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.