Nausea, dizziness, weight gain: potential side effects included in the familiar fine-print or briskly spoken warnings that accompany prescription drug adverts. What those warnings fail to mention is that additional suffering may occur when attempting to obtain the prescription and then have it filled. With the number of parties involved in the process, the possibility of the ball—or pill—being dropped along the way is significant.
As the father of 2 special-needs children, I’ve become adept at communicating with those parties, which include physicians, insurance providers, and pharmacies. Despite my skills, I am routinely frustrated by how widespread the deficiencies are and how frequently they must be addressed. Granted, my circumstances aren’t typical, but I am aware that the process can be challenging for those with more straightforward scenarios too.
To no one’s surprise, shortcomings in communication, training, and technology cause the most pain. What has surprised me is the simplicity of the issues, the fact that they are not anticipated, and the relative ease with which they could be rectified. My family’s recent transition to a new health insurance provider is a real-world example of how and where these deficiencies can manifest.
My teenage twin sons are prescribed the same medications, one of which is available only through a specialty pharmacy. They’re covered by a primary health insurance policy offered through my employer and a secondary policy provided by the state in which we reside. I’ve had the medication filled by the specialty pharmacy for the last 6 months, each time requiring a telephone call. I’m unable to refill the prescriptions online because my contact information is associated with both boys’ records; apparently the system becomes confused when the same contact information is tied to multiple accounts. This particular specialty pharmacy is also a subsidiary of a larger pharmacy, through which all prescriptions are verified. Amazingly, their CRM systems are not integrated, which means that preauthorization and other pertinent prescription details are often missing or unavailable.
This means monthly refill calls are a recurring nightmare.
I begin by identifying which son the call is regarding, and since they’re twins, they have the same birthday; this usually confuses the representative handling the call. Next, I confirm that both the primary and secondary insurance policies are on file, and invariably, the secondary has been omitted. Once I’ve provided the policy details for them to reenter, if the representative is able to do so, I confirm the medication I am refilling. But alas, the preauthorization is often not in their possession despite the fact that I’m requesting a refill.
It’s a refill, so the prescription has already been preauthorized. And preauthorizations for this medication last for a year. I know, because I’ve checked. More than once.
At this point, the representative must either do some troubleshooting or speak to a supervisor, both tasks that result in being put on hold for an undisclosed amount of time or arranging for a return call. I usually choose to stay on the line because the last 3 return calls never arrived.
I often suggest that the representative refer to my other son’s account for clues, because more than once, details have been attached to the wrong boy. If I’m lucky, the delivery of the refill is arranged during that call, which is a challenge in itself because the medication is perishable and a signature is required upon delivery.
One boy’s refill completed. Now onto his brother’s…
I failed to mention the part where the specialty pharmacy that my previous health insurer used decided to fill the same prescription during the 3 weeks between the old insurance policy ending and the new policy taking effect. But they shouldn’t have. Our secondary insurance would have covered it.
Instead, the pharmacy submitted it to the primary policy, which approved the refill despite the policy being cancelled nearly 2 weeks prior. If the primary insurer would have denied the claim, which one would expect, the pharmacy would have submitted the claim to the secondary insurer…if they hadn’t omitted or misplaced the secondary insurer’s information…which they had.
So, I got a bill for $9,000 from the primary insurer.
That’s twice the cost of the prescription, nevermind that it was their mistake. They had combined the cost of both boys’ meds and listed it under 1 claim instead of 2. It is now my responsibility to collect all the proper documentation—from both the primary insurer and pharmacy—so I can submit it to the secondary insurer who will hopefully reimburse the primary insurer.
It didn’t take many of these calls for me to become an expert or at least acquire a better understanding of the process than those whose job it is to facilitate. So why hasn’t the industry yet recognized these failures and fixed them? Is it not worth their money, or are they just not patient enough to take the time to learn the patients’ journeys?
At Fingerpaint, that’s our objective, to recognize the journeys of our clients, healthcare providers, and the people who rely on their products. We identify the pain points (pun-intended) and help them communicate with each other in the most effective and meaningful way. And we do that by spending time with them, understanding their perspectives, learning about their needs, and listening to their desires. Because to us, business is personal.
While I don’t expect the problems I’ve been experiencing with prescriptions to be solved overnight, I’m confident the painful side effects won’t be chronic. I’ve observed physicians, insurers, and pharmacies that are more willing to listen, and I hope they’ll also be willing to respond to what they learn by investing in new and insightful solutions.
Jonathan Richardson who works out of our Scottsdale office, is an experienced copywriter with a deep appreciation for rich context. He complements Fingerpaint’s medical expertise with a strong patient and family perspective—inspired by his teenage twin boys with special needs. Jonathan has a keen interest in healthcare trends and writes with the goal of creating emotional connections with readers.