番茄社区

Now it's getting personal.

The other day, I realized I was running desperately low on one of my prescription medicines. Shaking out the bottle for my morning dose, I realized there were only a couple of pills left. How could this have possibly happened? Nothing life-threatening, but still an inconvenience.

I looked at the pill bottle, and saw that it had been filled for a 3-month supply about 3 months ago through the pharmacy benefits manager mail-order system which is covered by my insurance. I also saw that there were multiple refills listed as available.

How Did I Mess This Up?

Dumbly, I stood there in the bathroom and wondered, "How did I possibly mess this up?" I only take a few medicines, and most of them have been coming on auto-refill, accompanied by a choppy robotic voicemail left on my home phone line telling me that my prescriptions were being filled and sent out to me. "Have a nice day."

Somehow, apparently this one had slipped through the cracks. So later that day, when I got a break at work, I sat down at my desk and tried to get a refill of my medicine. I started with the online website of the company, as instructed by them on my pharmacy benefits card. "Refilling and managing your medicines is easy with our self-service website."

I entered the website address, and tried to log on. It did not recognize my username, my email, or my detailed personal information when I entered it, nor the account name and password that I had previously set up. I kept reentering things, thinking maybe I had messed up typing into the form or left the All-Caps button on, but everything matched up what I had in my records. Eventually, after the third try, I got one of those red warning boxes that said "We are experiencing technical difficulties with our website; please call the customer service hotline at 1-800-GIVEUSACALL".

So, I turned to the phone. When I got to their phone tree, the first option they gave me was, "Are you calling from the doctor's office? If yes, press 1." I had to stop and think: I was in my office, so yes, technically, I was calling from a doctor's office. But I was doing so as a patient, so like a good patient I did not choose that option. The next available option was "At the moment we are unable to help you, so please visit our website at www.pharmacybenefitmanager.com". Unfortunately, this is how I got into their phone tree in the first place, because the website was not letting me in, not getting me what I needed.

Success at Last

I called again, and then tried using the voice override feature to request "Customer service" or "Speak with a customer representative" or "Let me talk to a live human being". Finally, through some sort of backdoor, I was able to connect to a person, who listened to my story, took all my personal information, went through all the medicines that I get from them and what I needed. And then she said, "Let me connect you to a customer service representative who can help you with this." I'm thinking, "Wasn't that what I was just doing with you?"

But she asked for my callback number in case we got disconnected, and transferred me over to somebody else, who collected the same information: my name, my date of birth, my telephone number, the last four digits of my Social Security number, and then we went through all of my medicines. After some contorted work on her end of the computer, she was able to confirm that this one medication had somehow slipped through and was not enrolled in their auto-refill program.

Would I like to make this medicine come to me on a regular basis? Because it's a chronic medicine that I have taken at a stable dose for several years, I said that yes, indeed, like all the other medicines they're sending me, I would very much like to enroll in their auto-refill program for this medication as well. We went through some more questions and answers, and then she told me that they would be able to send the medicine out in 2 weeks.

I told her that since I was down to the last few pills, I was hoping there was some sort of expedited delivery program where they could ship it out today and get it to me sooner rather than later. Otherwise, I would have to call in an interim supply to a local pharmacy, which would undoubtedly get the computers and the insurance company and the pharmacy benefits managers all in a tizzy as to who was paying for what. She offered me a two-day express mail option, or a next-day version -- one for $17, and the other for $23. Since I figured that my local pharmacy would probably charge me at least that much for a couple days' supply of this dirt-cheap generic medicine, I might as well go all out and get the next day delivery.

Making the System Work Better

Well, as you can imagine, nothing has arrived, and although I'm sure no harm is being done, it really does make you wonder. I have the time, and the wherewithal, and the ability to even pay for express delivery, to work through this convoluted system to get me a refill of a medicine that they already have noted down in my system as being chronically dispensed to me. But think how hard this must be for so many of our patients, to navigate these systems, to put in this effort, to deal with all of these things not working, and certainly not making their lives any easier.

I love the way refills work on our patient portal, where my patients can click on a medicine that I've prescribed for them and it sends me a refill authorization message. Even better is when the system includes a number of checks and balances: Has the patient had a recent office visit with me? Do they have an upcoming office visit scheduled? When did they refill it last? Do they have the appropriate lab testing or blood pressure check noted in the electronic medical record? Then refills from our end, at least, are as easy as the click of a button.

The patient clicks once on their end, and I click "Approve" on the other. If I need to send in a short supply, if the patient hasn't been seen in over a year, or if they need lab monitoring to safely continue, I can take off the refills and add a notation to the pharmacist asking them to inform the patient to schedule a follow-up appointment before future refills.

Patients often express how frustrated they are getting their medications, how much of a burden it is, including their costs and co-pays and prior authorizations. It's incredibly frustrating to know that we live in a world where patients have to skimp on or skip their medicines to pay for food or rent, or cannot even afford a life-sustaining medicine like insulin. And when the system is stacked against them, when websites don't work, and phone trees go nowhere, we only add more barriers to healthcare -- more hurdles our patients have to jump over -- that a system as sophisticated as ours should be able to overcome.

We know that healthcare is complicated, but as we move to change our fractured healthcare system, we need to smooth out the road and do whatever we can to improve access and efficiency and limit the headaches our patients need to endure to get the care they need.

Refill until our cups runneth over.

, of Weill Cornell Internal Medicine Associates and weekly blogger for 番茄社区, follows what's going on in the world of primary care medicine from the perspective of his own practice.

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