HJNO Jul/Aug 2024

HEALTHCARE SYSTEM 38 JUL / AUG 2024 I  HEALTHCARE JOURNAL OF NEW ORLEANS   ing. And hospital and clinic administrators, may I suggest getting a few of those scooters, like the ones found at the grocery stores, for non-patients who need a little help making it around your facility. You will get brownie points from my father if the scooters have an active map so he can make it to the cafeteria and back to the room with ease to see his wife. n standard treatment of vancomycin was called in. He said it has a 75% success rate after 10 days of meds. We all wanted to get this in her as quickly as possible because, well, it is C. diff. The Absurdity and Stress of Prior Approval for Standard Treatments and the Lack of Providers and Pharmacies to Track Available Meds We called the pharmacy to see what time we could pick up the medication. The pharmacist said it had not been filled because it need- ed “prior approval.” To fill it then would be $502.54. They asked if we still wanted it. I was now in another session from the conference. My mother heard us discussing the price and actually turned to my father and apologized for being sick because it was so expensive. I snapped my head around and said, “Well that is why you have money,” and I was grateful we did, so we could say, “fill it.” Even then, we all hoped that the prior approval would happen retroactively; we were not sure. How many people simply cannot afford to say “yes”? We thought we were on our way but then were told the drug was not even in stock; it would probably be in tomorrow if they ordered it. I asked if they would call to see if any other pharmacies had it, and she said she would check. My mom bragged, “They know and take care of me there.” We often do not give enough accolades to pharmacists. They are on their feet all day, check for interactions, and are sometimes one of the few social lifelines for patients and caretakers as diseases and age progress. We got a call back with good finan- cial news — GoodRx could fill it for only $67, but none of the pharmacies in their system had it; we would have to wait for it to hopefully ar- rive tomorrow at that pharmacy. I called the on- call doctor to see if we could pick up the pre- scription at another pharmacy chain. He said he couldn’t tell which pharmacy might have the drug, couldn’t help with prior authorization, but did say I could call around to other pharmacies and he would call me back in 20 minutes and switch the prescription to that pharmacy — he suggested Walgreens. I called the store near her and was on hold for 17 minutes, then was disconnected. Unbelievable. By that time, the doctor called back, and since I could not find the drug, he suggested to just continue watch- ing her and if symptoms got worse or fever spiked, “bring her to the emergency room.” Not exactly a cost-effective situation, but it helps explain why healthcare is now 20% of GDP. My mother went to bed, and I wondered if we all had done the best we could for her. At 8:24 the next morning, mother got an email from Humana; the prior authorization had been approved. The Medicare price was $79.82, almost $13 more than what she would pay with the GoodRx price her pharmacy found. Perhaps the GoodRx folks should be negotiat- ing for CMS; I might suggest that next time I have an opportunity to question the Medicare director. Then, mother’s caretaker side kicked in and she asked me, “Will you please look at the rash under your father’s arms?” It did not look good, and he said he could not get an ap- pointment with his regular dermatologist for another month. He even called the previous week in the midst of taking care of her to try and be worked in. “It is the doctor’s discretion if he will work him in,” I was told when I called to see if, perhaps, they had just forgotten about him. And I wonder, can we do better by him? That generation typically does not question medical authority, so he just sat quietly, wait- ing. I got an appointment for him the next day. As I look through the system from all sides, I am simply blown away by the angels in the system who see what they do as a calling. Whether you are cleaning someone who soiled themselves, giving directions, setting an ap- pointment, filling a prescription, or asking a patient a few more questions because you hear anxiety, thank you for making the world better. If you don’t see this industry as a call- ing, perhaps you should bow out. For those who can, please simplify this system with the goal of dignity, kindness, and respect for all involved, including our healthcare workers. It will attract more angels, and you will definitely want this when you are on the receiving end. None of us choose to age or to get sick, and nobody should be ruined by debt be- cause they are. And I honestly wonder, should healthcare be a business at all? P.S. — Those of us in good shape, please consider parking further away in lots; you will get a few more steps in and make life less stressful for those who have difficulty walk- “I am simply blown away by the angels in the system who see what they do as a calling. Whether you are cleaning someone who soiled themselves, giving directions, setting an appointment, filling a prescription, or asking a patient a few more questions because you hear anxiety, thank you for making the world better. If you don’t see this industry as a calling, perhaps you should bow out.”