Sunday, November 17, 2013


This is NOT about Obamacare.  When I even say that word, people froth at the mouth, bleed from the nose, and become incoherent.  This is about Bush’s version of health care insurance, which was Plan D, a pass-through subsidy that greatly benefits the Mega Pharm industry entwined with the Mega Insurance industry, and helps a few real people along the way.  Former President Clinton reminds us that its start-up was as rocky as Obamacare’s, but not attacked so violently because it benefitted the rich as in corporations.  It is REQUIRED.  One can’t opt out.

Plan D is the insurance that pays for drugs, in my case Metformin and Benazapril/HCT2.  One pill of each (both low dose) once a day.  The justifying blood analysis in both cases is right on “the line” which is the score the doctors use to define who needs the drug and who does not.  If I walked a few miles a day and lost twenty pounds, I probably would not need either drug.  My diet is pretty irreproachable: no sugar, no white flour.  Lots of veggies.  My own muffins loaded with nuts and fruit.

Here I am, an active senior in a small Montana town with a trusted pharmacist who works at a big box store thirty miles away and is very alert about filling prescriptions and finding generics or -- when my compounded benazipril/HCT2 was not available -- finding an alternative (1 pill of the benazipril and a separate pill for HCT2) until manufacturing caught up again.  Since our roads in winter are often much more dangerous than either diabetes or high blood pressure, the store mails me my prescription on request.  But if I ask for it too soon, it’s denied by the insurance company. Access is controlled by a computer.  So is the money.  There's a little window of time.

In the snail mail I’m always getting six or more pages from my Plan D Silverscript Insurance provider which was evidently bought by CareMark Insurance Company at some point.   There’s so much of it and I’m so passive about such things, I’ve always ignored them.  Until I realize now that I had racked up a bill with these people that exceeds $400.  I’m below the poverty line and have both Medicare Extra Help and BigSkyRX, which in theory pay all of my premium of $8.50 a month.  Evidently when CareMark acquired Silverscript, that ended -- not the subsidies, which continued, but where they were sent which changed from the company to me.  I just deposited them.  Now that I understand what’s going on, they go to the company as they did before CareMark.

My deductible at Silverscript is $325 a year, which I will not reach in 2013.  It used to be $76 or so.  My premium would be $31.50 if I paid it myself.  “ExtraHelp” from Medicare lowers the premium to $8.50.  I also get Big Sky RX which would pay the rest except that I’ve just kept the money, sorta wondering what it meant.  So I have racked up a bill with Silverscript of about $400.  They are happy to arrange payments, no interest.  Until I have a payment agreement with Silverscript, I will not be able to change companies.  There are several companies with deductibles about $30, even NO deductibles.

When Silverscript was bought out by Caremark there was a huge jump in the number of their clients plus records had to be migrated from one system to another.  I have experience with this challenge and INEVITABLY the information is corrupted and some of it is lost.  In fact, the problems with bookkeeping were so severe that Silverscript is “just emerging” from being sanctioned by Medicare.  They cannot take new clients.  It appears that because I made no proactive choice of Plan D company, I was assigned to Silverscript which has a deductible higher than the public cost of my drugs in a year.  Metformin would cost me privately about $40 a month and the Benazapril would be much less.   I called Silverscript to see how much THEY paid for my drugs . They are paying $2.71 for Metformin and $.47 for Benazapril PER MONTH.  Less than four dollars in return for a premium of $8.50.  Basically, my only benefit is that I get a negotiated price for meds.

It’s my own fault.  I have not been taking care of my own business in the way that a mature person ought to.  I’m not senile, I’m negligent.  In the end it was not the money that got my attention, though looking back at this pile of paper, I see that it’s all documented and I could have figured it out.  What got me focused was what I blogged about earlier:  they began to call in person, robocall, and mail letters accusing me of not taking my meds.  That was irritating.  They are not my doctor.  Their business is to pay, not to prescribe.  How is it that they can nag me about taking my pills but can’t call or write to see why I’m not paying my premium?

Now the tiny once-a-week Valier clinic, which I use because my little old pickiup doesn’t have many miles left on it and the roads are risky in winter, has lost its latest doctor.  This is not unremarkable except that this time there is no new doctor.  Instead we have a nurse practitioner.  That’s fine.  But she is young and, like many young women around here, still in school mode. (The schools here are orderly but not progressive.)  She looks at my blood test scores, sees that they’re borderline and doubles my meds as well as adding a statin.  I monitor this stuff closely.  No one has tested me for the side effects of Metformin. (I take B6 sublingually to compensate, though the doc was happy to give me shots).  The nurse-practitioner was not aware of the present controversy over statins.  

The doc, whom I liked, took the view that one could overmedicate pretty easily, esp. when old, and that the emphasis should be on diet and exercise.  (I’ve never smoked and don’t drink except for champagne at weddings and expensive Scotch on great occasions.)  She left with her physician husband without notice, which is not unusual.  (Doctors in Montana are a different blog to write some day.) 

I cannot tell you how suspicious and paranoid I am about Big Pharm.  IMHO it’s a racket preying on the unsuspecting with the collusion of Big Insurance and -- ultimately -- Big Government Oversight.  That last word is the tricky one -- a double-meaning: supervision or ignoring. 

My first task was to stay sane.  I envisioned Silverscript/Caremark somehow taking my debt out of my monthly $800 Social Security check, leaving me only a few hundred dollars to live on.  Don’t tell me this wouldn’t happen -- similar draconian decisions have been made in the past.  But a woman poorer than me said, “Oh, all they’ll do is put it on your bill.”  Not so long as they have a regular check to garnish, even though there may be safeguards on things like that with Social Security.  And the national climate is beginning to change in a harsh way:  we are bringing back debtor’s prison.  Once again it’s a crime to be poor.

My second task was to work the phone, which is what I spent the morning doing.  The number on the back of the Medicare booklet that directs one where to call for help was a total bust.  It went to a local office staffed by volunteers who wouldn’t talk to me.  The call to Silverscript was certainly enlightening, though the person who answered clearly didn’t expect the kind of questions I asked.  BigSkyRX was terrific.  At last someone who would draw back the curtain and stop trying to diddle my Social Security.  The next step is to negotiate payments with SilverScript so that I can change to a different company before December 7.  That’s a whole new blog post.  I'm not in danger of running out of material.

1 comment:

Anonymous said...

This information is enlightening for people who do not use
Medicare or Bush's Pharmacare.
It belie's the claims that the poor and undeserving are getting too
much for free. Keep it coming.