prior disapproval

PRIOR DISAPPROVAL

this is a picture of a tube of 5% fluorouracil cream that has been generic now for awhile
it should be cheap
right
not

this spring i had mohs surgery to remove a basal cell cancer on my nose
its the second one i have had in 3 years
this second surgery was more involved than the first
it required a plastic surgeon to do two procedures to cover up the big ole hole left on my nose
it was located you know on the cute spot
if you have seen a freckled kid with a sunburned nose
its that spot that has peeled after the sunburn

alas
i had a lot of those cute freckled nose sunburns in my life
leading to
both my skin cancer surgeries

now after this surgery the dermatologist suggested i do a treatment with the fluorouracil 5% cream
or
as its know in the medical field
5fu

not only is it a cream for skin cancer but its given iv for other cancers
ie
my 5fu is my chemo for my skin cancer

if i use it it will kill any precancer cells and any cancer cells that are growing in the skin flap he pulled over to fill up the nose hole

seems straight forward right
oh
i will do this every year or two to keep the skin cancer at bay
i dont
i repeat
dont want to do this surgery again
so
i decided im going to be persistent here in getting my prescription

so
the derm sent over my rx to the three letter pharmacy
sir
they said
you need to have this get a prior disapproval
thats not what he said but thats what i heard

then
later the nurse called
we just got notified we need to do a prior disapproval on this drug

so
i decided
im just going to see how well the system works to get my prior disapproval done

i have one more procedure to do in two weeks then when its healed i will start my 5fu
well
if my prior disapproval goes through

so i waited
the three letter pharmacy waited
they sent me prior disapproval notices
the derm called we need your updated drug insurance this was 3 weeks after the rx was sent in
so
now im 4 weeks into the prior disapproval process

i thought
ok
now im giving them 2 more weeks to get this prior disapproval to be done

then
after two weeks i made the dreaded phone call to the first letter of the alphabet insurance company

of course
i was put on hold
it took 50 minutes for this phone call to be completed
after talking to four different folks

they asked what i wanted
i said i need my chemotherapy cream for my skin cancer before my nose falls off
they said
you need this to have prior disapproval
that not what they said thats how i heard it
so
i said to the person whose accent made me think she was in atlanta
deep drawl she had
i said
oh you mean prior disapproval
there was silence
no thats not what i said
let me send you to my boss
then another boss
then to a pharmacy decider technician

as i was talking i could tell she didnt know what she was talking about

she started asking me questions about why i was having this done
i thought to myself i think she is confused
i think she thinks i am the doctors office
so
i answered the questions like i was the doctors office

she said
is this being used for what sounded like some terrible skin cancer going awry
i wasnt sure what that was but it sure sounded bad
so
i said
yep thats why im using it

oh ok she said
we will approve it for one year

what the heck i thought to myself

oh by the way i said
how much will it cost me with insurance
$192

later i called the three letter pharmacy and asked the cash price
$230

so
i thought
i wonder if that wholesale company that you have to have a membership fee to use but not the pharmacy if they would have a cheaper price
the pleasant pharmacy tech said sure here is the cash price
$98

thats right i said what the heck again

so i pulled out a hundred dollar bill and paid the man
saving over a hundred dollars by not using my insurance

i thought im glad i wasnt dying or something needing this medicine
one that has been around almost my whole medical career

if i was going to put a fair price on the medicine it would be $45

so you can see theres a lot of profit or someone is making money on the deal
had i not been persistent and sort of understood the game i could have paid almost 3 times the price

so
next time
say to your doctor or hospital or pharmacy or insurance company
oh
so i need this prior disapproval done

some will laugh
some wont

the organicgreen doctor