Tuesday, December 16, 2014

What Happened Next


Like many people who live far outside the Beltway, I tend to think of Medicare as an undifferentiated part of a faceless federal bureaucracy. After writing the letter, I kept it around for a couple of days, then sent it off to Marilyn Tavenner’s e-mail address on Thursday, December 11, in mid-afternoon.

That evening I received a call from Humana saying that my request for Premarin had been approved for one more year. This year my doctor’s nurse had requested the drug for me twice and been turned down twice. After that, I had had to file a grievance; my doctor and I each wrote a letter to Humana. One of those last two attempts had succeeded. This sequence of events is pretty typical of our experience in the three years we have been doing this.

In response to my e-mail to Medicare, I expected to receive a form letter or, at most, an e-mail from the PA of a PA well down in the food chain. I was therefore quite startled to find a message, sent the following morning, from a doctor at Medicare saying that someone would be in touch with me. If I wanted to speak to him directly, he said, I should e-mail my phone number. I wrote back and told him that, since I had received the approval from Humana, the immediate situation was resolved but that I was frustrated at having to go through this process each year and concerned that, at some point, I might not be able to get this medication at all. I included my telephone number but said that I didn’t necessarily need to talk with him.

Minutes after that message went off, the phone rang. It was the same Medicare doctor. Not expecting an important call, I had been playing a brain game on the computer. I had to scramble for a few seconds to get rid of my headphones so I could focus on what he was saying. Our conversation was quite friendly, although we were approaching the issue from different vantage points. His primary concern was to reassure me that I would always be able to get Premarin, although it didn’t sound as though the appeals process would be going away anytime soon.

When I asked why there were so many obstacles for women wanting to use this medication, he said that Medicare wants to be sure that doctors and patients understand the risks involved; some doctors prescribe estrogens for patients who really should not take them. I said that some doctors refuse to prescribe these drugs, even for women would benefit from using them. After WHI 2002, many women were persuaded to stop hormone therapy. (One woman I know had terrible problems with insomnia; another is now taking a bisphosphonate for bone density, which poses its own risks.) We agreed that it would be better if there were some way of providing easier access for women who can and are willing to take estrogens, while discouraging those for whom it is truly a risky drug. He thought that electronic records might make it easier to do this.

At the end of our conversation I had the sense that the Medicare doctor had really heard what I was saying and would continue to think about it. Whether any actual changes will come about is, of course, another story.

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