For those of you, like me, who are optimistic that health care reform (AKA "ObamaCare") is a positive step forward for the United States, I have two bits of information to share that might dampen your hopeful enthusiasm.
How many of you read in yesterday's USA TODAY that because of a certain provision in the new federal legislation, millions of Americans across almost three dozen states will NOT be eligible for immediate low-cost health insurance that waives the pre-existing condition clause? That's right folks... the inadequate health care reform bill that almost tore both houses of Congress apart, the health care reform the majority of us still have to wait until 2014 for, excludes anyone who currently has health insurance, no matter how useless it is.
What does this mean? If you're paying for lousy health insurance and biding your time because your carrier imposed a pre-existing condition clause, you can't switch to the new federal insurance program. This program is only available to people WITHOUT any insurance. Somehow, our representatives overlooked or chose to ignore that relief for Americans battered by health insurance companies because of pre-existing health conditions won't exist. Just like so many other half-assed legislative "accomplishments" in Washington, DC, members of the Senate and House of Representatives, and likely President Obama's administration, forgot to take care of the UNDERINSURED while providing help for the uninsured.
Would I prefer it the other way around?! NO! I personally advocate every American citizen and legal immigrant be eligible for the same level of quality health care and insurance coverage, and if we all can buy into the same health insurance program that our political leaders pay for (yes, THAT'S RIGHT... everyone on Capitol Hill PAYS a certain premium for that coverage! It ain't on the House, pardon the pun), on a sliding scale according to our Social Security wages. Call me naive, but what's so hard about this, right?
Now, here's the second wet blanket to share about the state of American health care. If you're uninsured, underinsured, or unemployed, chances are you have one hell of a challenge affording name brand prescription medications if unavailable in generic form. Welcome to my world and banging my head against the wall with "Patient Assistance" programs offered and run by many pharmaceutical companies. Unless you happen to qualify for public assistance or are a federally-minted senior citizen or disabled person (i.e., you are federally approved for medicare and/or medicaid), you're at the mercy of every single pharmaceutical company for each of your name-brand medications.
For example, if you have high blood pressure, there's only one pharmaceutical company who manufactures your specific medication, so you have to apply to their Patient Assistance Program for free or reduced-cost supplies. Same thing if you have high cholesterol, or diabetes, or bipolar disorder, or arthritis, or enlarged prostate, or overactive bladder, or irritable bowel syndrome. Name a health problem requiring a name-brand medication, and you'll find one single pharmaceutical company for each drug, hence you'll be dealing with a Patient Assistance Program for each name-brand medication you take. No one company has a corner on the market, so if your body's slowly falling apart and your medicine cabinet seems like a pharmaceutical smorgasbord, you may know the names of enough pharmaceutical companies to fill an entire Rolodex!
But guess what? One of the juicy little quirks in life and the health care industry... the vast majority of these pharmaceutical companies' Patient Assistance Programs are housed and operate in St. Louis, Missouri, AND NONE OF THEM USE THE SAME CRITERIA to determine eligibility for free or reduced-cost medication. For example, you can be poor or sick enough to qualify for your blood pressure medication, but not for your cholesterol medication. Or, you can be poor and sick enough to qualify for medication to address the neuropathic side effects of diabetes, but you fail to meet the eligibility requirements for the insulin necessary to treat your diabetes.
You think this seems stupid? I agree. For example, even though I've been a vegetarian for years and follow a healthy diet, I need to take two different medications for cholesterol, one for the "bad" cholesterol (i.e., LDL) and one for total triglycerides. As a yet-to-be federally-minted disabled person, due to a 2006 spine injury and 3 years of legal headaches fighting the system, I'm considered poor and sick enough to qualify for only free 90-day supplies of the LDL drug, not the triglyceride one. Why? Because to qualify for the triglyceride drug, I have to be eligible for medicare, which I'm not yet, because the Social Security Administration still refuses to approve me as permanently disabled, even though I'm a spinal cord patient.
Okay, if I'm a spinal cord patient, why the hell should I care about my cholesterol anymore? DUH! I'd prefer not to die of cardiovascular disease on top of the many complications I'm already experiencing from a damaged spinal cord... So, let's talk about name-brand drugs that help people with spinal injuries, neurological and/or orthopedic. Two drugs I happen to need in order to cope with pain and decreasing mobility are Lidocaine and Celebrex. The former is a local anesthetic, available in patch form, which you can apply directly to your body. The latter is an anti-inflammatory medication to treat arthritis, which my spinal vertebra have plenty of to go along with the load of Titanium metal rods, screws, and other hardware holding things together.
It only took me three tries, countless phone calls and nasty letters to Endo Pharmaceuticals as well as the Missouri Attorney General's Office in order to finally receive my supplies of Lidocaine, approximately three months after I first submitted my application. On the other hand, I have yet to see my application approved by Pfizer Pharmaceuticals for Celebrex, and we're going on six months and counting.
Why? First, when I submitted my original application to Pfizer, just like every other pharmaceutical company, I did not have my physician's signature on the form, and explained to every company (SEVEN in all) via en masse letter and document packet, that I suddenly lost my medication coverage and didn't have time to obtain physician signatures in order to expedite my application submissions. Some companies actually faxed me a letter requesting a retroactive physician signature via fax while my application was already entered into their system. Some companies directly contacted my physicians.
What did Pfizer do? They mailed the entire packet back to me and requested I fill out a new application with my physician's signature. So, I had to chase down my "Celebrex doctor" for his signature on a form that I already completed for him, including his state license number, and MAIL everything back, because Pfizer does not keep rejected applications or supporting materials, and they don't work via fax.
A few weeks later, Pfizer sent the entire packet back as rejected again. Why? Because I didn't provide my 1040 for 2008 earnings. Apparently, copies of all my W-2s and 1099s from 2008, as well as a nasty letter from the Social Security Administration that specifically stated my taxable wages for 2008 wasn't good enough for Pfizer, even though their application form specifically includes 1099 statements as forms of income proof.
Why didn't I just give Pfizer a copy of my 1040 for 2008? It's a little complicated. I filed a joint return with my former wife for 2008, and we separated and divorced in 2009. Not wanting my ex-wife's income, SIX TIMES what my income was, to be used against me, since we were no longer living together and I was not deriving any financial benefit from her income, I submitted back everything to Pfizer with a letter explaining that my 2008 income tax returns would not be available for their use, and this letter was copied to the Missouri Attorney General's Office.
Pfizer's response? Reject the application again, send everything back to me, and then make me complete a federal form stating that I never filed an income tax return for 2008. HELLO?! Was anyone listening there? We're required by law to file income tax returns, no matter how little we earn. I didn't have a separate income tax return for me in 2008 to provide. What idiot sends me a form to declare I didn't file ANY income tax return? Would any of you be foolish enough to complete a form like that? I could just imagine it... IRS agents coming to arrest me for not filing a 2008 income tax return, because Pfizer reported me, but on the bright side, here's your Celebrex?!
Sighhhhhhhhhh.....
So, I tried one more time to resubmit everything to these bozos, with additional letters to and from the Missouri Attorney General's Office. You guessed it... two weeks later, Pfizer rejected the entire thing, but with a twist. They said I didn't include a copy of my prescription! And this time they called me on the phone to tell me they couldn't find the copy of my prescription. Gee... if these idiots didn't keep sending everything back to me in the mail, for me to mail it all back, maybe they wouldn't have LOST the prescription?!
So, here I go, locating a spare copy of the prescription, which I scanned into my computer months ago for my own records (you can do this with non-controlled substances, by the way), and sending the entire packet back, AND with a copy of my 2009 federal income tax returns, since Pfizer's idiocy dragged this ordeal into the spring of 2010. And lo and behold, two weeks later, the entire packet is sent back to me, rejected on the basis that my 2009 income was too high compared to their threshold, which my 2008 income was under.
And what did I do, besides finally get really pissed off? I wrote a letter directly to the President and CEO of Pfizer, Jeffrey B. Kindler, at his Manhattan office, copied it to the Missouri Attorney General’s Office as well as a personal contact at CBS News (CBS has received copies of every correspondence during this adventure). I told him what I thought of his company and his Patient Assistance Program, essentially calling him out for corporate greed and being a major part in what’s wrong with American health care, not the solution. I also demanded that he immediately rectify not only my difficulties with his Patient Assistance Program but also the difficulties of EVERY American who’s been jerked around by his pharmaceutical company all in the name of profits and patent protection for name-brand medications.
I also informed him that I was going to start a Twitter campaign against him and Pfizer Pharmaceuticals, which this commentary is the first step. Has anything happened yet? Sure, I received a phone call this morning from one of Pfizer’s first-name only pinheads based in St. Louis, to let me know that they were working on my case and were going to make an “exception” for me and enroll me in the Patient Assistance Program. In the immortal words of former New Jersey Net Derrick Coleman, whoopdiedamndo…
Why are they going to make an exception for me? Because of my “slightly too much income” in 2009 for eligibility. Never mind Pfizer wasted months of 2009 trying to reject my 2008 income, and in fact, this first-name only pinhead said, “Sir, I’m not here to argue about what happened before…”, code for I’M JUST A PINHEAD WHO WORKS HERE AND HAS NO BRAIN OR SENSE OF COROPORATE ACCOUNTABILITY. He didn’t even have all my documents with him, just my complaint letter to correspond to my rejection status in the computer system. Where are the rest of my documents I submitted to CEO Kindler?! Who knows, and I doubt Mr. Kindler honestly cares as long as his golf schedule doesn’t get interrupted again.
So, what would I like my fellow Facebook and Twitter members to do? First, share with me your challenges and frustrations with the American health care system. Let me know I’m not alone in this idiotic battle. Second, if you’re as fed up as I am with the American health care system, and the insane costs and profits associated with the pharmaceutical industry, make a stink like I am, and make sure you mention Jeffrey Kindler while you’re at it. There’s nothing wrong with our nation’s pharmaceutical companies making profit for the hard work they do in developing new medications to help us live longer and healthier, but there comes a point where they don’t have to put profit over the fiscal health of the people their drugs are supposed to help.
