Tuesday, May 20, 2014

Follow-up to Furious

As I wrote yesterday, we've been having issues getting the P17 injections, and it felt like my doc wasn't advocating for me. To those that commented on my last post, if we weren't happy with what we heard today we were going to get a consult from the other OB who says he handles high-risk pregnancies. We now live in a small town, so there aren't that many options for OB's that handle cases like mine, and the nearest MFM is almost 2 hours away.

So, today I had an appointment with the doc, and it turns out, partially, that the nurse was not conveying proper information to me. Because my insurance company said that I didn't meet the FDA requirements for Makena, he was comfortable writing the script for Makena (as a name brand). If I could get it filled at a compound pharmacy he was fine with that, but if anything went wrong with the compounded version he didn't want the liability involved with him signing off on the compounded version. He said that he told his nurse that. We told him that the message conveyed to us was not that.

So, I walked out with a paper copy of the prescription, clearly marked that generics were okay, and was told that I could take it to any pharmacy I wanted. I called the compounding pharmacy that I wanted to use and was told that my doc would need to fill out a form that states that the doc knows a commercially product is available and that he's okay with the compounded version. I think this is where we have no other options but to spend the $2100 and get the Makena instead of the $330 for the compounded version. I don't think he's going to sign that form. Jon agreed and tomorrow I will work on getting the prescription sent to be filled with the name-brand P17, in hopes that we can start the injections next week. I guess the only positive thing is that because this has taken so long to figure out, I don't need as much of the medicine, so that's reducing our cost from $3000 to $2100.

As much as I'm trying to not have the negativity and stress overtake me, so as not to do harm to Bean, I hate the emotions I've having with this. I hate feeling backed into a corner. I hate feeling the same things I did when we first started going through infertility treatments and knowing that we were going to have to pay for everything out-of-pocket. Now, here we are again. Having to pay for something out-of-pocket because the stupid insurance company says so. Annoyed. Deflated. Feeling defeated. But, it's what we will do to try and give Bean the best chance at staying healthy and not coming too early.

We also spoke with the doc about the u/s techs. He said that he did put a note in my chart for the techs to confirm life, so it looks like there was a communication breakdown somewhere between him and the techs. He wrote another, very detailed note, during the appointment stating several times that the techs are to show me the heartbeat at each cervical length u/s, of which there are only 2. So, if I have to fight to see Bean again this Thursday or next Thursday, at least I know that the note is in there and will just keep fighting with the techs to see Bean. Of course, I can also hope for the really good u/s tech!!!

At the end of the day, Jon wasn't 100% happy with the doc, but not enough to warrant a 2nd opinion. I guess we'll see what happens as we move forward. We are now 18w6d. Bean's heartbeat was around 147. My fundal height is measuring find. My weight is doing well (I've gained 4lbs in the last 4 weeks, so within the normal range). I go in this Thursday and next Thursday for my last 2 cervical length checks, anatomy scan June 5 and next doc appointment on June 16.

Jon has pointed out that, except for that one episode of bleeding after a BM, this pregnancy has been normal, and that we're just waiting for the shoe to drop and become abnormal, like all our other pregnancies. I'm trying to be hopeful that this pregnancy will continue to be normal, but I don't think I'll ever stop waiting for that shoe.


  1. I am going through a similar insurance issue but with lovenox, not p17. I never did get my covered, but I did shop around to different pharmacies. You mention you live in a small town but try if you can. The first pharmacy wanted to charge me $1000 and I was able to find one that only charged $300. A few phone calls saved me $700. I was shocked at the price difference for the exact same medication. I'm still mad that I have to pay out of pocket for something that my doctor think is necessary, it's absolutely stupid.

    1. I know! There just aren't that many specialty pharmacies, you know? I'm waiting for a call from the specialty pharmacy (I dropped by script off at a local location yesterday) to move the process forward. Hoping that the quote they gave me is accurate.

  2. I am so sorry you are dealing with such frustration with insurance. It's ridiculous when they won't cover medications. I am glad that your appointment with your doc went well and hope the communication issues between him and the nurse and u/s techs gets worked out. You don't need this stress! Hang in there, sending you lots of hugs!

    1. Thank you so much! At my u/s yesterday the tech did both the cervical check and showed me the hb, but she was not very talkative at all. Hoping she was just having a bad day and it wasn't because it was me.