I Need a Doctor's Prescription for Elastic Now?

What's happened with getting medicine when you need it?

When I was a small child I can remember being sick—or better yet my sister being sick. An early evening call would go out to the pediatrician and about an hour later, at seven or eight o’clock at night, the doorbell would ring and a man from the Kaegel drugstore in Webster Groves would be there with medicine.

Later, on weekends, I delivered prescriptions for the Shumate Prescription Shop on East Lockwood in Webster. (I liked to date girls and that usually required money.)

The Shumate delivery car was a yellow Ford Maverick. Sitting on the roof of the car was a giant lighted plastic mortar and pestle. A real girl magnet!

However, I liked the job of getting prescriptions to people who needed them. People who got medicine on a regular schedule almost became friends. The only downer was delivering cancer drugs. I knew the customer was probably going to die.

Back in 1970, that job paid $2/hr. There were no tips involved either, since it was an expected service from any drug store.          

Now, I pay for Blue Cross and Blue Shield insurance. Suddenly, the plan will not pay for a cholesterol prescription I have been taking with excellent results since a heart attack in 1995. So I either must switch to a different medicine that is maybe only 75 percent as effective or pay for the drug myself.

Fortunately, I am in a position to pay for the drug myself. I also got my doctor to prescribe a dose that is four times stronger than what I was taking. That way I can get one 3-month prescription, cut the pills in quarters for a one-year supply.

Let's try mail order

I recently called the Walgreens mail order pharmacy and spoke with Katherine. I told her my plan would not cover the medicine. She said she would look up the costs. Her next words were not a good sign.

“Oh wow,” she said, then paused and added: “This is really expensive.”

Katherine suggested I go online and get a manufacturers coupon. I did and called back.

I told the person on the phone that my plan would not cover the prescription and I’d pay for it, but I had a manufacturer’s coupon. I gave her the information and she said the medicine would be on the way. I even got an email saying when it would be shipped.

It didn’t arrive. Instead, I got a letter saying the medicine is not covered by my Blue Cross insurance. This is something I already knew.

I called back and decided to go directly to a supervisor. I explained my insurance didn’t cover the medicine I wanted and I would simply pay for it. I mentioned that I had a coupon and he took the coupon information. He said they would be sending the medicine. This was followed up by an email saying the medicine was on the way.

It didn’t come. Instead, I got a letter saying Blue Cross drug plan did not cover the medicine.

I called back and got a new supervisor. He discovered the problem. The manufacturer’s coupon was not good if I paid the entire cost. It was only good if I had a high insurance deductable, not if I was paying for the whole thing.

I said fine, and 90 tablets of Lescol 80mg costing $651 finally arrived a month after I first called.

I decided next year I was taking the Lescol prescription to a local pharmacist, a human that I can talk to. This "new way" of getting prescriptions has forced me to go back to the old ways.

My next new-age prescription issue involved elastic. Even before I had the heart attack, quit smoking, and got fat, I was diagnosed with sleep apnea. (I would stop breathing during the night, wake up sucking for air. I was keeping my wife awake with worry.)

I got a breathing machine known as a CPAP (Continuous Positive Airway Pressure) machine. You go to a sleep clinic and then your doctor writes a prescription for a setting on the machine.

An elastic headpiece keeps nasal plugs or mask in position. Over a period of time the elastic gets stretched out and needs to be replaced.

This year, I went to the office of the machine's distributor, in Olivette.

Wrestling over a $130 elastic band

I told them I needed a new elastic headpiece. The woman at the front desk asked for my prescription. I said I didn’t have one. She said I needed one. I asked her when did elastic become a Scheduled Drug in the State of Missouri. She said the insurance companies and Medicaid would not pay for it without a prescription.

I asked to speak to a supervisor. The supervisor said I needed a prescription. I finally got her to admit that I could pay cash. The cost for the elastic headpiece was $130 with tax.

I could have gone back to my doctor in Chesterfield, which would charge the insurance company for an office visit, and also paid my deductable for the visit—or simply hand over $130 plus tax to that supervisor.

Thirty-five minutes later they reluctantly accepted the money, and I left with some new pieces of elastic.

In summary, so far this year I've learned the mail order pharmacy doesn’t want to sell me expensive medicine that I have a prescription for, while a medical supply company doesn’t want to sell me some elastic without a prescription. 

With issues like these, the health care system is hopelessly messed up.