Microblog Mondays: New Day, Same Old BS

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Last week CVS Caremark assured me that I wouldn't get any more auto dialed calls. They warned me that it had been disabled in the system, so even if they were needed calls, like refill reminders, I wouldn't get them.

Guess who left not just one, but TWO messages for me today?

How can any organization be this incompetent and not go bankrupt?

I ought to find another pharmacy, but thanks to another screw-up, this one in my favor, if I buy through them, I pay everything, but it counts toward my OOP max. For Pregnyl, the cost is the same as most other US pharmacies. Gonal-F is now also about the same as most other pharmacies. Menopur, though? If I re-order my Menopur through them, it will cost about $3,500 for 20 vials. That compares to roughly $1,750 everywhere else. So not only are they incompetent, but they're double the price of everyone else (and were double the price on Follistim last year, too). Why does my employer stick with them as our only Rx choice?

CVS Caremark, You Never Change. Please Reconsider!

New cycle, new meds order. Thanks to a bit of a meds debacle at year end, I have everything except Pregnyl. I had asked my clinic to refill all my current meds, but with a full-cycle dosage, instead of half-cycle. Knowing how hard it is to get meds, there's no point in only ordering a half cycle's worth, the other half wouldn't arrive in time and I'd be screwed.

I asked my clinic to send ME the prescriptions so that I could fax them to the pharmacy and manage things. Instead, I got a phone call from a pharmacy that I don't use, telling me they had questions about my prescriptions. After calling the clinic and asking that things be faxed to me, again, the prescriptions showed up. I could understand why the pharmacy had questions, since there were two different prescriptions for Follistim (at different dosages), and the Estrace that said to take both two and three times a day.

Aside from those problems, the stack of prescriptions also included Ovidrel. My last two cycles, Pregnyl was ordered for me. My first cycle, Ovidrel was ordered, then I was told to use Pregnyl on the day of trigger. So, I pushed back. Said I thought I should be on Pregnyl, not Ovidrel. Was told that my order said "Ovidrel." I asked if my order had been changed, since the last two cycles, they ordered Pregnyl for me. Instead of answering that question, they told me "they both do the same thing." That's not what I asked!!!

At my forced regroup appointment, I asked about trigger. Dr. B said it was fine to use Ovidrel since I'm petite, but Pregnyl had clearly worked in the past, so she'd order that if I wanted. I walked away with the order and agreed with the nurse that I'd have the pharmacy call them to request a refill, to avoid any confusion. Hah!

Dearest, darling CVS Caremark called to request the refill and told me they'd call me back when it came through. Apparently it came through on the 27th, but they never called. I called them yesterday, gave them my payment info, confirmed a shipping date and address, and thought I was set.

Around 11:30, my phone rang. It was CVS Caremark auto dialing me because I "needed to verify payment and shipping information for your prescription." Their auto dailer then put me into hold for 10 minutes to wait for a rep. The rep looked at my order, said I had everything, and told me to disregard.

At 11:59, my phone rang again. It was . . . . wait for it. . . CVS Caremark auto dialing me because I "needed to verify payment and shipping information for your prescription." After another 7 minutes on hold, we repeated the conversation, only I told them I expected NOT to get another call.

At 12:15, my phone rang. You'll never guess who! Same bloody message.

At least they're consistent. You always know what you're going to get, even if it's what you don't want!

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.

Like Mother, Like . . . .

I know I've been absent for a while. Too long. In this case, no news is a combo of good news and horrible morning sickness.

Let's start with the morning sickness. Every day. Nausea. Burping, oh dear god the burping. Uncontrollable retching. Vomiting. The only time I didn't feel like death was when I was asleep. You'd think that's good, right? Because most pregnant women get really tired in the first trimester. During my first pregnancy, I got the best sleep of my life until it ended at 10 weeks. My head would hit the pillow, any time of day, and I'd be out.

Now? Nope. No sleep. Why, you ask? Because I've managed to develop a case of pregnancy-induced Graves Disease. That means that my thyroid has gone hyperactive. My heart is constantly racing and feels like it's pounding in my chest. My ability to sleep past 2 am is minuscule, and I have trouble falling asleep. Add those symptoms to horrific nausea and you get a really special brand of misery. It kept me off the computer unless I needed to be there, hence the radio silence.

I asked my OB for something for the nausea. At that point, I was down 7 pounds from my starting weight, which I told her. Her response? "Yes, it's worse with twins. Try eating crackers." It was a 'let them eat cake' moment if ever one existed. Needless to say, I'll be seeing other OBs in the group from here on out.

But that takes us to the good news portion. Two weeks ago, I went to the U of M's MFM center for CVS testing on the babies. After that, DH and I held our breaths and waited for the next shoe to drop. It never did! The FISH results revealed two healthy girls! We are over the moon excited.

I got the babies' full karyotypes back yesterday. The genetic counselor was great and told me everyone was healthy. Then she told me that Baby A is a totally normal 46xx, while Baby B is a 46xx with a pericentric inversion of chromosome 9. I guess there's no denying that one is mine!

I am madly in love and desperately hopeful that I'll start feeling human again soon.