In which our narrator beats the evil health insurance bastards

June 9, 2008 at 1:05 pm | Posted in Raves & Rants, The Other D (Better Living Through Chemistry) | 9 Comments

So I recently refilled my mail order pharmacy supply of happy pills… I get the name brand b/c the generic is uncoated and sticks in my throat every single time.  It’s a slightly higher copay, but it’s worth it.

My previous copay for this was $80 for a 90 day supply.

I get my credit card bill and realize I’ve been charged $492!!!

I call and am told that on 4/3/08 (huh? random date?) a MAC penalty was added to that drug, meaning that if you take the name brand instead of the generic, you get penalized big time.  I was never notified of this – obviously, I’d have refilled the script before 4/3 if I knew that was going to happen!

MAC PENALTY? Do I get a happy meal with that?

A few forceful “I was not notifieds” and “may I speak to your supervisor PLEASE”s and I’m put on hold for 10 minutes.  When the woman comes back, she says that she has been authorized to give me a one-time exception, and I will be getting a refund for the amount I was overcharged.  In the future, I can have my doctor’s office fill out an “exception request form” if I need the name brand drug.

Thing I always wonder after encounters like this.  What if I wasn’t…

– educated & literate enough to read my insurance plan documents
– a native speaker of English
– privileged enough to believe I deserve better treatment
– privileged enough to have a job where I can make personal phone calls during work hours (because these folks are 9-5, baby)

I’d be screwed out of $400.  And more.


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  1. Wow they are evil. And I often wonder what would happen if I wasn’t able to make some waves when those kinds of things come up. So frustrating.

  2. oh MAN! good save, lady. I just did a mini battle with my pharm this am when they charged me my old copay for my happy pills.

    these people are idiots for fighting with those of us on the happy pills!!!


  3. You tell ’em! What I don’t understand is why the insurance company can send me umpteen brochures about how important it is to take care of my diabetes…filled with useless info I already know. But somehow, they cannot notify me ahead of time that they have decided to cut my monthly allowed amout of Novalog from 2 vials to 1 vial despite no change in my prescription. You know, Novolog, the drug that allows me to stay alive? Nope, got to find that out when I went to pick up my prescription right before I headed out on vacation. Middle of the plan year, no change in anything else, they just decided. There ought to be a law….

  4. This is (one of) the reason(s) why I love you! My tiger.

    But those *f***ck** assh*l##s!! That makes me so mad. It’s so true that they deluge you with worthless paper about some silly scheme they’ve got cooked up, but when it comes to important shyte like “we’re punishing for not bending to our awesome will” they don’t lift a finger to contact you.

    Airlines, pharmaceutical companies….what happened to the customer is always right?


  5. amen on all counts. the same applies with cable. i call every 6 months or so to get a “promo” rate for my highspeed internet. it saves me about $150 for those 6 months. but i get it each and every time. just threaten to leave. so for a cost savings of $300/year, many people are not getting the same benefit because they don’t realize that those kinds of things can and should be challenged. now if i could just figure out how to negotiate for cheaper gas!!

  6. You know who’s really behind this C**P? A “pharmacy benefit manager.” This is the newest middleman/pick-pocket involved in health care. They tell employers that they can save them money on prescription drugs by “negotiating” for lower prices w/the pharmaceutical manufacturers. What happens is the PBM takes a kickback, I mean rebate, to sell certain drugs and not sell others. So the health insurance company may not even know exactly what the PBM is doing. Certainly the employer is clueless. Check out

  7. oh man. you hit a nerve with me on this one. I too just did battle with my insurance company for denying a prescription because I’m FEMALE. Sure, it’s traditionally prescribed for men, but don’t you think my UROLOGIST (a real live doctor!) knows better than to prescribe a drug that might kill me because I don’t have a penie?? Anyway, they made the mistake of notifying me that I could challenge this decision if my doctor provided evidence…so we did. And they wrote back that they’re thinking about it. They’ll let me know. Grrrrr.

  8. Before Zyrtec went OTC and my insurance company wanted me to take Claritin (which I had an allergic reaction to), they punished me for still taking Zyrtec by making my co-pay MORE THAN THE COST OF THE DRUG. When the pharmacist told me, I told her to not charge it to insurance at all. Gah!

    Now that it’s OTC, I’m saving money on it.

  9. Good for you for fighting them off. It’s ridiculous that they would try to pull that but you’re right, they probably make out big time on people who aren’t up to fighting them for whatever reason.

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