The insidious disenfranchisement of the local pharmacy

I've lately discovered the joy of batching paperwork. Every Friday afternoon at work, I blast through incoming freelance bills and payment complications; doing it once, at a scheduled time, keeps me saner and makes it go faster than trying to field every query right as it comes in.

Similarly, I don't like dealing with bills and bureaucracy as they comes in. I'd rather stack it up and deal with a bunch of related paperwork at once. Tonight, I finally broke down and attempted to sort out accumulated medical paperwork.

First cranky sidenote: I have at least three (prescription, physical doctors, head doctors) and probably five (add vision and dental) separate medical providers, for one (1) company health care plan. Now, this company health care plan is by far the best I've ever been on and I'm wildly grateful to have coverage at all, so I'm not complaining strenuously, but it took me several rounds of Login Routlette to land on the right combination of website and user name to pull up the first bill I wanted to sort out.

Once I finally found the bill, the first bit was easy if a bit pricey for those of us suddenly on a fixed budget: an $84.11 ambulance bill. "Er?" I inquired of spouse.

In January, he fell on an icy sidewalk and whacked his head, hard enough to spook those nearby. "Hi from the ER!" is not the text message you really want to get right after you walk in the door at work. Happily, all was well; the ER docs took a look and pronounced him probably fine, I came home to keep an eye on him for the day, and three months later, all is good. But it turns out he got to the ER via a local ambulance, which happened to pass by moments after he fell, and which those nearby flagged down. (This is not quite as random as it sounds, since we're literally a 13-block, 1/2 mile ride straight up one street from the local hospital, and there always seem to be ambulances around this particular intersection.)

Want a case study in the unfair tilt insurance gives to health-care access? The rack rate for this 13-block ambulance trip was apparently $908.25. Our plan reimbursed the hospital for $694.82 of the cost, and negotiated a $136.23 discount. (So if you were uninsured, you'd pay $136.23 more for the identical service. No, this does not strike me as a sane way to run a health care system.) Our remaining copay was $77.20. Writing an unexpected check does not fill me with joy, but I'd much rather pay $77 and have a spouse who came through a potentially ghastly head injury with no problems than not pay it and have Later Complications, so I happily filled out the paperwork and moved on to the next hurdle.

Our medical plan uses Medco to fill prescriptions. Last year, Medco barraged us with info about how much we'd save filling prescriptions online instead of at retail. We have one prescription that need to be filled every month, at $40 per pop. Medco wanted us to know that if we instead ordered it online, we'd instead pay $60 for a 90-day supply, or $20 a month.

The tricky part: This prescription is for more than the (legally? medically? I've never been wholly clear) recommended dose. This is the dose that works, and my cursory troll of Google when this prescription got ramped up turned up ample evidence that this drug is widely prescribed in higher-than-guidelined doses, but every time this prescription goes to a new pharmacist, they refuse to fill it without calling the doctor to confirm that this is the intended and prescribed dose. Which can get be slightly frustrating when you're in a hurry, but is fine; pharmacists are supposed to be a check-and-balance against prescribing doctors.

So, Medco kept sending little alerts that we could save money filling this prescription by mail, but we chose to keep filling it at our local pharmacy. The pharmacist knows the prescribing doctor, the store is very conveniently located, and it's worth the extra $20 a month to us to fill it in person.

Until this December, when Medco's little "helpful alerts" turned into "urgent warnings": The company was switching from carrots to sticks. In 2009, if we chose to take a covered drug (and this one counts) to a retail pharmacy instead of using their mail-order system, they'd radically cut their subsidy. A drug that used to cost us $40 a month would now cost vastly more -- banging around on their online system, the closest thing I can get to a "how much?" answer is either $68/month or $300/month. Nifty.

So, Medco is essentially forcing us to switch to online ordering -- but for a drug quantity that their automated order systems will almost certainly reject, since I don't think they can legally dispense a full 90-day supply of what is actually the prescribed 90-day supply, and at the cost of cutting out our local pharmacist who actually knows this case and does a good job keeping tabs on it.

Guess what I'll be spending lunch break tomorrow on the phone with Medco wrangling about? Can we please replace this mess with a functional health-care system, stat?