We finally got Cigna to approve the type 1 diabetes treatment that Maggie had been getting for four years before we switched insurers. So, yay? I still have a two billing problems to deal with, but at least she is going to live long enough for to see that get straighten out.
But for myself and my non-life threatening problems...
Skin Care
Just before my mom died in 2022, my skin rebelled against me. I had a rosacea flare, pityriasis rosea, and eczema all gang up on me at once. I made an appointment with a dermatologist...for four months later, by which time, two of the three had resolved by themselves.
In the mean time, to treat my rosacea, I went online and got a prescription for low dose doxycycline and a cream that I was amused to see contained, among other things, (not covid-killing) ivermectin from a compounding pharmacy that does not bother with insurance. I had to upload a couple of the worst selfies I've ever taken and within a few days, I had my meds. Within a couple of weeks, the disfiguring bumpiness of the rosacea was under control. Some redness, evidently, I'm stuck with for life. It cost $50/mo out-of-pocket that insurance wouldn't cover, but it was at least being treated nearly immediately.
When I finally got in for my dermatology appointment, I saw a physician's assistant, not the dermatologist, who also prescribed the low dose doxycycline plus prescription strength azelaic acid. Insurance declined coverage on Oracea—40mg/day doxycycline retailing at $700/mo—but was willing to pay for generic 50mg/day caplets at less than $20/mo retail. Can someone please explain to me why it costs 35 times as much for 20% LESS of the drug. (Yes, yes, they are *slightly* different formulations, but FFS.) Similarly, they declined coverage on $450/mo Finacea foam, but paid for a generic $50 gel formulation of 15% azelaic acid. It's hard to blame the insurance for "suggesting an alternative."
When insurance changed, I stopped refilling my prescriptions for a couple of years. I use most of my energy for arguing with healthcare on taking care of Maggie. But I had a terrible breakout starting last month, and I knew exactly what I needed. I called the dermatologist. Another four month wait for an appointment. So I went online to my insurance website which referred me to a Telehealth visit—it says skin care right there on the website! I paid, made the appointment, and within 10 minutes I was talking to a doctor. Except it turns out that the harried doctor seems to have wholly misunderstand my need. He sent a prescription to the pharmacy for a 7 day course of doxycycline rather than ongoing low dose doxycycline. That is NOT what I needed.
Soooo... I went online, uploaded more bad selfies, and for less than the cost of the Telehealth visit, I am getting enough low dose doxycycline to get me through to my dermatology appointment. Again, insurance won't cover this.
General Health
After my mom and my brother died in quick succession, I figured I'd better go at least get a physical to see if my heart was about to give out too. It took—I shit you not—a year and a half to finally see my doctor. When I initially called, the "first available appointment" was—you guessed it—four months out. Then he went on medical leave and the office kept postponing every couple of months. After a YEAR of this, I explained that I really needed an appointment to get my blood pressure meds renewed, and I finally saw someone else in the office to get a quickie blood pressure check and routine blood work.
Mental Health
In the mean time, I was, not shockingly, depressed. I went to find a therapist, and the few who were accepting my insurance and accepting new patients had—you guessed it—a four month wait. So I went online again and got a prescription for an antidepressant from a company that does not accept insurance, but will provide prescription meds through the mail within a couple of days rather than waiting months to see a doctor. Another $49/mo out-of-pocket for generic Wellbutrin XL, which would be entirely covered by the insurance if I could just get in to see my own doctor. *sigh*
Weight Loss
In the interim, I got a lovely letter from my insurance saying they would subsidize weight loss programs, including Noom. So I signed up for Noom, and, what with my aforementioned high blood pressure and tragically demonstrated family history of heart disease, I fit the diagnostic criteria for weight loss drugs. They shunted me into their new Noom Med program, and for $400 (partially paid for by my insurance!), I got an appointment with a nurse practitioner, orders for some blood work, and then a prescription for Wegovy. To my utter astonishment, my insurance approved it!!! Only...there was none to be had because of the shortage of injectors. I waited six months with the pharmacy saying every two weeks that they had placed a special order. Then my insurance changed again, and the new one was not paying for any part of Noom Med, and there was no guarantee they would pay for the Wegovy when Noom requested pre-authorization. Oh well... Guess I get to stay fat.
Except that if you care to, and can afford it, you can pay $200-500/mo out-of-pocket for compounded semaglutide, the same drug as Ozempic/Wegovy but without the nifty injector, through any number of dodgy websites with minimal medical supervision.
Erectile Dysfunction
All of the above applies to erectile dysfunction meds, though this is clearly not a problem I have.
Summary
It is easier and faster to pay out-of-pocket, without seeing a doctor, for prescription drugs that SHOULD BE COVERED THE INSURANCE, WHICH I DO HAVE AND AM PAYING A FORTUNE FOR!!!
Best healthcare in the world, eh?
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