Shown below is the text I have sent to my U.S. Senator regarding my appeals to TRICARE/EXPRESS scripts to have them provide a name brand medication to my wife instead of a "generic equivalent". The details of all of this have been amply provided in previous blogs, as shown in the links below:
http://thepatrioticsoldiersblog.blogspot.com/2012/03/obamacare-example-of-what-we-can-expect.html
http://thepatrioticsoldiersblog.blogspot.com/2012/03/update-on-preview-of-obamacare.html
http://thepatrioticsoldiersblog.blogspot.com/2012/05/obamacare-curse-strikes-again.html
We received the results of our final appeal option yesterday. I have posted this text of a letter to my Senator in which I have quoted the decision of the appeal. I have blacked out the names of the medications involved, her symptoms, and the name of my wife's doctor to provide some privacy for my wife. But the decision and my reaction to it are obvious. Make your own decisons from here, but from my perspective, the future for America's healthcare as would be dictated by the government, and believe me that is where we are heading under Obamacare, is disastrous. If you doubt me, just examine the type of treatment received when you go into the Social Security office for help, the U.S. Post Office, or talk to anyone under Medicare or Medicaid and see what type of treatment they receive compared to what individuals receive under private healthcare options. The government's treatment is nothing short of inhumane and barbaric.
Dear Senator Vitter:
I
have kept you advised regarding our appeals to TRICARE/EXPRESS
SCRIPTS to have my wife's prescription for the name brand
medicationYAZ
reinstated. As you know, we have made three written appeals to have
the prescription reinstated. We just received the most recent one, a
denial, from the outside agency which is the final appeal available
under TRICARE/EXPRESS SCRIPTS's policies. Again, the appeal was
denied. I am enclosing below the text of the letter regarding the
decision:
TQMC
DECISION
In
response to your request for a reconsideration of the initial denial
determination made regarding the above-referenced service, this case
was presented to a board certified independent physician reviewer.
After
conducting a thorough re-examination of all the information contained
in your medical record and consideration of any additional
information submitted, the physician reviewer has upheld the denial.
There
was no information about which generic substitutes were tried by the
patient nor the duration that each was used. There were no specific
details provided about the generic equivalents failure to control
cramps
and abnormal
bleeding.
This
is very unusual because the Food and Drug Administration (FDA) and
American College of Obstetricians and Gynecologists (ACOG) clearly
state that generic equivalent drugs produce the same clinical results
and safety profiles and are interchangeable for therapeutic benefit
(1,2). There is no detailed evidence in the records reviewed to
challenge this conclusion.
It
is also unclear as to what generic drugs the patient used and how
long she tried each one. It
would be reasonable for the patient to try all the Yaz
generic equivalents, such as Vestura,
Loryna,
or Gianvi,
whichever she has not used yet and to do so for at least three (3)
months in order to determine if it is effective.
I
find it abhorrent that a medical physician who supposedly reviewed
all the information provided by us and by Dr.
Pennebaker
would make such a statement. And please keep in mind that we are
talking about appealing a decision on a prescription that will cost
approximately $40 to $65 more per month than the generic brand
product that TRICARE/EXPRESS SCRIPTS wants to force my wife to take.
As
I read this letter, the United States Government's policy, as
enforced on its veterans and their families, thinks it appropriate
that one of its citizens be forced to try as many as three different
medications for a period of up to three months with the possibility
that the citizen could suffer severe bleeding
and cramps
that she already has experienced when forced to try a different
generic drug a year earlier, when there is a product that the citizen
has already tried which it is known causes no suffering side effects.
Is
there any other conclusion than that which states the United States
Government is willing to take a chance and inflict up to nine months
of suffering onto one of its citizens in order to save $70 per month
when it throws more than that away on a variety of worthless
give-away plans to citizens who pay no taxes and have never served a
day in their lives in the service of this country? It is improper for
me so show absolute disgust that my government will allow the
President of the United States to waste millions of dollars
politicking by flying around the country at $8 million per hour in
Air Force One, but cannot justify paying even as much as $70 a month
for a prescription which it know absolutely to cause no side effects
to the wife of a man who spent twenty years and fought in two foreign
conflicts?
What
happened to the primary oath that all physicians follow of “First,
do no harm.”? It appears to me that this covenant has been
overshadowed by the Government's covenant of “damn the patient,
save a dollar”.
Needless
to say, I am disgusted and disappointed and depressed. Disgusted at
the priorities that my government has established with regard to the
medical treatment of its veterans and their families as is shown in
my and my wife's case. Disappointed that in a country like the United
States of America, the Federal Government could institute a policy or
even make a statement that would suggest it would think it
appropriate to force medications on a woman for up to nine months
that could cause her to suffer with excessive bleeding and cramping
when there is a medication proven by the patient's usage for years
available that has no risk of side effects. That is just barbaric.
I
am depressed to think that this is the type of care and the type of
conflict that I can expect for the rest of my and my wife's lifetime.
I served my country for twenty years. I would think that I have
earned for my wife and my family at least humane treatment when I or
my wife are sick. But all I am receiving is treatment that tells me
the Government is willing to accept my wife or I suffering pain and
discomfort for up to nine months in order that the government can
save from $40 to $70 per month.
When
I joined the military in 1969, I was promised, if I served twenty
years, free medical care for me and my family and a pension for life.
That promise was broken years ago. Now, I cannot even expect humane
treatment for me and my wife, even with me paying for the coverage.
Let
me ask you, Senator? Would you allow this type of treatment for your
wife or your children? Would you stand by and watch your wife double
over in pain and suffer sever bleeding and do nothing? Would you
force her to try different medications that could cause her pain and
suffering for up to nine months when there is drug she had been
taking for YEARS before which was now being denied her that did not
cause any side effects?
Sincerely,
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