No seriously everyone, this is so great! I just got new insurance coverage and when I took my new card to the pharmacy, the pharmacy was told that they can't refill my prescription for 18mg Concerta because a) I'm over 19 so I can't have ADHD and b) because I don't exist, because you know, adults don't have ADHD and I haven't been taking this drug for quite some time now, I have to get prior authorization from my prescriber. You know...the one that wrote the prescription? The prescription that says "hey, my patient is 35 and has ADHD and needs this medication".
I am SO not joking right now. This really just happened.
The pharmacy sent a fax to my "doctor's office"...but I don't know if that means the mental health center (aka my REAL doctor's office for the past two years, who actually deal with me on a regular basis) that prescribes all of my medications and who clearly are aware that they have "authorized" me to take Concerta, or the PCP office that doesn't prescribe it, that, if contacted is going to go "Yeah, I guess so, I mean we've never treated this person for ADHD because they go to a MENTAL HEALTH CENTER FOR THAT but the patient did self-report that they take it and showed us the bottle...so does this count as pre-authorization? And can we get extra cheese with that?".
Hey insurance company--no wait, let me get more specific, hey ANTHEM BLUE CROSS HMO BLUE NEW ENGLAND--FUCK YOU.
FUCK. YOU.
FUCKYOU!
Sheesh.
At least there's good news in there somewhere: there's no such thing as ADHD if you're over 35! Which must be why I feel bitchy, volatile, and probably disproportionately reactive about the whole thing. Because I don't have ADHD, and didn't just about cry in the middle of the pharmacy.
Because people pretending to have ADHD over the age of 19 are what's wrong with America's healthcare system. MAN, I'm so glad they just called me out like that and refused me my medication, I mean people like me are really taking advantage of the system. It's not the unhealthy lifestyle choices of the majority of Americans that are screwing insurance companies out of their bottom line, and making insurance coverage suck for everyone else, it's people like me, in generally good health, PRETENDING TO HAVE ADHD.
FUCK YOU ANTHEM!
I am SO not joking right now. This really just happened.
The pharmacy sent a fax to my "doctor's office"...but I don't know if that means the mental health center (aka my REAL doctor's office for the past two years, who actually deal with me on a regular basis) that prescribes all of my medications and who clearly are aware that they have "authorized" me to take Concerta, or the PCP office that doesn't prescribe it, that, if contacted is going to go "Yeah, I guess so, I mean we've never treated this person for ADHD because they go to a MENTAL HEALTH CENTER FOR THAT but the patient did self-report that they take it and showed us the bottle...so does this count as pre-authorization? And can we get extra cheese with that?".
Hey insurance company--no wait, let me get more specific, hey ANTHEM BLUE CROSS HMO BLUE NEW ENGLAND--FUCK YOU.
FUCK. YOU.
FUCKYOU!
Sheesh.
At least there's good news in there somewhere: there's no such thing as ADHD if you're over 35! Which must be why I feel bitchy, volatile, and probably disproportionately reactive about the whole thing. Because I don't have ADHD, and didn't just about cry in the middle of the pharmacy.
Because people pretending to have ADHD over the age of 19 are what's wrong with America's healthcare system. MAN, I'm so glad they just called me out like that and refused me my medication, I mean people like me are really taking advantage of the system. It's not the unhealthy lifestyle choices of the majority of Americans that are screwing insurance companies out of their bottom line, and making insurance coverage suck for everyone else, it's people like me, in generally good health, PRETENDING TO HAVE ADHD.
FUCK YOU ANTHEM!
My insurance is the same--I need prior auth on a new prescription even if I'm just changing the dosage. Pretty annoying. The good news is that it generally only takes a phone call or fax from your doctor to straighten it out.
ReplyDeleteIt just makes no sense. I know, I'm preaching to the choir...but I can't believe that with a prescription in my HAND I have to get "authorization". WHAT'S THE FUCKING DIFFERENCE?! Geez. I just got new insurance, so this bullshit is all new to me....
ReplyDeleteSo I must not have ADHD either ... this is a bit disconcerting to me because I was just starting to get comfortable with this new identity after years of ineffectual meds and misdiagnoses.
ReplyDeleteI've got access to a number of medical reference sites, and I just spent an hour trying to find any scholarly paper or clinical study that might suggest that ADHD does not exist in adults. As you'd expect, I didn't find that reference.
What I did find was that there's no onset of ADHD in adults, and that the symptoms in the DSM-iv are considered to be tailored to diagnosis in kids. But, that was it ...
I am quite curious about just where it is that your HMO gets there information ... and I hope they're not in cahoots with my insurance company.
Sending you strength from Alaska
The bullshittiest bullshit I've ever faced is having my pharmacy be UNABLE TO ORDER 5mg Adderall in the quantity on my script (3 months' supply). What?
ReplyDelete(The pharmacist was lovely, but no dice. It's the lone rx I get from the campus pharmacy.)
Sheepy: do you ever wish there was an awesome soundtrack to these moments? I know I do...because when you look at this stuff as though it were a movie, it's fairly hilarious.
ReplyDeleteScott: Kooks I tell ya! They're all kooks! I'm about to call the pharmacy and see if they sorted these shenanigans out...or if I need to cue up my "circus" soundtrack on my iPod :)
K, this is SUCH a relief. Thanks for letting us know - and from an authority no less - that ADHD goes away once we become adults. I'm guessing the brain falls out like a baby tooth and is replaced overnight by an adult brain.
ReplyDeleteNot to be petty or anything, but I'm feeling a bit ripped off. The brain fairy NEVER left me a dollar under my pillow when my baby brain fell out.
But of course, I'm being silly. I know there's no such thing as the brain fairy. And of course, there's no such thing as Adult ADHD.
An extra special shout-out to your very smrtt pharmacist for quickly identifying that you're an adult and therefore can't have Adult ADHD.
Finally, DON'T try to do anything subversive such as handing that pharmacist a sticky note next time you're at the pharmacy with the following URL carefully written down on it: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515906/?tool=pubmed.
Sincerely,
Mungo
This is great news! Perhaps all us faux-ADHDers should now shut down our blogs...right? Makes sense.
ReplyDeleteBut on a serious note...I would have been arrested if that happened to me...because I would have broken everything in that pharmacy...forced them to arrest me...and gladly tell my story to the news media. And once in the prison system...I could get a court-appointed lawyer to fight for my ADHD meds. So...by breaking up the pharmacy you relieve your stress and by getting a court-appointed attorney you get your meds and by being in prison you get three meals a day. Sounds like a win-win-win to me. ;)
Mungo: The BRAIN FAIRY! YESSSSS! Actually, interestingly, the pharmacist was CLEARLY picking up what I was putting down and based on a few things she said, I'm pretty sure that SHE also takes Concerta and has ADHD, and is over 19, lol. She was very nice, very sympathetic...it was a don't kill the messenger situation for sure, she was just explaining the thinking of my insurance company. And indeed, they were able to fill the prescription after verifying with the prescriber that wrote the prescription, that he really intended to prescribe it. He actually REALLY did try me on the generic methylphenidate XR, which was a horror of disabling anxiety for me, which is why YES, he DID mean to prescribe me the expensive "good stuff" which works like a charm and keeps me from wrecking pharmacies ;)
ReplyDeleteJeff: when I worked as a criminal defense paralegal it really freaked me out to see how many people with obvious ADHD or ADHD-like issues were there in the prison and jail populations. Yikes. There but for the grace go we.
ReplyDeleteProbably. But I'm a 35 year old stepmother of three with no arrest record, whose prescriber can attest to the fact that I don't like taking drugs of any kind (just a personal choice, not a moral commentary). Having worked as a criminal defense paralegal I'm happy to stereotype and confirm that it's pretty easy to tell when people are a) abusing drugs or b) lying about forging prescriptions. I get why they're cautious but I have displayed no sign of anything that should trigger that type of "caution".
ReplyDeleteI still think insurance companies are crack smoking satan worshipping harbingers of evil and there are certainly other reasons that insurance companies behave this way. Concerta is still on-patent for example and insurance companies, in an effort to maximize their own profits, end of stopping just short of practicing medicine by questioning the decisions of trained prescribers. Apparently my insurance company was qualified to tell me that grown-ups don't take Concerta. Really? That's funny, because I do.
I'm pretty sure it was just a profit maximizing issue here. While I'm delighted that the issue was resolved quickly, it would have been immensely satisfying to get to submit to them the reason that I don't take a generic XR methylphenidate...you know, paralyzing anxiety that causes more problems that it's worth and renders me unable to function. Not to mention the horrific experience I had on a generic Celexa...but I digress.
If I sound annoyed, it's not by your comment, I just think insurance companies need to burn in hell :)