Apparently those folks in HR went to medical school and know exactly which prescriptions are best for me. I kid you not. That's pretty much what my insurance company told me. And if I want my prescription covered by some silly ol' insurance policy then I have to go to HR and ask them to please put it on the list. And if they feel like it, they can. Really. I'm not making this up.
Yesterday I finally had the long-awaited medical follow-up wherein I learned that I don't have cancer but I do have some pesky but common female-getting-older issues. TMI for my male friends so I'll stop there. Suffice it to say my Doctor prescribed some pills. Brand name. She warned me there is a Generic equivalent but that it wasn't the same and was missing, for my issues, a key ingredient, and thus she wanted me on the brand name.
Red flag - red flag - red flag - "Danger Will Robinson." Prescribe a brand name and try to get insurance to pay? Ha ha ha. So I called my insurance company to check before I did anything stupid like listen to my doctor and fill the prescription.
Turns out for a mere $45 copay for the "third tier drug" (aka "unfavored" b/c it's a brand with a generic equivalent) plus the difference between the generic and the brand = a mere $120 a month for my new drug.
But wait, can't the doctor write an exception notice or something to the insurance company and explain why the generic equivalent is a mere equivalent and not going to work for me? nooooooo.
If I want the brand name drug, I need to take myself down to HR, locate the person responsible for choosing our plan, and share with her/him the intimate details of my medical health and history and why I need this particular pill and why he/she should add it to "the list."
Does my medical company understand the difference between a generic equivalent and a generic equal? Apparently they don't care. There is no mechanism to override the approved drugs on HR's list choosen by those HR folks with an apparent medical degree.** My doctor does not know what's best for me medically. According to Insurance Company, only HR does.
So my response to the insurance company? "I don't think I'll fill this prescription. Instead, I'll go to the doctor Every Single Month, pay my co-pay of $25 and let you pick up the other $175+ while the doctor monitors my ailments and explains why the drug she prescribed would make me feel better and see you next month (and give me a free sample)." Somehow I think paying for my silly drug would be cheaper for them. And my snarky comment might've put me in the red on "kindness" points....
**This is not a diss on HR people. I understand that they have a job and guidelines and are likely quite knowledgeable about the statistics and choose drugs based on the good of the people in the company as a whole as balanced against costs. and the fact that my insurance company does not have an override mechanism is not my HR's fault. But the result from my silly insurance company's policy is that my HR person's choices trump my Doctor's recommendations. and THAT is the target of this rant. Believe me I love my HR people.