How hard it is to get prescription drugs

I have a friend who takes a prescription for a seizure
disorder, that if she doesn’t take it every day she could well
die, if she has a seizure at the wrong time. She has a rant about
how any drug without major public health consequences should be
available over-the-counter to anyone who thinks they need it. She
is unusually good at dealing with complex systems, and she still
has problems if she goes on vacation or changes insurance
companies or whatever.

The insulin I take for my diabetes isn’t in quite that life-sustaining
category, but the health care providers I talk to do claim that
it’s pretty important to take it every day. But that’s not what
the people who work in the system for getting me refills when I’m
out seem to think.

Here’s the system.

  1. When I go to the pharmacy, I get a vial with 1000 units of
    insulin.
  2. I inject myself with, currently 45 units of insulin, every
    day. I’m supposed to modify this if necessary, going up if my
    blood sugars are running high, or down if I’m getting low blood
    sugar reactions. The last time I talked to my doctor, I was
    taking only 40 units, but I upped that after getting my
    haemoglobin A1C result from that visit.
  3. When I point out to the pharmacy that 1000 units is not a 30
    day supply, they explain that the shelf life of the insulin is
    only 28 days, so they don’t want to give me 2 of them, so
    they’ll just give me another one a little sooner. Usually this
    works.
  4. However, the prescription is written for 1 year or 12
    refills. 12 refills takes noticeably less than a year.
  5. So last Monday, I called to get a refill and the computer
    told me that I didn’t have any refills left, and it would notify
    my doctor that I needed a new prescription.
  6. This usually works, but this time, whoever processes these
    requests (I think not either a doctor or a nurse, so it’s quite
    possible that this person didn’t even know that Lantus is a form
    of insulin) decided that they couldn’t really need a new
    prescription, because it was under a year since I got the old
    one. This seems to be the real breakdown in the system — if I
    say I need insulin, and the pharmacy says they need a new
    prescription, the system maybe should allow this person to argue
    with the pharmacy, but certainly shouldn’t allow them to just
    ignore the request.
  7. Three days, and about a dozen phone calls later, I talked to
    a nurse, and finally got her to agree to get the doctor to write
    a new prescription.

This has nothing to do with Obamacare, because this problem has
existed in some form for at least a decade. It probably isn’t
really related to government health care, although the Cambridge
Hospital Association, which operates both the pharmacy and the
clinic in this story, is funded in a major way by the city of
Cambridge. My friend with the seizure disorder isn’t using
government-operated healthcare any more than anyone else in this
country.

But I have been hitting this problem for a decade, and every
time I hit it, I mention to my health care provider that the
system seems to be screwed up. Most recently, I told the nurse
who finally got me the prescription, and she said she understood
my concerns, but not that she knew of any way to address them.

So it’s probably time to call or write someone else. You can
consider this a rough draft of that letter.

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