A thought. I gently label it “The American Pharmaceuticals Industry needs a full re-flow. Bake off the bad solder joints, get some fresh stuff in place, and remember the people.” and float on.

Prior to this week, I was relatively tolerant of the idea of a mail order pharmacy, having been forced by Express Scripts to switch, find my way to Walgreens, or only get 30 day supplies of my medicine. This also came with colorful documentation to be like Kyle, who gets all of his prescriptions mailed to his doorstep, doesn’t have to spend time going to the pharmacy, etc.

A preface: I do not hate Walgreens in the context of this discussion. Walgreens, however, isn’t located in a good location with regard to transit in this story. Two buses on different roads run through and turn to head the same direction that I need to go. To get to a stop that allows you to catch either bus without having to find out which bus is coming next (requires: smartphone or a paper copy of both schedules), one must walk a little over a quarter mile to the combined stop. FredMeyer is equidistant with regard to stop access, but has the advantage of not requiring an additional step to get to a grocery store while out grabbing pills. Albertson’s, with their Sav-On Pharmacy, wins for distance with a six hundred foot walk to a combined bus stop — the same one I’d get to on foot if I went to Walgreens, incidentally.

My prior insurance carrier, Providence, allowed me to have 90 day fills at ANY local pharmacy, which I grew quickly fond of after coming off the state’s Medicaid programme — only having to go every 90 days to a pharmacy of my choosing, getting all my scrips synchronized so I don’t have to go frequently and remember to pick up pills, and the like? Who wouldn’t like that kind of convenience, seriously?

Express Scripts would only give me that level of access if I went to Walgreens.

When you think about that, for people who don’t or can’t drive, you bet they’re going to want to line up their travel to be as direct as they can. If I’m going to have to spend a bunch of time waiting on buses, or having to take a Lyft or a taxi, you bet I’d rather have also picked up my groceries while being out to pick up my pills and shots, so I can just go home when I’m done.
If I’m wanting that, I’m sure I’m not alone on it.

So, for the current carrier, to continue getting my quarterly supply of pills, injectables, and nasal sprays, I complied by migrating most of my medicines over. My insulin and my GLP-1 agonist were two of the last three to be migrated, and those were done slowly, one at a time to make sure that things weren’t going to go pear shaped at a bad time. I had extra weeks of each medicine at the time of migration, and wasn’t immediately compelled into this. Everything arrived timely, even though my only incentive was to get medicine in bulk then.

Things were fine, and I was back to a point of spending less personal time going to the pharmacy. I then got my fCGM. Express Scripts was very particular about how I got this filled: I could only pick up ONE sensor at a time, every two weeks.

This irks me for a number of reasons:

• I’m not even allowed a one month supply of sensors. That is, two sensors at a time.
• Sensors are attached to the skin with glue. If something pulls it off, I can’t replace it until either the manufacturer sends me a new sensor, or insurance approves an emergency pharmacy refill. Both tasks can take days.
• I’m not even afforded the courtesy of a backup to remove some of the urgency in case of a sensor removal event.
• I now have to visit a pharmacy every two weeks, because heck my personal time, it ain’t worth jack to them.

I tolerate this up until Thanksgiving, though — I got that prescription filled a couple days early, because it’s a holiday weekend, and it’s a good thing that I did. I had my first unplanned sensor pull the Saturday after Thanksgiving, with nearly a week left on it. I was able to clean and sanitize the site, and apply a new sensor that I would normally not have had on hand if my local pharmacy hadn’t been awesome and filled ahead of the weekend.

It was at that point that this incident, combined with reading the next year pamphlet for my prescription benefits and seeing the clause about being required to move maintenance prescriptions to mail order or Walgreens, or be denied fills after two courtesy local fills that I decided I’d bite and start the migration after my next local fill to get that process out of the way. It would get me sensors to have on hand, and I could deal with the manufacturer sending me a new sensor kit in the interim is where my thought process took it.

Most of you reading here probably know what happened with that. If not, have a read — it’s illuminating.

Now, I’m sort of laughing at myself after all this, but it’s not for the reasons some of you might think.

Hello again, I’m Xial (pronounced ‘Zeal’, rhymes with ‘eel’). By day, I’m a non-emergency medical transport dispatcher. I help people get to their doctor’s appointments, pharmacies, and the like as part of their health plan benefits on a same day urgency basis. Something that my personal health insurance doesn’t offer, but theirs does.

One of my personal gripes at work had been with folks needing to go to the pharmacy so frequently. I am guilty of grumbling about folks that should be using their mail order pharmacy benefit, because the very line of work I do makes me aware of the cost of transportation.

This week’s events, rather tellingly, changes my tune from “use your mail order benefit” to “Please ask your local pharmacist to synchronize your prescription refills, so you don’t have to go four times a week.“

It changes because I’ve learned how horribly inefficient mail order pharmacies can be when they screw up for the populace, and so many people are afraid to give them access to an opportunity to screw them up. I hadn’t encountered the screw-up, and the ineptitude of Express Scripts when handling these problems, so I was very much a blind eye for the darker side of mail order.

People are justifiably afraid of what can happen when mail ordered medicines don’t arrive on time, or arrive in unusable conditions. We’re in the colder part of the year out here in the Pacific Northwest — I’m really not going to want to chance having them mail me insulin and the GLP-1 agonist that I take — neither one of them are rated for being frozen during transport. My refills were staged in such a way that we should be out of the coldest part of the season by the time it’s time for me to refill either medicine.

If I were still in Florida, I would also cringe at the idea of shipping injectables via mail. They’re typically rated for limited temperature bands for excursion. Florida gets very hot to go with its high humidity. It’ll be 97°F (36.1°C) in the sun, with a feels like temperature of 105°F (40.5°C) just standing in the sun as an organic meat computer. Now add a big box truck with poor thermal controls to the equation (which covers USPS, UPS, and FedEx), and you have vehicles hot enough to liquefy chocolate, wilt flowers, and spoil medicines. And this is how these companies want to ship life-sustaining things like insulin‽

All of this just makes me want to force the decision makers at each of these pharmaceutical benefits management companies to eat a four ounce serving of sugar free gummy bears for every validated report of delivery screw-ups. Let these decision makers feel the suffering to the tune of gastric distress every time someone has to start fighting with their damned company because an important medicine is wandering around in the back of a delivery truck half the country away.

Maybe then, they’ll be willing to listen to the rest of us when we say “This is a bad thing. We want choice, and you should pay them fairly.”

… That, or they live with constant diarrhoea.