Once upon a time, a family switched insurance companies. Mother went to Target to pickup groceries methotrexate with a $10 coupon. When she went to the counter to pay, the insurance had “denied” coverage for the medicine. In the age of cell phones, mother figured she could cure this problem in a moment right there in the store. So she called her insurance company.
Customer service: Can you ask the doctor to prescribe another option? Mother: No, methotrexate is a generic drug, there is not another version.
CS: Isn’t there an alternative to metrex-re-erer-eate? Mother: No, this is considered the background treatment for the disease. Ninety-five percent of Rheumatoid Arthritis patients are prescribed meth-o-trex-ate.
CS: Your diagnosis is arthritis? You need injections for arthritis? Mother: No. It’s a disease. I have to have these injections as treatment. And they are required to continue with my other treatment as well.
CS: But it is arthritis, right? Mother: No. It’s not.
Mother: Look, it doesn’t matter. This is the about the cheapest treatment for this disease available. And it’s almost universally prescribed. I’ve taken it for years and you need to cover it.
CS: We don’t have to cover it because you inject it. We don’t cover things you inject at home.
Mother: It’s no one’s business how my doctor and I decide I’ll deliver it. It’s always been covered. If it were insulin, would you cover it?
CS: But that’s a treatment for diabetes. Do you have diabetes?
Mother: No, but that’s exactly my point. RA is a disease like diabetes. And methotrexate is the treatment.
Mother made several other calls and the insurance company covered subsequent methotrexate prescriptions. Fast forward two years.
Mother gets most of her prescriptions at CVS because Target hasn’t sent any coupons lately and… because the CVS pharmacist always seems willing and able to help figure out solutions. Whether it’s devising a plan for easier methotrexate injections, getting a priority antibiotic filled immediately, or ordering methotrexate to be sure it’s available during the shortage, this CVS pharmacy has provided exceptional service.
Last week, the insurance company rejected the methotrexate prescription again – after two years of paying for it. The CVS pharmacist spent time on the phone arguing on behalf of Mother without success. But the pharmacist did not give up trying to help. Until the insurance company can again be persuaded that RA is a disease for which methotrexate is the standard treatment, the pharmacist sold the methotrexate with a discount. ~THE END~
I don’t know about you, but usually when I need something from a pharmacy, it’s because I’m sick. Which means something’s not right. Usually I’m in pain. Or worried about myself or one of my children. There have been countless times when I needed the pharmacy at a stressful time. Every time I’ve needed assistance, my local CVS pharmacist has been helpful and cheerful. That generous attitude filters down to staff as well. When I saw the Laura’s CVS commercial recently, I couldn’t wait to talk about Kelly’s CVS!
Postblog: This story really happened to me! People who work for insurance companies or medical facilities can have the same problems that employers, neighbors, and disability judges do with comprehending that RA is a disease and not “a type of arthritis.”
- 3 Reasons to Stop Saying “Complications of Rheumatoid Arthritis”
- Methotrexate Injections for Rheumatoid Arthritis
- Methotrexate Injections for Rheumatoid Arthritis, part 2: Needles
- We Refuse to Be Mislabeled: Updating Rheumatoid Arthritis (RA) to Rheumatoid Autoimmune Disease (RAD)