I Just Want My Mefloquine

What follows is a copy of the letters I sent to Sens. McCaskill (D-Mo.) and Bond (R-Mo.) today. Trying to get my antimalarial medication mefloquine (which, by the way, is not even a controlled substance) has been more frustrating than I can express.

Senator McCaskill [Senator Bond] and staff,

I’ve been watching the health care reform debate from the sidelines. Though I appreciate the need for preventive care and support basic care for all, I am employed, have comprehensive medical insurance and felt removed from the most ardent parts of the debate.

But something happened today that has spurred me to write to you.

I am leaving in a week on a yearlong trip to Cotonou, Bénin, in West Africa, sponsored by Rotary International. I was prescribed by my primary care physician 50 weeks’ worth of mefloquine, an antimalaria drug.

[Forgive the length of the following description, but it does illustrate the labyrinth of bureaucracy.]

When I went to the pharmacy to pick up the medication, the pharmacist advised me that my insurance wouldn’t approve the whole prescription — just the first 12 pills. I was advised by the pharmacist to contact the insurance company (a Blue Cross/Blue Shield subsidiary). I did so. BCBS told me to have the pharmacist call CareMark to apply for an override. I called the pharmacist. The pharmacist called CareMark. CareMark told the pharmacist to fax certain override forms to the doctor. The pharmacist did so. The doctor filled out the forms. The doctor called BCBS and CareMark. No one would accept the forms, but they advised the doctor to have ME call BCBS. The doctor called me. I called BCBS, both the out-of-network number and the customer service number. I was on the phone with BCBS for more than 30 minutes. The customer service representative — who was very kind — had no idea what to do. She found no evidence that an override had been approved, though she did find a record that I had requested one. She advised me to call my doctor and provide him with another phone number. I called the doctor. The doctor had called the number and had spoken to representatives of BOTH BCBS and CareMark — each of which told the doctor to call the other — and gotten no clear response. The doctor is trying again now.

I still have no antimalaria medication. So far I’ve spent more than five hours — not to mention my pharmacist’s and doctor’s time and not an inconsiderable amount of money — trying to GET access to medication that I ostensibly HAVE access to. We may acknowledge 47 million uninsured Americans and another 25 million underinsured Americans, but I am neither un- nor underinsured, and yet, getting the care I’m owed is a protracted fight.

This is not a failure of my doctor or my pharmacist, both of whom have been competent, efficient and accommodating. This is a failure of a bloated insurance company whose stated goal is to make profit — and avoid its obligations to its subscribers under any pretext.

Most private companies do not act like this. They can’t — or their customers will leave them. But I CAN’T leave my insurance company, which is not subject to the strictures of competition in the same way other businesses are.

Something must be done about this. When I pay for a service, I expect it to be there when I need it, not to get the runaround. Customer service representatives from BCBS are well-intentioned, but they are stuck in a culture antagonistic to the needs of their subscribers and not given the authority and access they need to take care of problems.

Please address this in the Senate! I, along with your other constituents, am fed up and we need your leadership and commitment to true representation.

Thanks very much.
Jessie Gasch