Thursday, April 19, 2012

Dear Doctor

I had a doctor appointment yesterday for an annual physical.  I am in fair health, for someone who drew my numbers in the genetic lottery.  My dad and mom both have GERD, and I got it in spades.  My insurance company has decided that Nexium is too expensive, so they are jacking around with my coverage to discourage me from taking it.  Here is a letter I just wrote to my doctor, which is a follow-up to the discussion from yesterday, when I didn't have the letter from the insurance company.

TO:         Dr. Doctorlady Withglasses
FROM:  GDad Lastname
RE:          Discussion from 04/18/2012 about Nexium vs. insurance coverage
PAGES: 2 (this cover and attachment)

Dr. Withglasses,

Attached is the letter from my prescription coverage plan advising me that I need to consider alternatives to Nexium in order to keep coverage.  I see that I failed to discuss this with you before April 1, as the letter mandated, but we’re close.  I spoke to Kelly at CVS/Caremark this morning, and she told me that I must have you call to provide a pre-authorization to ensure that Nexium is medically necessary.

Item for discussion next time I see you – How is “pre-authorization” different from your prescription?  Isn’t the act of writing a prescription regulated to the nth degree already, and don’t you, as a doctor, have what amounts to a sacred trust to keep your patient’s medical needs in the forefront?   Kelly seemed chipper until I questioned this, then she was a bit curt with me.

In any case, if you could do me the favor of calling CVS/Caremark to provide a pre-authorization for GDad Lastname regarding my Nexium prescription, I would greatly appreciate it.  If you think another route is medically advisable, please let me know.  The CVS/Caremark number is 1-800-[redacted].


GDad Lastname

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