I have spent most of this week on the phone with various people, organizations, and hold music, all with one goal: to get my disease modifying medication for rheumatoid arthritis. Here is a week in the life…
Monday:
Me, calling Medicare part D company: Hello, I was told to call once I had prior authorization for XXX medication in order to apply for a tier reduction.
Part d: Yes, I’ll be happy to submit that for you. [asks several questions] Someone will contact you within 72 hours to let you know if it was approved. You may also want to submit an application for financial assistance with the manufacturer. [Thank God I already have one on file.]
Me: Is it possible for me to find out how much this medication costs at the current tier?
Part d: I can transfer you to our mail order pharmacy and they may be able to help you.
[hold music]
Mail order: This call may be recorded or monitored. May I please have your name, birthdate, address?
Me: [gives info, explains question]
Pharmacy: I’ll need to transfer you to our specialty pharmacy and they can help you.
[hold]
Specialty: [monitoring disclaimer; asks for identifying info]
Me: [gives info, explains question]
Pharmacy: We can’t give that info without an active prescription on file.
me: [thinks: Am I supposed to have a prescription sent to every potential pharmacy so I can price shop???] Thank you. [disconnects]
Me, calling patient assistance foundation: [ready to push lots of buttons to get to advocate]
PAF: If this is a medical emergency, hang up and dial 911.
Me: [thinks, Why would I take so much time to call you in a medical emergency, especially knowing I would have to deal with your number-punching madness???]
PAF: Para assistencia en espanol, marke el 2.
Me: Ok, don’t press 2.
PAF: If you are new to [name of PAF] or are calling to speak with a patient assistence advocate, press 3.
Me: [frantically presses 3, because I may fall asleep at any second]
PAF: Ok, just a few more questions.
Me: [inwardly screaming, NO MORE QUESTIONS, NO MORE BUTTONS!]
PAF: For [my medication] press 1…
Me: [presses 1] Please please please give me a human!!!
PAF: Your call is very important to us. All patient assistance counselors are assisting other patients. [start piano music which is nice and soft but guaranteed to keep me awake] Did you know that you can access program information and forms at our web site?
Me: If I wanted that info I would have gone to your web site instead of calling and sitting on hold for a thousand years!
PAF: [more piano music] Thank you for continuing to hold. your call is very important to us…
Me: I can see it is.
PAF: Your current wait time is 735 minutes. If you would like us to call you back…
Me: [hangs up] By the time they call back I would forget my question!
Tuesday morning:
[Phone rings, I answer]
Part D: We are calling to let you know that your tier reduction application was denied.
Me: Ok, thank you. [suppising it is useless to ask why]
Me: [calls doctor’s office to request a prescription be sent to the specialty pharmacy.
Doctor’s nurse: I sent it on this date and this date.
Me: Can you give me the number to the pharmacy?
Nurse: I can transfer you there.
[hold]
Pharmacy: [monitoring disclaimer, asks for my info]
Me: [gives info, asks about prescription]
Pharmacy: We don’t have that. We only have YYY prescription [from another doctor].
Me: Thank you. [Loses it while hanging up.
Wednesday morning, after sleepless night due to pain]
Me [calling PAF]: It’s 8:00. Maybe the wait time won’t be so bad. [repeats all the motions from Monday]
PAF [after I press all the numbers]: Your wait time is 1 minute.
Me: [celebrates]
PAF [20 minutes later]: Thank you for continuing to hold… [The same song is playing and has not restarted. Big finish seems imminent. No it’s not. Yes it is. No it’s not. Yes … wait … wait … Oh yes! There it really is, and here the song starts over! That is one really long minute! Hangs up. Calls doctor back, leaves message]
After 5:00, phone rings, I answer.
Nurse, sounding exhausted: I sent the prescription again. I don’t know why they aren’t getting it.
Me: Thank you so much. [takes pharmacy number] I also keep trying to call PAF and they are giving me very long wait times.
Nurse: [promises to try calling them herself]
Thursday:
Me: [Calls pharmacy, answers identifying questions, asks about prescription]
Pharmacy: Yes, we have that prescription. It is very expensive.
Me: How expensive?
Pharmacy: Thousands of dollars. Do you have insurance?
Me: [I have Medicare part D. It’s tier 5.
Pharmacy: I’ll transfer you to our Medicare counselor and they can help you.
[hold]
Counselor: I can take your Medicare number and help you.
Me: [gives number]
Medicare: Ok, that is processing and someone will call you.
Me: I’m trying to find out how much this medication costs.
Medicare: We will not fill your medication without letting you know how much it costs.
All of this has been written during one hour while I have, again, been sitting on the phone with PAF, listening to the never-ending piano piece punctuated by messages about my important call and where I can access program information forms.
Remember: don’t call the PAF in an emergency. You’ll still be on hold ten years after you died!
