A Three Hour Tour

In actuality, three weeks, but you can't sing that as easily.

So, youngest has ADHD. Reasonably severe. Medication helps. Ish. But it's still a process to find the right med and the right dose, and we've been on the merry go round for a while. Things are going reasonably well, but the doctor recently agreed (thank goodness) that we need to bump his dose a bit.

Que what should be a simple process of she calls the pharmacy, they fill the meds, we pick them up and give them our copay.

HAHAHAHAHAAAaaaaaa.....

Ahem.

See, the med she wants him on is one that our insurance feels is the same as a different one (narrator: it isn't) so she had to fight them to be able to use it in the first place, because we have already tried the one they think is the same and it didn't do what we needed it to do.

So okay, fine, they finally approved it. Yay.

Except, it appears they approved that specific dose.

So she's had to restart the prior auth process to get this new dose approved. Which she did. And the pharmacy texted that it wasn't covered. And I called her and she said she'd done her part. And so I called the insurance and they said she hadn't and that the pharmacy had to initiate it. So I called them and they said...

Yeah. Big game of "not it."

FOR. THREE. WEEKS.

And of course the story changed as we went along.

Well this week, the story was that the insurance only approved a particular MANUFACTURER of the drug, and that is out of stock and there's no resupply date available.

Que chasing tails to see who cares about the manufacturer. The doctor? Nope. Just the insurance.

So today I spent nearly 90 minutes on hold (off and on) as the insurance company called around to other "nearby" pharmacies to see if they might have the manufacturer available. (Nope.) Then they tried to override it so we could get it filled from a different manufacturer (the pharmacy has plenty of that available) and...no override. Because it's not a covered medication (see the previous about fighting to get this one.)

So they've filed an appeal and I can wait 48-72 hours to see if they're going to deign to approve it or...we can just pay out of pocket. They found a coupon to get it down to $60 and you know what fine. Just pay it.

But good grief. Who knew insurance companies could demand a specific manufacturer?? Not I. And it's ridiculous.