Open Letter To Express Scripts

Who the fuck do you think you are?

I don’t know what kind of pencil-neck, paper pusher you are.  I don’t know how many years of experience in your fucking job you have.  I don’t care if you can say that you personally saved your shitty company and their greedy fucking shareholders millions of dollars.  What I do know, is that if you make the decision on what medications you will and will not cover…you should kill yourself.

That’s right, motherfucker.  Take one for Team Humanity, you soulless, evil, greedy, egotistical waste of DNA.

In case you don’t know me, I am a cancer survivor with a shit-ton of damage from the cancer itself, the chemotherapy, the stem cell transplant, the Graft verses Host Disease, the medications used to stop it, the prophylactic antibiotics & antivirals used to prevent infection due to my immunosupression, the medication I continue to take for those reasons, and on, and on.

One of the most debilitating issues is the peripheral neuropathy that I acquired from the chemotherapy, and possibly from the Cipro that I had to take during nadir.  I bet you don’t even know what fucking nadir is, do you, you fucking bean counter?  Nadir is when your counts are at zero.  Zero white blood cells.  Zero platelets.  Zero red blood cells.  I had transfusions of red blood cells and platelets all the time, but you can’t do transfusions of white blood cells.  So I lived without them.  For months.  Could you do that?  I fucking doubt it.

So when I saw my brilliant oncologist (one of the world’s foremost experts in bone marrow and blood stem cell transplants and the patients who have them, who works as part of the center that fucking PIONEERED them), & let her know that my neuropathy in my feet is so bad (particularly in the cold) that I can barely walk some days, she prescribed Lyrica.

And you sent her a questionnaire asking her why.

And I waited.

And she filled out the questionnaire explaining her reasoning for choosing to prescribe that particular drug for me.

And I waited.

And you sent her another questionnaire with more questions.

And I waited.  And my fucking feet hurt.

And then you sent her office a denial notice.

You, some fucking desk-jockey at (since your merger with Medco) what is basically a monopolistic prescription coverage insurance provider.  You, after receiving my brilliant doctor’s explanation of why that drug was prescribed over the cheaper alternatives, you denied coverage.

I guarantee you, you do not know one-tenth the information about the effectiveness, and consequences of the medications I’m prescribed as my oncologist does.  If my oncologist gives you reasons the cheaper alternatives would not be in my best interest, she is right.

Remember this argument as a reason single-payer, government administered health care was a bad idea?  Because government “death panels” would be overriding the decisions of the doctors?  Well, wouldn’t that be better than greedy, private monopolies, beholden to their shareholders only doing the same fucking thing?  At least the government doing it would have made the process cheaper.  And, usually, if my brilliant oncologist gives a reasonable explanation of the necessity of something, the government bureaucrats believe it.  How do I know this?  Because part of my medical coverage is Medicare.  Medicare tells you upfront what isn’t covered, and if they initially deny something they do cover, or ask questions, and my doctor explains what the need is, they are intelligent enough to yield to the decision of my doctor.  Express Scripts doesn’t flat-out not cover Lyrica.  No, Express Scripts will, if you have tried the cheaper alternatives first, and they didn’t work.  Even if this cheaper alternatives will kill you.

So the private, near monopoly (for group coverage) death panel decides for you.

So, my options at this point are to either risk my life taking their preferred medications, or suffer with the crippling pain and numbness.

Yes, taking these medications is a risk to my life.  My white cell count is low.  Borderline low, but low.  My neutrophils are just above what could be considered neutropenic.  My world-class oncologist advises me that the alternative medications are known to be toxic to my white blood cells.  Since you, Express Scripts worker obviously are too stupid to understand the implications of that, I will explain.

Despite what those dumb probiotic commercials claim, 70% of your immune system is not in your gut.  (Don’t believe me?  Ask someone with full-blown AIDS.)  It is in your blood.  Your various types of white blood cells.  Sure, the microbes in your gut may protect you from food-born illness, but it does not compromise 70% of your immune system.  So, basically any drop in my white cell count further compromises my already compromised immune system.  This leaves me at an extreme risk of infection, and a higher likelihood of death.  The cheaper alternatives you are trying to force on me, can kill me in that way.

But wait!  There’s more!

Due to the side-effects of some of the other life-saving medications I needed to take, I have kidney damage.  I’d call it renal damage, but you probably couldn’t understand that, so let’s stick to basics, shall we?  The cheaper alternative medications you require, also are known to damage kidney function.  And this isn’t just to people with impaired kidneys, this is for healthy people too.  Even Lyrica has this possible side-effect, but at low-doses is known to be less harmful.  Known by who?  Well, there is my world-class oncologist, the pharmacist she consults with, and oh yeah, the drug manufacturers themselves.

Why does Lyrica exist, if these other medications are safe and effective?  They aren’t safe and effective for everyone.  This medication is more advanced, newer, and as a result, more expensive.  But do you know what is more expensive to your company than paying for this drug?  Bad publicity.

You have just started a fight that your legal department, PR teams, and representation on retainer give you the illusion that you can’t lose.

But, you started a fight with someone who beat cancer.  I’ve already won a fight I was told I wouldn’t win.  I’ve been against the ropes and down on the mat, & everytime, I got up and knocked my opponent out.  I’ve got some wounds, sure.  But I’m only getting stronger, and once I fight, I don’t stop.

Eat shit and die because your insurance won’t cover the medication necessary to treat your infection from eating shit.

Most sincerely,



Author: Josh Wrenn

Cancer survivor, wanna-be artist, musician, author, and all around good guy.

30 thoughts on “Open Letter To Express Scripts”

  1. If you think this sort of nightmare is unusual, wake up, people. This IS managed care. It’s the house refusing to pay when it lost. It’s about greed running over Healthcare, every day. It’s corruption made legal. When it runs you over, don’t tell me you’re surprised. Please. You get what you pay for. I’m telling you what you’re paying for: you’re betting against the house, and it’s all rigged. Healthcare insurance is a casino without any rules, except Make The Most Money Regardless Of Consequences. You’ve been warned.

    Liked by 1 person

  2. Here is a link to a petition asking Express Scripts to change their practices. It is not quite as vitriolic as this post. []


  3. You hit the nail on the head my friend…these demons must be called out and eliminated from Mother Nature’s realm!!!! How dare they harm Her children and think they will get away with this….WOE TO THEM♥♥♥♥♥♥♥♥♥

    I send you Love & healing thoughts….


  4. ‘beam counter’ LOL! I know what renal means because I’ve had a lot of kidney stones. Drinking a lot of clean water every day solved that problem for me. I thought Lyrical was for Fibromyalgia. Shows what I know…

    I’m a firm believer in coaxing the body to fight for itself. Have you heard of PQQ? It’s a co-enzyme that put catalyzes 20,000 actions your body takes for your protection when taken in combination with Co-Q10 as compared with Vitamin C which only catalyzes 4. The research is human tested. It produces new Mitochondrial DNA from dying cells, and mitochondria doesn’t have the protective shielding membrane that cell DNA has. What’s your diet like? Mushrooms and garlic boost your immune system.

    It know it all sounds fruitless to you but please take heart. I’m a Minister and I’m in good with the guy upstairs: ‘Ralph Nadir!’ LOL! I will pray for you long and hard my friend! And I completely agree that beaucratic red tape should be used to cover their mouths… I see you’re definitely a fighter, and I’m confident you will get well!


  5. Lawyer up, buddy. Fight for the care you deserve. There are patient advocacy centers that can help you with your fight (I’d recommend starting with them, because I used to work for an attorney doing health and disability insurance law and I can tell you that an attorney hired on your own will cost you a fortune). Check out or and see if they can help you. Be sure to get a copy of your policy or plan document (if your insurance is through work, that’s what it’s called), and pay attention to any deadlines to appeal mentioned in the denial letter. Good luck. Fuck them.


  6. Just read another of your posts and I think your insurance would still be covered by ERISA because you originally got it through your employer. Be sure to mention that when/if you contact one of the patient advocacy group. And really, really, really pay attention to appeal deadlines if that’s the case.


  7. Great work Greg.

    The local hospital here has garnished my daughter, a single mom with three kids under six,so that she had to quit her career at the research center. Two days before Christmas Radiology associates served us papers late one evening.

    How in the hell could you choose a job delivering news like that. Must be desperate.

    Here are a couple of articles. This shit is starting to get the light of day.

    The hospitals here are the biggest collection hounds in town by far. Mthe same emergency room doc trying to save your life will throw you out on the street for his money six months later.

    Healers they are not. Gillian’s they are becoming.


  8. Update: As expected, Express Scripts did not change their decision. Their social media manager contacted me this morning and basically told me I could appeal the decision (I already knew that, thanks.) They did not take into account the safety concerns my doctor has, and did not even take into account the extra cost the decision will place on the insurer they administer for.
    Here is the email I sent, name of insurer omitted:

    Yes, I didn’t expect any help. 

    You can believe their will be an appeal.   Just because my provider has resorted to a lower dose as a POSSIBLE way to mitigate the damage Gabapentin will cause to my already low blood counts, does not mean it is the best course of action. 

    This decision actually costs the insurer money (since (company) is self-insured and you and UHC only administer their plans) because (company) will have to pay for the additional monitoring required, as well as the Neupogen shots should I fall into the Neutropenic range. 

    Furthermore, once this medicine at this dose proves to be ineffective, (company) will STILL end up paying for the Lyrica (an almost certain inevitability), & the only thing that is gained is more suffering on my part in the mean time, as well as possible danger to my health. 

    The bottom line here, is that my doctor prescribed this medication for me, for a REASON. 

    I am beyond frustrated at this point.  You better believe there will be an appeal. 

    Please do not contact me again. 

    I will continue to share my opinion of this decision and your company, until everybody knows that we are living under corporate managed care and their doctor’s decisions are being overridden by the wishes of shareholders. 

    How do you sleep at night?


  9. Whew! As if it weren’t bad enough to have medical problems, you have to fight an massive damn corporation single handed as well.

    Over here in the UK, the government has introduced all sorts of privatizations into the National Health Service on the grounds that it will make it “more efficient.” I could just scream. I’m an American and my partner used to work in the American medical system, so I’ve seen the “efficiency.” The National Health System isn’t perfect–what is?–but it’s rated at the top of the scale for both good care and cost–way above the system in the U.S.

    Liked by 1 person

  10. It’s an outrage—especially given the fact that so many of the people who want to shove for profit medicine down our throats are cheering net neutrality. I’m cheering it too but I also think that letting unregulated capitalism run our nations health care system is a rotten idea. If you don’t trust your bandwidth to capitalism why would you trust it with your health care?

    Liked by 1 person

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