Paul F. (Oregon)

My Patient Rights > Paul F. (Oregon)

Paul F. (Oregon)

When did Medicare Advantage companies obtain the right to practice medicine? Last time I checked, it was doctors who went through medical school to do so, not insurers. When OptumRx refused to allow me to take my normally prescribed dosage of two pills per day for Pioglitazone, a diabetes drug, I was outraged.

My doctor regularly prescribes me 15mg of Pioglitazone, which improves muscle intake of blood sugar for Type 2 Diabetes, to be taken twice daily – for a total daily dosage of 30mg. Recently, OptumRx claimed I needed a new prescription from my doctor because UnitedHealthcare changed their formulary to allow only one pill of Pioglitazone per day, in a 15mg, 30mg, or 45mg dose. However, my doctor and I believe splitting the dose between two 15mg pills a day reduces the potential for adverse side effects and improves the efficacy of the drug, since its retention in the body is between three to seven hours.  This sentence is confusing.

We appealed UnitedHealthcare’s decision, and now they are allowing me to fill the original prescription until the end of this year, but the appeal process was no walk in the park. UnitedHealthcare created unreasonable barriers and problems for me and my doctor every step of the way. Today, they are still pressuring my doctor to prescribe a statin, which helps lower LDL cholesterol in the blood, even though my blood work proves I don’t need one. I have previously refused to take a statin and if they force my doctor to prescribe one, I will not pay for it, and I will not take it.

As if UnitedHealthcare didn’t cause me enough grief already, they intend to make me repeat the appeal process next year. Requesting another special dispensation year after year will be a burdensome, stressful endeavor. One that I do not wish on any other patients. No one should have to fight so hard for their treatment.

Although I was able to appeal and obtain my correct prescription, it is unacceptable to spend so much time and energy battling insurers’ decisions. Insurance companies should not be able to overrule a doctor’s medical decision. Patients deserve to access their medication at the exact dosage they need.

My advice? Trust yourself and your doctor and fight to get the care and medication you need and deserve. And if you need help filing complaints, grievances, and appeals, contact My Patient Rights. They helped me and they can help you too.

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