La Pharmacia

I think most of us agree that the American healthcare system is fucked up and becoming more fucked up by the minute. And I do apologize for using French for something that is very on-brand for America but I am midway through round 37 of updating our health insurance coverage with a variety of doctors – a project that I proactively started way back in May and have now repeated 37 times. 

You see, it was in May that my husband transferred to a new company and, therefore, we were transferred to a new insurance and, therefore, I still had OCD and took it upon myself to update every medical office we frequented and many that we did not. 

I was so proud of the rows of ✅s on my spreadsheet.

I was less proud when, with each new post-May appointment, we were met with the confirmation that our previous insurance was still valid. Or that we have endless envelopes arriving holding requests for Payment in Full as that pesky updated insurance information had not yet made it to the correct person(s).

Ummm … what about all my phone calls on which I provided our new IDs? 

To make it just a little more complicated … my husband’s new corporate sponsor is California-based and, therefore, doesn’t provide physical insurance cards. I bet that works excellently in more, well, hip areas than the sticks of Virginia. While there are many benefits to living among the raccoons and deer, one unavailable benefit is the ability to email insurance cards to our caretakers. Yes, a very few do offer the option to use the facsimile but they do not appreciate jokes that start with “Sure, let me just start up the time machine … “ 

Oh, and patient portals? A terrific option for updating your details that is evidently unrelated to information stored at the check-in kiosks.

Look, I may be a political freeloader but if universal healthcare coverage will make this melee meleave, sign me up.

Isn’t it bad enough that we still live in an age where we have to fill out three forms, wait six days to be seen, and stand in a pharmacy line full of fevered patrons each and every time we get a sinus infection? 

A few days ago, I drove thirty minutes (to the city!) to pick up a prescription for my husband’s psoriasis. This was actually very exciting as it followed a visit to a real live skin doctor (Ladies, did you see that? My husband went to the dermatologist.). I’d been suggesting this for years but was always met with “I’ve tried everything,” as if progress past “everything” hadn’t been made in the last decade and a half. 

I felt gleeful when the dermatologist explained the latest and greatest in treatments (though I remained very cool and calm and I didn’t even say “I told you so” once).

Right. So the cream.

I didn’t pre-pay for the prescription because the price was listed as $55 in the pharmacist’s portal (yet another portal … ) and I hadn’t provided our coverage details. Upon arrival, the incredibly kind tech told me that they had already applied a savings coupon for the cream as that offered more savings than any prescription program. Perfect! 

His next words were “Yeah, it’s normally $1300.

What the what? $1300 for a cream? Was this a tube filled with caviar? While I was grateful not to have to perform the traditional three cartwheels, swallow a beetle, and recite the Gettysburg Address in order to get the savings coupon applied … what the actual?

If you’re not familiar with psoriasis, it is a skin condition whose hosts, including my husband, often feel quite self-conscious about the spotty, painful rash that seems to worsen at the most inopportune times. Just kidding, there is no opportune time to have a spotty, painful rash and, therefore, it lasts forever.

Look, I know this next statement is going to activate some of you but …

We are living in a country where it has been deemed acceptable to lop actual parts from a person’s body because those parts make them feel unhappy at no cost because, hey, we can’t have anyone feeling unhappy, right? 

What about my husband? What about him? Psoriasis makes him feel unhappy. It makes him feel uneasy about showing his legs. It makes him feel self-conscious. All feeling defined under the dysphoric umbrella.

Of course we are thrilled to have the cream (and a coupon!), but what about a few years down the road? Are we not locking ourselves into a remedy that will exceed our out-of-pocket abilities in that short distance down the road to retirement? I should not that our potential monthly out-of-pocket tally already exceeds ten thousand dollars. So, really, no big deal. As it stands we have already begun to imagine life with decreased care. We even went through a practice round at the time of the insurance change as we fought of demands to try more cost-effective options for blood pressure meds, mental health meds, psoriatic arthritis meds, and more. Yes, we had plenty of documentation on why we take what we take and eventually most were approved but, honestly, it was terrifying.  

Did I really need the Trintellix?Um, yes. I even wrote about it, here. No, thank you, I won’t stop taking it for several months to test out more cost-effective options. 

My child? Has he tried the other ADHD meds? Well, no, not all of them. He just started taking them a few months ago and this one seems to work. Also, maybe can we not mess with that until school’s out.

My husband? Testosterone? Yes, he has decades of supporting documents indicating that his body doesn’t produce it sufficiently. You want him to stop taking that as well so you can “see?”. You know what, never mind, we’ll just go out of pocket for now. It’s just that, without it, he will be perpetually exhausted and moody and lethargic and … not a great way to start a brand new job. 

My husband again? I know he’s expensive. He’s worth it. The Cosentyx? Yes, for psoriatic arthritis. Yes, it is one of the most expensive options. That’s because it actually works.

My husband did miss eight weeks of treatment on this one while phone calls were flying back and forth. When we did finally secure the prescription, we couldn’t fill any of our other prescriptions because this one left us with $2000 balance that would eventually be erased with yet another savings card, but until then … thoughts and prayers

Look, I know this next paragraph is going to activate some of you but …

The testosterone? A known necessity in males? Given for free to the teenager who walked into a clinic and participated in a fifteen minute discussion about gender issues. And this isn’t to say that gender dysphoria isn’t real, but my goodness … a vial of testosterone, a box of needles, zero ongoing care, all for free? While my husband has to fight for it? A known necessity in males? This paragraph is not about that child (who we love, dearly), this paragraph is about the fucked-upness of our healthcare system.

After I picked up the new psoriasis cream, I came home and put the two sample tubes we’d gotten in the mail to send to my nephew. He recently welcomed psoriasis to his feet, of all places, likely related to the stress of major life changes (as exciting as they are). I know there’s very little chance of his own insurance company approving a $1300 cream without an epic battle and, frankly, he’s a young adult. The chances of him knowing how to jump into that battle and lasting to victory are slim. Even if he does start the path of more cost-effective options, the kid is getting married in a matter of months and I think a really good dream is to be able to walk his bride up the aisle without pin pricks in his shoes.

Our healthcare system is a hot mess. Even worse, I see no hope of it every getting fixed. We live in a system where profit is so, so, so much better than making people well. And, yes, I know, if we don’t like it, leave. That’s a really stupid solution, but it does have merit. 

Just last weekend, actually, I had one of those pesky sinus infections show itself. I had a tiny window between two trips and zero hopes of snagging an appointment with our doctor for the antibiotics that I knew would fix it. 

Yes, I know this is controversial but, at 52, I am able to diagnose my own sinus infections and name the most efficient antibiotic.

Still, with so little time to address is, my only options seemed to be to spend six days in misery or … to crack open the box of antibiotics that we have compiled on various jaunts across the borders. I chose the latter and went off on trip two feeling one thousand times better. Gracious, la pharmacia de Cozumel. I imagine as we work our way off work-provided insurance, this could be our norm as a weekend visit to la pharmacia is a tenth the cost of that American out-of-pocket menu .

We do get a lot of things right in this land of the free but, my goodness, it is not healthcare.

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