I am a 57-year-old white American male infected with Hepatitis C. I am involved in a controlled medical research study by Roche Pharmaceuticals of an experimental Polymerase Inhibitor (RO5024048 also known as RG7128) drug therapy for the virus. This document is the story of my illness and the experience of treatment. My lovely and pretty damn wonderful wife will be contributing her take on the experience as well.

Wednesday, December 8, 2010

Another Day Another Insurance Functionary

It is amazing how exhausting phone conversations with health insurance bureaucrats can be. After composing and sending several emails, I hit the phones to try for more direct answers concerning the details of the potential coverages available to me. I talked to a number of folks who ran the gamut from clueless, bewildered, helpful but clueless, helpful but wrong and helpful and possibly correct. The problem is that determining the difference between the final two types, helpful but wrong and helpful but possible correct is neither easy nor readily apparent.

After sending a set of detailed questions to my HR department, they punted me further on to the insurance broker who handles our account. They were nice folks and quite helpful, but the insurance plan drug formulary comparison tool on their website indicated that Neupogen and Ribavirin were not in either the Blue Cross or the Healthnet formularies. I found that a bit hard to believe as both are large health care providers and must have more than a few Hep C patients. I managed to track down the pdf file of the actual Blue Cross formulary updated as of November, 2010 and all the drugs I am taking are in their formulary. Naturally, this does not raise one’s confidence level about the quality of the answers to the other questions I asked.

The two other questions I asked were about the drug copays for specialty drugs and any special tasks I needed to complete to insure continuity of care. The drug co-payment information they provided was straight out of the handbook and concerned the difference in co-payments between generic and brand name drugs, it did not address the specialty drug question. It may not even be an issue, but, again, it’s all up in the air until the actual paperwork goes through.

As far as continuity of care: heck, not a problem. Just let everyone know as soon as possible that the change in plans is occurring, get them to write new prescriptions for everything you take, get authorizations from the insurance company for all of them and have it all happen before any of the current scrips run out. Oh, and have it all happen during the highly productive holiday season.

If only they could switch the open enrollment period to some other time of the year...Ho! Ho! Ho!

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