So, today the bureaucracies I want to talk about are four: Intuit Turbo Tax, the Empire State CVS Caremark prescription programme, and the New York State Civil Service. Let's start with Intuit.
Today I got up early in the morning--around six am to be precise--to do my taxes, one of the most hated things I have to do in addition to going to a laundromat, going to doctors, having one of those CT Scan dye tests, being forced to watch American television and YouTube reaction videos, and dealing with bureaucracies in general in my life. Though I have used Turbo Tax before I could not get into my account this morning because they wanted to send me--shades of idiocies past--a security code to a phone number that is no longer in operation as the phone died and I ended my awful relationship with Tracfone. Will they send the security code to my email which they have? Of course not. Welcome back to Kafkaville.
Now on to CVS Caremark and the New York State Civil Service. The problems I had with CVS Caremark and the New York State Civil Service this morning are the same and both revolve around the same thing, prescription issues. Some backstory first. I have been taking Advair for my asthma since 1990. When I retired and my pre-retirement prescription coverage was changed to CVS Caremark Silver Script things changed despite claims to the contrary by the good old useless union who told me little if anything would change for me. I was immediately given a generic version of Advair that unbeknownst to me and my doctor, had just come on the market. I did not know that I should not get this generic given the change in my coverage. Now don't get me wrong, I like generics and I find it morally disgusting that the rich pharmaceutical companies do everything in their power--and their power is extensive; just ask the lawmakers in DC--to keep cheaper generics off the market. They care more about profits than people after all. However, I unfortunately had an allergic reaction to this generic Advair which my health has still not recovered. So, I had to go back on Advair.
Jump ahead some two years later: CVS Caremark (remember corporations are always about profits over people despite their demagogic rhetoric), took Advair off my formulary, the holy list of the elect and the damned kept by America's insurance corporations. Both I and someone at my doctor's office noted that I had an allergic reaction to this medicine and that therefore Advair should be approved for me at formulary prices. CVS Caremark denied this peasant's petition saying the PA who put in the request did not have royal permission do so. Given this my pharmacy had to charge me $120 dollars for the medicine. Needless to say, I skipped this honour, this act of royal health insurance patronage, as I don't have that amount of monies to pay for this medicine on a regular basis and even if I did I would would not pay such an obscene price for it. Welcome back to Kafkaville.
So, I contacted my doctors office and I called the number on the back of my Empire Plan, NYSHIP, CVS Silver Script prescription card, 877.769.7447. Empire Plan NYSHIP, CVS Silver Script, in turn, told me to call New York State Civil Service. So I called NYSCS at 518.457.9375. They told me to call Empire Plan, NYSHIP, CVS Silver Script...AGAIN. Since Empire Plan, NYSHIP, CVS Silver Script had previously told me to call NYState Civil Service that seemed like a no go. Welcome back to Kafkaville.So, I asked to speak to a supervisor. He put me on hold--of course--and tried to transfer me to the New York State Retirement System. Eventually I was able to request a call back but since they had my telephone number completely and utterly wrong I don't have much hope for a call back. I did, of course, put in the correct number but that was followed by a request for an extension, which I, of course don't have since I have a personal rather than a corporate phone. Welcome back to Kafkaville.
At this point I have given up. I simply can't deal with this bureaucratic bullshite anymore. I am fucking tired of having to manage crisis after crisis every month of my retired life. The doctor's office, the only competent one of the bunch, is trying to get this rectified. I am at the point, however, in favour of going on a less effective medicine that is on the Holy Formulary simply to avoid this never ending bureaucratic bullshite. Bureaucracies, after all, particularly in the unmerry-go-round world of brave new digital age, wear and beat you down mentally and physically, eventually.
So, the doctor's office reports that I can no longer get Advair. The alternatives on the formulary are too expensive. Let's hear it for the American health care system, the worst in the "civilised" world, the health care unsystem that puts profits over people's health. Speaking of profits over people, GSK, who makes Advair, no longer offers assistance to those who use it now that it has gone all generic on my allergic arse.
For your information...Notes from my doctor's office on this matter...
Note One:Hi Ron, I am on the phone right now with Caremark, they manage Empires prescription drug plan. They confirmed that the Advair Diskus 100-50 is non-formulary, but they did approve it with a PA last year, I confirmed the PA on file is active, I explained that you have trialed basically every formulary alternative they have suggested, generic or otherwise, and you copay for the inhalers have gone up from $10/3month to $120/3 month and that's not appropriate for a medication that we have obtained Prior Auth for and there are no reasonable alternatives for you to trial. I am also submitting with your insurance a "Tier lowering" form to see if we can get the cost reduced. The plan also recommended that you contact the number on the back of your card for member services. Just in case we cannot get the tier lowering form approved with your insurance, they may have other options for you such as patient assistance programs and such. As far as alternatives, there are not many available in the class of inhaler you are prescribed that are comparable and formulary and would be as effective.
Note Two: I hit a road block myself too. I got all the way up to the clinical specialty pharmacist. Medicare has really covered all of the loop holes, and I tried to get the formulary tier exception pushed through. So even though you have a prior auth on file, its not assigned a "tier" what the pharmacist told is that means they cannot lower the tier because the PA's don't officially have a "tier" assigned, even tho it sounds like it gets assigned to the highest tier anyway. I reiterated that you have tried almost every formulary alternative, generic, etc. And that none of the alternatives that are preferred or lower tier that are in the class of med you are taking are appropriate. Medicare guidelines also don't allow tier lowering exceptions for Brand medications, only generic. And Medicare has been smart by taking a lot of the generics off the formulary and putting the brand medications as "formulary" this year. So now they set the brand medications to a slightly higher "tier" so that we cannot request a tier exception. There are only 2 other inhalers that you haven't tried that your insurance recommended that are on your plan, both name brand medications so they are set at Tier 2. One is Breo Ellipta, the other is Trelegy. The Breo is in the same class of medications as the advair diskus so it is comparable. The Trelegy is a triple therapy inhaler. Both of those inhalers are $30 for a 30day supply, $90 for 90day, Advair 100-50 diskus that you are currently using remains at $40/30day, $120/90 day. Wixela is the generic for Advair Diskus that you trialed in the past, that one is formulary preferred tier 1 but not appropriate for you to be on because you had a medication reaction. I am at a loss I am so sorry. I spent over an hour on the phone today trying to get this to work. Would you be interested in trying the Breo ($30 a month is still a lot)? Or would you prefer to discuss further with Dr. Conuel when you see him on the 28th?
So much for the bs that CVS takes exemptions seriously and that they CARE. Bullshite. Welcome to Kafkaville again. Hospital here I come.
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