About the drugs…
I have good news and bad news from my own little private front in the constant battle to afford health care.
You probably don't remember this passage from my Nov. 26, 2007, column ("‘Health care reform?’ Hush! You’ll anger the Insurance Gods!"), so I'll repeat it here:
results of my first skin tests in 20 years. I’d been getting allergy
shots based on the old tests all that time, and my allergist, being a
highly trained professional, thought it might be a good idea to see if
I was still allergic to the same stuff. Actually, I can’t tell you for
sure that the shots ever helped. So why get them? Because my insurance pays for allergy shots, but won’t pay any more for me to take Zyrtec, which I know relieved my symptoms. The Insurance Gods say I don’t need Zyrtec.
… Earlier this year, after surgery worked only briefly to relieve
head-pounding sinus pain, my surgeon gave me a prescription for Allegra.
I started to protest adding yet another drug to the 11 I was already
taking, counting the prednisone he was putting me on, but then he said
it was the generic version, so I said OK. My copay is only like $10 on generics; the Insurance Gods say generics are good.
Then my pharmacy said my copay for my 30 generic pills would be $81.95. Stunned, I asked why? They shrugged and said no one knew; the Insurance Gods just said so.
I shut up and paid it, even though it meant delaying paying on my
mortgage or my electricity bill or some other frill. I think the pills
helped, but I certainly wasn’t going to get a refill.
Well, two good things have happened since then.
First, at the start of 2008, Zyrtec became available over-the-counter, quickly followed by the cheaper generic version, also available over the counter, so I've been able to supply myself with that for the past year at less than my co-pay would have been had my insurance covered it.
Unfortunately, the Zyrtec hasn't been helping all that much (and "helping" for me, with my extreme allergies, simply means keeping the ever-present symptoms down to a dull roar), even though I take twice the recommended daily adult dose every night (as my allergist told me to do).
So, on a whim, I asked him to write me a scrip for the generic version of Allegra 180, just to see what would happen at the pharmacy now that I have a different health care provider, and lo and behold — it went through, with only a $15 co-pay. So I said "fill it!" I'll tell you the results later, I've only taken it once so far.
That's the good news. Here's the bad…
The reason I was at the allergist yesterday is that I needed some Xopenex vials for my nebulizer to treat my asthma. I've been blessed the last couple of years by being almost completely free of asthma symptoms thanks to a miracle drug called Asmanex, of which I take two puffs nightly — and which, Thank The Lord, my insurance pays for, with a reasonable co-pay.
But the latest stage of this crud that I've had for three weeks is that ever since the weekend (about the time I was finishing the course of Levaquin, for the second stage of the crud, which was bronchitis), my bronchial tubes have been closing up on me even as the more obvious signs of infection subsided. A breathing treatment Tuesday night helped, but I needed refills. Rather than just calling in the refills, the allergist insisted I come in yesterday, and sure enough he told me what I didn't want to hear: I needed to do a course of prednisone.
He had me scarf down 60 mg. there in his office, and told me to take 20 mg more that night. Today, I scaled down to 40 in the a.m., and another 20 tonight. I'll repeat that tomorrow, then step down again the next day, and so on until I'm off it. You don't just go cold turkey off prednisone.
Now, I don't know if you've every had 80 mg. of prednisone rattling around in your skull, but that's just about enough right there to give you brief "Band of Brothers" hallucinations. And that's not the whole story.
Between the prednisone (which ought to have dealt with the worst of the asthma by tomorrow) and the Allegra, I forgot to get my Xopenex refill. I used my next-to-last dose last night, and called the doc back today, and they called it in.
But not so fast. They called me back minutes later, and said my insurance won't cover Xopenex. They had to go with the older, cruder drug, generic albuterol.
Now that's fine, except for one thing. Even when not taking prednisone, a dose of albuterol, administered via nebulizer machine, causes my heart to pound like I just ran about a mile. (If you take albuterol via the simple inhaler, it doesn't do that — but then, it does nothing for my asthma, either.) But I can live with that, because it opens me up. The only trouble is, if it's the middle of the night, I've got to sit up an hour or two until I calm down, because the pounding of my pulse through my throat and head against my pillow makes sleep impossible — pretty much the same as if I HAD just run about the block.
The nice thing about Xopenex is it has the therapeutic effect without the heart-pounding, so I can go to sleep within minutes after a treatment.
I asked my druggist, and he says Xopenex costs about twice as much. And of course, if my doctor and I jumped through a few more hoops and demonstrated that yes, we've tried albuterol, and yes, my doctor does have a legitimate reason to prefer that I use Xopenex because he is a trained medico and not a complete idiot (nor am I, but I doubt I could get them to believe that), they'd probably spring for the name brand. But of course, the business model of private, for-profit health insurance is to make you jump through enough hoops that you give up, and I had already spent WAY more time than I had time to spend on all this being-sick garbage this week. I've got work to do.
So I paid my $15 co-pay, took my albuterol and my nebulizer machine back to the office, and did a treatment sitting at my desk while reading The Economist. I started breathing a lot easier, and the only ill effect was that when I was proofing Robert Ariail's cartoon for tomorrow, I noticed my hand was shaking à la Tom Hanks in "Saving Private Ryan." But I could still lead my company up the beach.
Here's the thing about all this: If the insurance simply demanded double the co-pay for me to get Xopenex (the way they do with Asmanex), I'd probably just say the heck with it, give me the albuterol, and put up with the heart-pounding. I AM cost-conscious. (In fact, I tried to talk my primary-care doc into giving me the much-cheaper tetracycline for the bronchitis, but he insisted it wouldn't work but Levaquin would — my allergist agreed yesterday when I asked him the same question. I'm VERY cost-conscious, and am always asking about these things.)
But they don't do that. They get all "we-know-more-than-your-doctor" on me, and assume that I don't care about cost, and so they have to tell me what I can have and what I can't have. And frankly, that ticks me off. I've had asthma for 55 years, and I know what I need and what I don't need.
I know what you're thinking: If we had a single-payer National Health plan the way I want, the gummint might also tell me I can't have Xopenex. Maybe. Then again, if the gummint was the sole provider of coverage, the drug company would be MUCH more likely to figure out a way to offer it at a lower cost, since they wouldn't be able to play all these difference consumer groups with different payment rules against each other. If the gummint wouldn't allow it, they wouldn't sell ANY Xopenex.
Of course, if they COULDN'T sell it cheaper, we'd all have to take albuterol. But that wouldn't be the end of the world, either. It gets the job done — ba-boom, ba-boom, ba-boom…
Anyway, I think that explains the drug reference earlier. All perfectly legit, I assure you.