Large corporations must be held accountable for unnecessary obstacles hindering patient well-being. Upon discharge from the Intensive Care Unit with a sepsis diagnosis, Patient X received a prescription for Monurol, a drug with no generic and no substitute. Having many known drug allergies, Patient X needed this to recover and overcome sepsis. Taking the prescription to Walgreens, the Patient X’s preferred Medicare pharmacy provider, led to a series of events I have never encountered. The pharmacist refused to accept the written prescription, stating that Medicare would not cover it and that she was following “protocol.” I assured her that I would get it covered, but she emphatically reiterated that it would not, and she insisted that I take back the prescription. I asked her how much it would cost if Medicare denied it. It would cost $1,025.69 for three doses as shown below.

Feeling confident that I would prevail, I took the written prescription back. The following morning, I notified the office of the wonderful prescribing physician and asked that they request an exception from Medicare. They promptly complied. Checking back later in the day, I was told nothing had been received from Medicare. I, then, entered the fray. Spending an inordinate amount of time on the phone, on hold, being transferred, and being given other numbers to call, my quest became more urgent. In the meantime, I searched the Internet for other options. I found several pharmacies that had the drug in case it did not get approved. Wegmans and others had it for $99 per dose with GoodRx. I took it to Wegmans, where I could pick it up the next day.

Back to my Medicare marathon phone call, I finally reached a representative in the Medicare Part D, Optum Department. Without hesitation, I was told, “Seven-day turnaround for review.” With that, I asked him to spell his name in case Patient X passed away. Under the cause of death on the death certificate, it would have Medicare Part D, Optum, and the agent’s name. Like magic, the agent asked me to hold for a moment and then told me, “If you want to save the life of the patient, have the physician’s office call and escalate the request to priority status, urgent.” I did so, and the office kindly obliged. Shazam! The next morning, I received a call that it had been approved in record-breaking time. The copay is $117.

If this did not provide enough angst, my next experience emphasizes the need for large corporations to concentrate on assuaging the anxiety of already anxious patients. Adding additional stressors to patients dealing with chronic illnesses causes great harm.

My second hurdle to overcome was the LabCorp debacle. It is regarding the same Patient X with another unnecessary and formidable challenge. An electronic submission of a prescription for lab work was sent to LabCorp. There was a crucial window of time that existed because of a follow-up appointment with the referring physician. Being extremely immunosuppressed, Patient X arrived at LabCorp only to be told that he/she was not in their system. While in a crowded waiting room, Patient X was thwarted in every reasonable attempt to resolve the issue at hand. As the advocate, I intervened and spoke to the representative. She told me that she was following “protocol” and that the test could not be performed. In addition, she told Patient X that the prescribing office would now need to fax the request. I spoke to the physician’s office, and they did everything possible to quickly mitigate the dire situation. Clearly, the physician’s office was able to pull up the electronic entry without difficulty.

Finally, after being stressed, mistreated, disrespected, and marginalized, Patient X received the test. LabCorp’s agent delayed efforts to address and correct the problem. The struggle is real! After this occurred, I called the office of the top administrator, only to reach the complaint line, telling me to leave a message, and my call would be promptly returned. I heard nothing, so I called the following Monday or Tuesday. My language was somewhat stronger this time; perhaps, they feared I would go public with the information. Regardless, I received calls within minutes. Those with whom I spoke offered apologies and agreed that the errors were egregious. My response was to address the issues. Delving deeper into how and why this happened, I was told that staff needed to be better trained and that these were ongoing problems with respect to the electronic submission glitches. Knowingly having an ongoing software issue is unacceptable.

Large corporations must be responsible for helping, not harassing, the public to seamlessly navigate the turbulent waters of healthcare in today’s landscape. Further compromising the well-being of immunosuppressed patients and the public at large needs to be addressed immediately. Price gouging and system errors cannot continue to rob us of our health. Additionally, I would suggest calling LabCorp prior to showing up to make sure your electronic prescription is in their system. Till next time, be well!