylenol every 4 hours, and 2 Ox.ycodone every 3 hours, and that did NOTHING for the pain I was in. I can imagine how much worse it will be after surgery, and I know that the drugs just don’t help. Overall, more difficult choices ahead.

That all reflects the physical part of healing. The emotional part is another matter. I have my good moments and my bad moments. I don’t think the postpartum hormones help, or the fact that I’m still in too much pain to return to my “normal” life, so I’m left with little to do. I hope the physical healing can help to be a catalyst for the mental healing. In the interim, I hope you’ll indulge a few things I want to share.

I only took one “bump” picture my entire pregnancy, because I was so sick the whole time I didn’t feel like it. Although the girls are gone, I feel like I need to share this. Why? Because it’s one of the last good memories I have with them. Because I hate that there are times it feels like they weren’t real, and by sharing this photo, I can disprove that feeling. Because, out of everything that happened that I might have controlled, I get the most upset that I never got to see or hold Zoe, and this photo reminds me that I got to hold her for 18 weeks and a day. Maybe just because it’s a talisman to me, that proves that DH and I can make beautiful, healthy babies, so that gives me hope that one day we’ll get to be great parents to babies we can take home and raise.

The other picture I want to share is of the girls’ bears. I mentioned how amazing the Fairview Southdale nurses and doctors were. Also amazing are two other parents, who also lost a child at Southdale. They started a program to give small teddy bears to other parents delivering babies who will never come home. This is a lousy picture, taken via my cell phone a few hours before we left the hospital. But these bears are so precious to me. Seeing them snuggle each other gives me hope that my girls are out there somewhere, taking care of each other.  In the first days home, DH would bring them to me, and we’d just hold each other and the bears on the sofa and talk to our girls. I have conversations with the bears most days. Today we went to the picture window and I showed them the six deer who were grazing in our yard. Am I crazy? Well, of course, we’ve known that for years! But does it help to think that maybe our girls are up there somewhere, listening as I talk to their bears? Yes, it does. To the parents who started this program: I am so, so sorry that you went through a loss, but so, so grateful to you for what you’ve done with it.