medicare and medication woes

I’ve mentioned this in a few places across the ‘net, and I realized I probably need to blog about it. See, Thomas saw an oral surgeon in Winchester back around the first of December about having his wisdom teeth out. And they definitely need to come out – anyone seeing the x-ray would agree; they’re coming in at a forty-five degree angle and are pressed hard against the neighboring molars. Just looking at the x-ray makes my mouth ache. So, the surgeon made an appointment for the surgery for January 13th.

Thomas had to see his nephrologist on the Monday before Christmas. Dr Goebel said that one of his immuno-suppressants / anti-rejection drugs would have to be swapped around. I thought this wouldn’t be any big deal; neither did he. So he wrote up an instruction sheet, faxed the prescription to Kroger, and we went on with the rest of the appointment.

Thomas was due to start taking his medication ten days before his surgery. Reducing the Rapamune down by half while increasing the newly prescribed Prograf. See, while on the Rapamune, he just doesn’t heal. Or if he does, he heals very, very slowly. For example – he has a crack on his bottom lip that’s more than likely permanent. His lips got really dry last Summer, cracked open; one of the splits was really bad, and just when we think it’s trying to heal, it splits back open. Because of his kidney failure and because of some of the medications he’s on, his skin stays really dry.

Well. This is where the nightmare starts.

I went to Kroger with Kathy and Ralph that first Wednesday in January – Thomas’ car was in the shop still, and they’d brought us home ahead of that first snow – and while I was there, I went into the pharmacy to pick up Thomas’ Prograf. I was told Medicare had denied coverage. What the hell? But I was in a hurry. I didn’t have time to argue. So I called Dr Goebel the next morning. Medicare was requiring a physician’s pre-approval form (PA). We couldn’t figure out why. Thomas was on Prograf from August 20, 2007 (the day he had his transplant) until April 3, 2008 (the second and worst time he tried to reject the transplant – this is when he went on the Rapamune). Questions on the form was, “Was this medication prescribed as part of treatment post-transplant?” and “Is this patient a transplant recipient?” blah blah blah So Dr Goebel sent the form to both Kroger and to Medicare.

Thomas was denied again. Again! I had to change the date of his surgery. I moved it up ten days.

Then he was denied a third time.

Tuesday I spent all day on the phone with both Medicare and Kroger. Again. Then Dr Goebel’s office called me back and told me it had finally been approved. I called Kroger to find out how much the deductible was so I could go pick up the Prograf before Kathy came to pick up Thomas – he’s gone to Renfro Valley for the week. $140. For the generic. Um. No. So I called Dr Goebel’s office back. They said they had coupons, a kind of prescription card, that would give me $200 off for up to twelve refills – although he’d not be on it that long. Just long enough for his gums to heal.

So I had to call and change his surgery again. Now it’s scheduled for the morning of March fifth.

I got the prescription card in the mail yesterday and called to activate it. That program isn’t available to people who carry Medicare and/or Medicaid. And Thomas has both. I called Dr Goebel’s office back. The member of our medical team I spoke with said she’d talk to Dr Goebel and their financial adviser to see what could be done.

So now we’re back to square one. And I have absolutely no idea what we’re supposed to do.