Prescription Perspectives

So. Big news.  Some of you might remember the blog post about the insurance nightmare of getting the drug Neulasta. Well, I sent copies of that post to the CEOs of Tufts Health Plan, CuraScript and Amgen. I recently received a four-page response from Tufts. The letter said stuff like:

•  "In order to address your concerns, we aligned your narrative with the documentation and records available from Tufts Health Plan, CuraScript and CVS..." (I guess these guys don't adhere to the view that the customer is always right. That must have something to do with ObamaCare.)
•  "A careful analysis of where the narratives blend and diverge provides us with an opportunity to thoughtfully acknowledge and appreciate your frustration." (I'm pretty sure it's just the "diverging" that provides this opportunity.)
• "In addition, our assessment illuminates the lattice of roles, responsibilities, and regulations inherent in the arrangement for and the delivery of healthcare." (Perhaps this illumination exercise might have been more beneficial had it been conducted prior to going into the mail-order drug business.)
• "The discrepancies among the narratives and in the results are indicative of an unfortunate misalignment of perspectives and responsibilities." (They got that right. My perspective was, I should take the medicine that the doctor prescribes. Theirs was, make her beg for it.)
• "...the manager evaluated the coordinator's focus to address your immediate needs..." (I wonder how this worked. Did the coordinator have to undergo an eye exam? I'm not sure the coordinator's "focus" was really relevant to the problem, but perhaps my confusion on this point has something to do with "misaligned perspectives.")

But, you've got to give them credit. It's not as if I received a word from any of the other companies...

So the letter attempted to explain the "misalignment" of how the process for filling the prescription should have occurred, and Tufts' "perspective" on how it did occur. The letter began its review of the prescription filling events on the day that I received my first dose. I guess they did not feel that the insane number of telephone calls that were necessary to convince them to supply the first dose were strictly on point. The letter did acknowledge, however, that my "telephone conversations with Member Specialists Michael (remember poor Michael?) and Nick (the supervisor with whom I never spoke because he was "not able to answer phone calls"(?)), are not available at this time to review and assess their content, tone, and sense of urgency..."  (Seems like their telephone logging system has a few glitches. Anyway, you'd think I had given them enough information about the "sense of urgency").

The true revelation of the letter was this amazing tidbit: "...however, what was missing was the recognition that the entire prescription for a total of four dosages was transferred to CVS and as such, CuraScript no longer held a valid prescription on file to accommodate future fills."

Ok. Let's consider that statement for a minute. Apparently, despite the astronomical sums they charge for drugs, and the existence of such cutting edge tools as computers, fax machines, the internet, and photocopy machines, once it sent the prescription to CVS, CuraScript no longer had a copy of it???!!!!  I mean seriously. CuraScripts receives a prescription from my doctor (which I imagine arrives as a fax, email, tweet...something other than in the form of a Hallmark card, which, admittedly, might be awkward to forward electronically) and then what do they do with it?  Do these people mean to tell me that they received a hard copy of the prescription, put it in an envelope, (forgetting to make a photocopy of it), addressed the envelope with a fountain pen, licked and sealed the envelope, stuck a stamp on it and dropped it in the nearest mailbox? Because that would be the only way that they would no longer have a copy of the prescription. Call me a cynic, but I ain't buying it.

And then there was this line, so filled with pathos and regret: "What should have been a seamless and contiguous process carried out according to protocol based on thoughtful and prudent planning, delegation of responsibilities, and integration of human and technical accountability--was not." While I appreciate this lofty aspiration, I don't think it is absolutely necessary for the Tufts HMO staff to figure out how to integrate "human and technical accountability." All they need to do is add two sentences to their procedures manual: "When you receive a prescription for multiple doses of a medicine that should not be dispensed all at once, be sure to keep a copy of it on file before sending the original to the drug store. Please note: Your job is to ensure that the patient receives the medicine by the time he or she is required to take it."

The letter concludes "Your concerns have been documented and are now on file with Tufts Health Plan. If you are not satisfied with this resolution, you have the right to request a reconsideration from Tufts Health Plan..."

I'm not convinced that the filing of the documentation will ensure that this "misalignment of perspectives" won't occur again, but I may have lost interest in further communication with these people. I am interested, however, to learn your thoughts. Check out the little poll at the top right-hand of this screen and let me know if you are "satisfied with this resolution." Together we will reform health insurance policy, assuming we can align our perspectives.