So, There’s This Conversation With My Pharmacist…

…that I am really tired of having.

For the most part, I am pretty fortunate when it comes to actually dealing with the process of getting medications. I don’t take any OMGADDICTIVEADDICTIVE medications which would require people to place hoops in front of me to jump through every time I need my meds. My pharmacy is usually very together and I rarely have any problems with them. Since I am currently surviving about half on samples and half on prescriptions paid for in cash, I don’t actually have to go into the pharmacy that often.

Except for this one medication.

Just the one.

Can you guess what it is?

Here’s how the conversation starts:

Me: Hi, I’m here to pick up a prescription for Smith?

Pharmacist/Pharmacy Tech: Ok, great.

(Whoever is helping me goes to grab it from the back. When they bring it to the front, I can clearly see that it’s not the right package.)

Me: Oh, uhm, Dr. Redacted called in a three month supply? That looks like a one month package.

Pharmacist/Pharmacy Tech: Oh, well, the discount plan only pays for one at a time.

Me (confused): I’m not in a discount plan? I always pay cash. For a three month supply.

Pharmacist/Pharmacy Tech: But the discount plan only pays for one month at a time.

Me: I have been getting this prescription at this pharmacy for a very long time. I always. Pay. Cash. For a three month supply. Every time! I swear!

Pharmacist/Pharmacy Tech: Oh, you’re not on the discount plan? Sorry. But the insurance still only pays for one at a time.

Me (gritting my teeth): I don’t have insurance. (I come in every three months to pick up this prescription, I pay in cash for a three month supply, and every time, we have this exact same conversation. In fact, the last time this happened, you were the person who helped me.)

Pharmacist/Pharmacy Tech: Oh, ok. Sorry. Well, do you want this?

Me: No, I want a three month supply.

Pharmacist/Pharmacy Tech: Oh, well, I’m going to have to put it back into stock…and then redo the prescription…are you sure? It’s very expensive to get a three month supply.

Me: Yes, I’ll wait, thank you. (No, I would not like a month supply, my need for this medication is not going to suddenly stop in a month, therefore, I would like three months, so that I can come into the pharmacy once, NOW, rather than three times.)

Now, what sort of prescription could possibly require this much fuss? Could it be expensive (it is, a bit)? Could it be dangerous (no, not really)? Could it be…birth control?! Yup, that’s right, it’s birth control. And the conversation gets better. The pharmacist checks off the new package with a three month supply, the tech brings it up to the counter to ring it up, and this happens:

Tech: Most people use those green cards1?

Me: Oh, I don’t qualify for that.

Tech: Have you considered applying for one?

Me: I don’t qualify for that program.

Tech: Oh, why not?

Me: … *eyebrow*

Tech: Ok, well, $235.87!

So, here’s the thing. This sounds like a kind of minor annoyance. And, in the grand scheme of things, it is. Way worse things happen to people with disabilities than this. Way worse things happen to people with disabilities in pharmacies than this. I am really not complaining that much. If this is the worst thing that happens to me in the pharmacy, so be it.

But, for me, this is an endeavor which basically turns the silverware drawer upside down. Spoons? I’m out. For days. The pharmacy is a loud place. It’s bright. It is filled with smells which make me anxious, and loud noises, and noxious magazines which tell me about how I can take a diet pill and trim inches and pounds off my tummy.

This prolonged social interaction agitates me every single time. There’s usually a line. People are glaring at me because I am taking so long. People are rolling their eyes because I insist on having my prescription filled properly. I am trying to control myself, because it’s not the tech’s fault, it’s probably some glitch in their system, but I want to lunge over the counter, speak sternly to someone, and liberate a year’s supply of BC from the back room before fleeing out the side door. I start to hyperventilate. I fidget. I feel like I am exploding inside.

And, every single time, I ask if it’s possible to put a flag in the system so that they know that I will pay in cash for a three month supply. So that a 40 minute ordeal every three months could be turned into a five minute in and out trip every three months. Every time, someone says “uh huh, we will look into that,” and then, the next time I come in, this happens again.

This is a pretty minor thing, in the grand scheme of things, but it’s yet another tiny little facet of the American health care system which is broken. While I’m waiting for my correctly prepared prescription, I watch people go through the line. People with MediCal or Medicare or CMSP or any number of other welfare programs get to the counter, hear that a prescription has been denied, and shuffle away without it. People with private insurance get told that the authorization for a prescription hasn’t come through, or it’s been denied, and they look at the prescription and the price on the register, and they walk away without it. I can tell that the people who know they will have to pay cash, like me, arrive at the counter and weigh their options; pick up the prescription today, put off grocery shopping another week?

I’ve actually had the pharmacist refuse to fill this prescription in the past until I’ve paid for it. And, you know, I think that they think they are doing me some sort of budgeting-related favour by trying to get me to take a month’s supply. But it’s not like I’m not going to need it next month. And the month after. And the month after that. The way I budget, I would rather pay a large lump sum every three months than get dinged every month. Every three months I see a collision of class issues in the pharmacy. The haves and have nots. The assumptions that get made by the pharmacy staff. The callous and routine denial of prescription benefits to people who need them. And every three months I think there was to be a better way to do this.

Comparatively, I’m lucky. I can at least afford to pay for my prescriptions most of the time. There are a lot of us out there who cannot.

  1. She is not, in this case, referring to a US Permanent Resident card, but rather to the cards issued to people in the FamilyPACT program, which provides reproductive health services for low income Californians. I would note, among other things, that this program at one point paid a bonus to low income folks who got sterilized. I don’t think they do this anymore, but they definitely pay for/encourage sterilization. Oh, and it gets better; once you are sterilized, the program refuses to pay for reproductive wellcare like Pap smears.

About s.e. smith

s.e. smith is a recalcitrant, grumpy person with disabilities who enjoys riling people up, talking about language, tearing apart poor science reporting, and chasing cats around the house with squeaky mice in hand. Ou personal website can be found at this ain't livin'.

20 thoughts on “So, There’s This Conversation With My Pharmacist…

  1. Oh, and it gets better; once you are sterilized, the program refuses to pay for reproductive wellcare like Pap smears.

    Because women who have tubals don’t have cervixes any more?

    Oh. Right. It all makes sense if the goal is to punish women. I KEEP FORGETTING.

  2. I’m also just going to go ahead and assume that the program is also cissexist and finds a way to deny benefits to trans folks who are transitioning/post transition.

  3. Oh dear lord. That’s ridiculous.

    I’m Canadian. When I dropped off my last BC prescription, the pharmacist asked if I wanted all 7 months of it right away–I didn’t–and would have charged me half that for the whole shebang. There IS a better way to do this! It’s NOT THAT HARD! That’s why I have to use the privilege of not being American to ignore most of the US healthcare debate–to me, it’s so cruel and so senseless that I want to throw up.
    .-= Lis´s last blog ..How not to have Disability Awareness Month =-.

  4. i have only sampled USA healthcare the once.. it was just ludicous how many times i had to explain i was going to pay cash, at every stage of the process. The people at every stage (getting an appointment, seeing a doctor, and getting meds from pharmacisT) just kept going over and over the “you don’t have insurance?” loop — they really didn’t understand how i could possibly be trying to get healthcare while not insured. I was repeatedly asked why i wasn’t going to the “emergency room” for my very trivial non-urgent medical problem.

    (i’m from New Zealand, i don’t need healthcare insurance! I’m in your country for 2 weeks. now treat me, take my money and then i can never see you again KTNXBYE! )

  5. It’s frankly absurd the level of difficulty I had trying to get birth control refills, and of course my insurance wouldn’t cover it, even though I needed it not to prevent babies I could not afford but because I was BLEEDING TO DEATH FROM MY VAGINA. I always said it like that to them on the phone. In caps.

    They never, never ever would give me more than a single month’s supply. What was I going to do? Snort them so I could get to the nausea and mood swings they gave me even FASTER? Sell them on the street to get schoolchildren high? Poison my neighbor’s dog? Commit suicide (granted, the hormones made me suicidal, so I guess that’s not all that out-there)?

    Our local Planned Parenthood was (and for all I know still is) an evil joke, and not only refused to give me more than one month’s supply, but kept dunning me for tests I did not need, could not afford, and which triggered me into fits of sobbing that lasted hours. Ratfucking crapsacks.

    Do we really deserve this kind of runaround? My husband has never been so much as blinked at for anything involving his reproductive organs, and he’s gotten into way more trouble with his than I ever have with mine.

  6. Wow, this is the sort of thing that makes me so glad I am now living in the UK. When I get my birth control pills, the whole thing is as easy as possible: I take the prescription to the local pharmacy, wait 15 minutes, they hand me a package of either 3 months or 6 months worth of pills depending on what me and my doctor decide is best, and I leave without paying a single penny (I have yet to figure out how this system works… I know most prescriptions here do cost something, but for some reason my birth control pills are completely free). As I’m formerly from America, I get angry beyond belief at this health care debate, especially their total demonization of the UK system. While NHS clearly has many, many terrible problems, the problems seem to me to pale in comparison to the utterly ridiculous system we have in the US, and I have yet to meet a person on NHS who doesn’t agree.

  7. What’s interesting about your story, Brenda, is that a lot of Americans don’t have insurance, and a fair number of us actually do seek treatment without insurance. And we all go through the same rigamarole with having to remind people, constantly, that we are paying in cash. Sometimes I feel like wearing one of those “Hello, my name is” tags and writing “I AM PAYING IN CASH FOR MY TREATMENT” on it. That “well, you must have insurance” attitude also seems to suggest that health care providers are well aware of the overinflated cost of health care, prescriptions, etc in the United States.

    Also Naamah, your Planned Parenthood sounds…dreadful. When I was living in the City I got services there and they weren’t like that at all. They were practically forcing more BC on me than I could possibly need, as a matter of fact. Maybe it’s because I was paying in cash or something. Insurance companies have really odd restrictions on birth control (as evidenced by my discussion with my pharmacist). I don’t get those restrictions either…it’s not like you’re going to sell it on the black market or something, you need it!

  8. Wow, that’s an awful experience to have to go through every 3 months and really makes me appreciate the NHS, it’s not great but it’s good. The pill is free, I have a yearly check up, get a 6 month supply & can fax over a request for the prescription for the next 6 months. The pharmacists treat it like any other prescription (they cost £7.10, birth control is free on the NHS) as far as I know, I’ve never been treated differently though I can’t speak for everyone.
    .-= Jaime´s last blog ..Halloween! Costume Dilemma & Links. =-.

  9. The family practice doctor I’m in the process of ditching won’t even allow patients to make appointments if they don’t have insurance. They don’t take cash-pay patients at all. I am an established patient there, and needed to make an appointment for my daughter to have a school physical. Somehow, my husband had left the house with all the ins. cards, so I didn’t have the number on me. Couldn’t make the appointment. Unbelievable.

  10. @Naamah Our local Planned Parenthood was (and for all I know still is) an evil joke, and not only refused to give me more than one month’s supply, but kept dunning me for tests I did not need, could not afford, and which triggered me into fits of sobbing that lasted hours.

    Though the NHS is a wonderful thing (@ Icy bear, birth control is free in the UK. It just is. Rejoice) my local Family Planning Clinic (UK equivalent to Planned Parenthood) is just useless if you need an alternative to the contraceptive pill.

    It took them months to be convinced that I needed an IUCD (coil) called a Mirena fitted. It reduces blood flow to almost nothing as I was constantly anaemic and didn’t take to the pill terribly well, but has to be fitted by an expert, your local doctor probably won’t do. Their struggle seemed to be based around the fact that they couldn’t understand (a) why a woman not in a sexual relationship would attend a Family Planning clinic and (b) why she’d choose that particular method. How many times did I have to repeat, “I hate what the pill does to me, I’m fat enough already.” Too many to count.

  11. I’m also just going to go ahead and assume that the program is also cissexist and finds a way to deny benefits to trans folks who are transitioning/post transition.

    I would be profoundly surprised if it were not cissexist. Every the health insurance policy I have ever had has had a clause in the EXCLUSIONS section specifically excluding treatment related to anything trans. On the even more evil than usual end of things this has included the denial of coverage for treatment of ovarian/cervical/uterine/breast cancers for trans women and testicular/penile cancers for trans men; because those are parts that some trans people would like to have removed as part of their physical transitions, hysterectomies, oophorectomies, mastectomies, orchiectomies aren’t covered even if they would be medically indicated for non-trans people who had those organs. And because radio and chemo are expensive therapies they deny coverage for those because they’re not going to cover anything that has to do with those parts at all. Because medical care related to being trans is fundamentally cosmetic and elective.

    I’d imagine the FamilyPACT would justify their anti-trans policies (presuming they have them) by pointing out that they have very limited resources available (which is true) and there aren’t a lot of trans people (maybe there’d be more if the world weren’t so violently opposed to our existence) so they have to put their money where it will do the most good. It’s not personal or anything, and they’ve got nothing against trans folk, they just don’t have the training to know what to do with them and the budget’s so tight and why are you freaks worried about reproducing anyway aren’t y’all sterile from taking hormones imported from Mexico already?

  12. I was lucky — the Planned Parenthood I visited in Santa Ana just gave me a brown bag with a 12 month supply of Ortho Tri Cyclin Lo. For nothing. Granted, the pill caused really awful angry mood swings, acne and bleeding, and I had to quit after a couple months toughing it out (got on a pill that did me very well up til my endo started getting too bad) and all those extra packs went to waste. But still…

    I want an IUD, and cannot get one. I will have to write on that. Suffice to say the insurance industry is fucked up. The ONE treatment that is highly effective for endometriosis with none of the side effects of the other effective treatments (GNRH antagonists, which stop production of estrogen, producing a state of synthetic menopause so to speak, and bringing with it the hot flashes and bone density loss and high risk for developing osteoporosis) they don’t fucking cover even for medical necessity. And I don’t get a “choice” — free market my squishy ass — I either pony up the $600 (but they have financing! ooh!) or don’t get it and suffer through the pain.

    Bleah.

  13. Oh, amandaw, this makes me…ugh. It’s of course part of the historic denial of birth control services (back in those halcyon days when I had insurance I was paying out of pocket for birth control), and…good god. Even with a doctor clearly saying that’s necessary, advised, etc, they are still denying it? That makes me flaming mad. And it’s just more reinforcement of the fact that people fortunate enough to have insurance in this country aren’t exactly luxuriating in benefits.

  14. And I have good insurance. And a choice of plans through his employer. But because the benefits are union-contracted, if something isn’t covered, you can’t just keep fighting and get it — it just plain isn’t covered. And IUDs are one of those things — it’s not a matter of each plan not covering it; it’s the benefit fund deciding it’s not covered based on whatever deals the union made last time they drew up a contract, so the insurance companies each have to abide by that.

    So I have no choice in the matter. At all.

    Well, except to get it financed, of course.

  15. I was pretty thrilled when my local PP instituted an automatic-billing mail-my-pack-once-a-month option, which made it one trip a year.* I don’t think that’s a very widespread option, though. So much of the stuff around birth control is utterly ridiculous. And insurance covering birth control–ahahaha.

    *Of course, I found out about this shortly before I ended up going off HBC because I’d finally realized that many of my health problems were, in fact, unacceptable side effects.

  16. Nope, it’s a consistent problem at any pharmacy because there are systemic problems, rather than pharmacy-specific. All pharmacies assume that everyone coming in is on a plan of some kind, which means that I will have to step through repeatedly telling them that I am not each time not matter where I go.

  17. In the Netherlands, the health system is generally good, but I’m not sure if birth control is covered under “basic” insurance (the insurance required for every resident). Back when this system was first implemented in 2005/2006, BC wasn’t covered after age 21 (what is that in your birthday cake that makes you not need BC anymore after 21?). I have additional coverage (not sure what for, but my insurance company offered me this plan in 2005/2006 and if you drop it and need it later, you’ll be turned down) and am institutionalized (in which case drugs may be covered that otherwise wouldn’t be), so I have no clue what my birth control gets paid from, but not my pocket at least. I also have no clue how much the pharmacy is supplying at a time, but I don’t care since it’s the nurses picking it up anyway. All other women I know get three-month supplies.
    .-= Astrid´s last blog ..Socialist Party May No Longer Keep Its Members’ Salaries =-.

  18. Yes, this, kaninchenzero. There are huge barriers to access in healthcare in general for trans people. I do not understand how denial of treatment/medications/care to trans people is not treated (and prosecuted) as the clear discrimination that it is. There is no good reason for a state-funded healthcare program to exclude low income people who qualify for its services on the basis of their gender identity.

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