The Health Care Donut Hole
BhagavadGita
Posts: 1,748
I wish I was Charles Bukowski right now so I could write this with real words, but I'm afraid I'm not quite here.
What is going on with the pharmaceutical companies?
What is going on with medicare?
and....
......What the hell is going on behind that desk in the medicare office where they decide whether or not the drug your taking will be covered on their formulary? Thus they are determining what it will cost to you....$10 co-pay or full price. Are they doctors? What if they had an argument with their wife that morning over oatmeal about where they are going on vacation and when he got to work was pissed off. Let's say he's working on my medication requirements and because it's fairly new and WORKS WELL, let's decide to make people pay full price. Especially the underinsured.
Why do I have to pay full price when I have medicare insurance? Because around the same time every year you reach something called a donut hole. Which means, your fucked. You will be paying full price for same drugs till the end of the year.
I'm freezing. Why the air is blasting. I'm wondering why I'm here at the QFC?
So my home town family pharmacy was closed and eaten up by the giant QFC grocery store chain.
Yesterday, instead of walking into a little shop where they know my name and my challenges, I walked into a giant shiny fucking cold as hell, grocery store with a pharmacy. There was my old friend, the one who lost his business to the big guys, now managing the store. He was so busy he could not come to greet me. A man who I have never seen ask me what I needed. They always knew what I needed when I walked into my old store.
The stranger with the white lab coat following company policy, took 30 minutes to fill my script. The medication that I have been on for two years and I can't miss a day of it or I lose my mind. I waiting, trying not to cry knowing something was wrong when he asked me for my insurance card.
So as to not break down in this friggin store in front of men buying Rockstar drinks, I started reading Charles Bukowski's Women book to change up the brain a bit.
The man announced my name over the LOUD speaker in the giant store. He handed another unknown worker, she said $250 please. I said "wait, my co-pay is $90 for that medication."
She went back and checked again. While I waited I could feel the anger well up in my gut. For all kinds of things. Especially for taking away the blissful feeling I had due to the Pearl Jam show the night before.
She returns.
$250 please. Your insurance won't cover it.
"I only have $90."
We just looked at each other. I looked around for the good friend who owned the business I use to go to..he did not acknowledge the problem because he was too busy learning their new computer system.
I put my wallet back in my purse and left without the meds I have been on for two years. The meds that keep me here in this world and telling you this story.
today, I have no meds.
tomorrow, I will have no meds.
I think my family pharmacy went out of business because he probably helped drop the price when this happened. Was it his willingness to help people what put him out of business? I suddenly feel sorry for him. Now having to comply to policies and white lab coats.
I'm frankly scared. The government is arguing over this reform and meanwhile, government and pharmy companies and insurance giants are going to put me back in the hospital to start the whole crazy process over again.
I have no hope anymore. I'm so tired of the fight to live and take care of my condition.
As I left the store with the air conditioning blasting and proceeded to the triple story parking garage, I was numb.
I thought of Charles Bukowski and wondered how he would write about this experience. I'm sure he would be swearing more.
Have to volunteer 12 hours today with no medication. I hope I can actually perform my duties without my brain.
Please, don't bitch at me for this post and NO I DONT KNOW HOW TO SOLVE IT!
What is going on with the pharmaceutical companies?
What is going on with medicare?
and....
......What the hell is going on behind that desk in the medicare office where they decide whether or not the drug your taking will be covered on their formulary? Thus they are determining what it will cost to you....$10 co-pay or full price. Are they doctors? What if they had an argument with their wife that morning over oatmeal about where they are going on vacation and when he got to work was pissed off. Let's say he's working on my medication requirements and because it's fairly new and WORKS WELL, let's decide to make people pay full price. Especially the underinsured.
Why do I have to pay full price when I have medicare insurance? Because around the same time every year you reach something called a donut hole. Which means, your fucked. You will be paying full price for same drugs till the end of the year.
I'm freezing. Why the air is blasting. I'm wondering why I'm here at the QFC?
So my home town family pharmacy was closed and eaten up by the giant QFC grocery store chain.
Yesterday, instead of walking into a little shop where they know my name and my challenges, I walked into a giant shiny fucking cold as hell, grocery store with a pharmacy. There was my old friend, the one who lost his business to the big guys, now managing the store. He was so busy he could not come to greet me. A man who I have never seen ask me what I needed. They always knew what I needed when I walked into my old store.
The stranger with the white lab coat following company policy, took 30 minutes to fill my script. The medication that I have been on for two years and I can't miss a day of it or I lose my mind. I waiting, trying not to cry knowing something was wrong when he asked me for my insurance card.
So as to not break down in this friggin store in front of men buying Rockstar drinks, I started reading Charles Bukowski's Women book to change up the brain a bit.
The man announced my name over the LOUD speaker in the giant store. He handed another unknown worker, she said $250 please. I said "wait, my co-pay is $90 for that medication."
She went back and checked again. While I waited I could feel the anger well up in my gut. For all kinds of things. Especially for taking away the blissful feeling I had due to the Pearl Jam show the night before.
She returns.
$250 please. Your insurance won't cover it.
"I only have $90."
We just looked at each other. I looked around for the good friend who owned the business I use to go to..he did not acknowledge the problem because he was too busy learning their new computer system.
I put my wallet back in my purse and left without the meds I have been on for two years. The meds that keep me here in this world and telling you this story.
today, I have no meds.
tomorrow, I will have no meds.
I think my family pharmacy went out of business because he probably helped drop the price when this happened. Was it his willingness to help people what put him out of business? I suddenly feel sorry for him. Now having to comply to policies and white lab coats.
I'm frankly scared. The government is arguing over this reform and meanwhile, government and pharmy companies and insurance giants are going to put me back in the hospital to start the whole crazy process over again.
I have no hope anymore. I'm so tired of the fight to live and take care of my condition.
As I left the store with the air conditioning blasting and proceeded to the triple story parking garage, I was numb.
I thought of Charles Bukowski and wondered how he would write about this experience. I'm sure he would be swearing more.
Have to volunteer 12 hours today with no medication. I hope I can actually perform my duties without my brain.
Please, don't bitch at me for this post and NO I DONT KNOW HOW TO SOLVE IT!
Post edited by Unknown User on
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Comments
*Don't let the light escape from you*
Can you call your doctor and see if he can fix it? My doctor's office did that for me a few weeks ago with a similar situation. Suddenly a prescrip wasn't covered and luckily I still had a few days supply left at home...
well said.
i believe his pharmacy was a liquor store.
I'm sorry this happens.. The cap sucks! I worked in a retail pharmacy chain for 8 years and was married to a pharmacist. The pharmacist I worked with and my ex at his store always gave out a few days worth to those in need such as yourself (unless it was a controlled substance)until the customer could contact their doctor. There is room for compassion in large chains, you just need to find the people willing to stand up for it.
They don't offer samples of these types of drugs.
I'm calling Medicare today. Thanks friends.
(JUST KIDDING!!!)
R.i.p. My Dad - May 28, 2007
R.i.p. Black Tail (cat) - Sept. 20, 2008
Millions of Americans are falling into the "Doughnut Hole," or Medicare Part D coverage gap. Once the costs for prescription drugs reach the initial coverage limit (about $2,300 per year), Medicare recipients have to pay out-of-pocket for their prescriptions on top of their premiums, until they reach the catastrophic coverage threshold (about $4,350).
This coverage gap increases the cost of health care for many older Americans -- often, they don't know what hit them until they open their medical bills. The "doughnut hole" is getting bigger as drug prices outpace inflation, and Americans can't keep up.
Nearly 20 percent of Medicare beneficiaries delayed or did not fill prescriptions because of cost and many others don't take their medications just to stay out of the hole. This coverage gap is dragging too many people down, putting both their health and their bank accounts in danger.
Please take advantage of the upcoming health care reform and close the "doughnut hole" so Americans don't have to pay full cost for their drugs as well as drug plan premiums.
http://www.thepetitionsite.com/takeacti ... m=19792885