Just an average day here at Sherpaa…

Client: My OBGYN is having trouble getting my prescription approved. I’ve been on my OCP (oral contraceptive pills) for 8 years, and my insurance company says they don’t cover it. Could you please let me know what the cost of this will be? (monthly). There is NO generic form of this drug available, and I certainly don’t want to switch at this stage. I’d appreciate any help you could provide. Thanks!

Dr. Santana: Sure, I’ll look into it for you. What’s the pharmacy where you get your medication? Also, did you try other brands of birth control pills before, or did you have any problems with other brands of birth control. I can try to get your insurance to make an exception.

Client: Duane Reade. THANK YOU!!! I leave for vacation on Friday and will need it in my hands by Friday morning.

Dr. Santana: We’re seeing that a 28 day pack of your OCP is $93.99. I’ve been on hold for 9 minutes waiting for the Duane Reade pharmacist at the number you provided, but I suspect the pharmacist may be gone for the day. Is there a reason why you don’t want to use an alternative brand other than you’ve been on your OCP for the past eight years? Have you thought about alternative forms of birth control such as an IUD?

Client: I have tried alternatives, but had side effects (gone through a years worth of trials). This has been the best option for me to date.

Dr. Santana: Ok. I can try to get your insurance company to make an exception if you’ve tried other OCPs and haven’t been able to tolerate side effects. Which other OCPs have you tried, and what side effects did you have?

Client: I’ve tried a variety of types. Yaz, and a variety of generic versions my school provided. I had terrible migraines and was very moody.

Dr. Santana: There’s a number that the pharmacy usually has to call to get prior authorization for coverage for medications. I can’t get through to your insurance company or the pharmacy at this time. I’ll be in touch in the morning. They might not be open until 9:00 am, but I’ll try at 8:00 am. I’ll let you know as soon as I get through to someone.

Client: Thank you.

(The next morning)

Dr. Santana: I got prior authorization for a 90-day prescription of your OCP. I called Duane Reade, and you’re good to go. You can go ahead and pick them up. I changed it to a 90 day supply with three refills. There will be a $0 copay. Your OB’s office tried for prior authorization yesterday, but they didn’t have information about your medication history. Btw, I have a 100% batting average for getting prior authorizations. Have a great vacation.

Client: This is incredible. Thank you! I greatly appreciate your help Ida! Thank you, Thank you. You guys are awesome!!!