This evening I learned something after some rather dogged persistence on my part in regards to getting coverage for one of my medications. My medication is classified as a Tier 4, Non-preferred Drug which is why I have a copay of 47% of the retail cost of the drug. So since this drug is medically necessary after having tried several different medications, it is up to my outpatient psychiatrist and her attending psychiatrist to draft up the appeal to have the medication re-classified as a Tier 3 drug which will bring the copay for 90 days to 110.00. This is a lot more reasonable than thousands of dollars out of pocket.
It took hours on the phone with both WellCare, my prescription drug coverage company, and Sunovion, the drug manufacturer to finally understand this. Neither company wanted to tell me that my physician had the ability to argue for and obtain the necessary authorization to reclassify this drug. I actually had to ask WellCare what the procedure was. Unfortunately, America is a country of capitalism and everybody wants their cut. This is a simple fact of life for the working class here in the United States. It takes persistence and emphasis that I won’t go away until I have an answer or at least clarity.
I see this as really good practice for when I become a social worker and I have a patient whom is unable to advocate for themselves because they are in the throes of mental illness. This is what a licensed clinical social worker is – an advocate. It is so rewarding doing this work simply for myself and not taking no for an answer. I will still need to develop good organizational and time management skills but this is within the realm of possibility if I ask the right people for advice and tools for making this happen.