Transplant patients take medications every day to stay alive. Today I’m going to share a story about how to deal with pharmacy errors so that you get your vital medications.
Mr. Graft Diaries has pretty dang good medical coverage through his employer. But, like most medical coverage, there are some hoops to jump through.
I want to preface this by saying that I will be naming the pharmacy I’ve had trouble with in this article. I do this so that others can be as proactive as possible when dealing with them.
Medications and Their Differences
Not all medications are created equal. For instance, I’m on medications for reflux, blood pressure, and transplant. Each type of medication can fall under a different category. Insurance companies will handle each category in a different way using tiers.
Generally speaking, the breakdown of tiers looks something like this:
Tier 1 – Lowest cost medications available and usually generic.
Tier 2 – Somewhat low-cost medications, but brand-specific.
Tier 3 – Higher cost medications that are either brand or generic.
Tier 4 – Specialty medications for serious illness or medical conditions. These can be either brand name or generic and are the highest cost.
An Example
Let’s look at what I take to see this breakdown.
Antacid – this is something you may be able to get over the counter (without a prescription). The insurance company would likely consider this a Tier 1 drug.
Antihypertension – this is something that requires a prescription to fill. The insurance company considers some of mine as Tier 2 and some as Tier 3.
Immunosuppressants – also something that requires a prescription, but far less common. Insurance companies consider these Tier 4 medications.
If you are unsure about what tier your medications fall under, don’t worry. You can find that by looking up your insurance company’s formulary online.
Pharmacy Errors – Getting to the Root of the Problem
Most insurance companies will have policies for how you can fill your medications. Some of this might be to pass on savings to you by filling larger quantities through mail order. Other times, there may be requirements to fill prescriptions through a specialty pharmacy.
What this means is that you may be filling your prescriptions through several different pharmacies. A retail pharmacy, a mail-order pharmacy, and a specialty pharmacy. Three pharmacies. All with differing requirements. Each with their own policies. Each coming from somewhere else.
For a transplant patient who is on many different types of medications, this can be a logistical nightmare.
Persistence When Dealing With Pharmacy Errors
From Funny
In all honesty, I’ve had more than my fair share of pharmacy errors. Like the time, pre-transplant, when I went to the pharmacy to pick up my lactulose.
Thinking I was getting one or two bottles, I about fell over when I saw them bringing them out to me. Two people were carting bag after bag of the stuff to the counter! They had filled several months worth in one shot! Anyone who has ever had to take lactulose knows you don’t want any more lactulose than you absolutely have to.
That time was an easy fix. They put the rest back on the counter for me to fill as needed and I took home a one-month supply.
To Absurd
One Pharmacy Error…
Almost two weeks ago, I placed my refill order online with CVS Specialty Pharmacy for my immunosuppressants. Aside from dosage changes to my Tacrolimus, my medications have not changed. I submitted my order and was to expect delivery of my medications on Tuesday of the following week.
Well, Tuesday came and I went online to track the delivery of my medications. Imagine my surprise when I saw that both of my medications had been canceled!
I immediately called CVS Specialty Pharmacy to determine what was going on. This was not the first time I’d had an issue with them, so I jumped on it right away. I would talk to one person. Then sit on hold. Then speak to someone else, and sit on hold.
In the end, I spoke with several specialists who assured me that they had resolved the error. My meds would now arrive on Wednesday.
Only one problem. I had taken my final dose of one of my meds that morning. So now what? Again, the specialist reassured me that my meds would be there the next day.
“Well, what should I do about tonight and tomorrow morning’s doses? These are for transplant rejection.” The specialist told me it was no problem. She would get an order into the system for a bridge dose sent to a local pharmacy near me. Great! All I had to do was wait for someone in their pharmacy department to call me and tell me where to pick it up.
Several hours later, I still had not heard from anyone, so I called back. And sat on hold. Again. I walked through my whole situation. Again. I spoke with a different specialist who said my order was still in the system and I should expect a call. He sent an instant message to someone in the pharmacy to call me back ASAP.
About an hour later, I received the call and could go get my medication. For $37 out of pocket (that they would reimburse). Fine. Off I went to pick up my medication.
To Another…
Wednesday came and I still had not received my medication by early afternoon. I looked online and could not decipher what was going on with my account, so I called up CVS Specialty again. And sat on hold. Again.
Once again, my order was canceled. Another pharmacy error! No phone call, no email, no text. *POOF* Gone. Again, the specialist I spoke with assured me my meds would be shipped. Arrival would be on Friday this time since Thursday was Thanksgiving.
Only one problem. My bridge prescription would only get me through Thursday morning. So again, I had a full day of meds that I would miss before my shipment arrived. “No problem,” they said. “We’ll get you another bridge to hold you over until then. Someone from our pharmacy department will be in touch to tell you where to pick that up.” Anyone else hear an echo?
And With Help This Time
By now, Mr. Graft Diaries had arrived home and saw what was going on. He immediately got on his phone and called up Aetna (our insurer) as I was sitting on hold with CVS Specialty.
He explained the situation and they obtained permission from me to work with him on the issue. He was rapidly moved up to a specialist to handle things.
After I finished with CVS, I took over on the call with Aetna and, together, we sat on hold with CVS trying to fix the error. The conversation I had just had with CVS was nowhere in their records, so we started all over.
This time, they were a little more reserved in their promises. “Hopefully, someone from our pharmacy department will call you this evening to tell you where to pick up your bridge doses.” Hopefully?? Oh boy.
This whole call took over two hours to complete. The specialist at Aetna opened an investigation to determine what had happened with CVS. They also started paperwork to make an exception for my medications. If approved, this would allow me to fill my prescriptions at a retail pharmacy.
Call Your Team With Pharmacy Errors
Needless to say, I did not have any confidence that I’d hear from CVS for my bridge and it was after 6 pm. I called the line for my transplant team which goes to an answering service after hours.
I asked for a return call from the on-call transplant coordinator to determine what I should do.
When a coordinator called me back, I explained the whole situation. They sent a three-day supply to the hospital pharmacy for me to pick up on Thursday.
On Thanksgiving, after traveling 40 miles and paying another $50 out of pocket, I had enough medication to hold me until my delivery arrived.
My order finally arrived on Friday morning.
Dealing With Pharmacy Errors
Sometimes, it is something simple like filling one month versus 12. Or switching from a pill form to a liquid form to save $1,000.
Other times, it’s 10 hours of sitting on hold, 50 total miles of travel (on Thanksgiving), calling on-call staff, $87, and a whole lot of stress.
One thing is consistent though. You’ll be able to deal with pharmacy errors when you are persistent, enlist help when you can, and call your team.
This is life or death for us, so fighting for what we need is part of what we do now. We’re not called transplant warriors for nothing!
