Jan. 24th, 2020 08:12 pm
People Did That
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nightengaleskndThis is a bit political. Not in the endorsing specific candidates sense, but in the sense that disagreements about what should be considered a right and provided by the government are political.
I’ve had A Week. A Month. A Career.
And I’m a rules-following, might even say rules-loving autistic.
But I’m sort of at the end of my patience with some (many? most?) of the rules I’ve encountered lately.
Because The Rules are not some immutable provision of the universe.
Rules and laws are made by people. People did that.
The formulary for our state medical assistance changed at the start of the year. A medication I prescribe a lot was taken off the “preferred” list. And money doesn’t completely explain it, because some more expensive medications ARE on the preferred list. Patients now have to fail five medications off the list before they might be granted access to a new prescription for the one that was removed. And many of the medications on the list are different formulations of one medication. I’m glad they are covering these different formulations, now, because that’s new. But. . .they shouldn’t count as different medications for this purpose. People already on the medication are generally getting approved. After going through the prior authorization process.
I now have a script, verbal and written (for the medical record) explaining this process to families. A literal script every time I write a script. I like scripts, but this one has gotten old after the 20th time.
Another medication is covered in capsule and liquid form but not the tablet that can be cut in half for a smaller dose. Another now needs an authorization for patients under 18, even though it has FDA indications starting at age 6. I fill out the forms, giving all my reasons, and then I get a denial that suggests no one actually read the reasons, and then I call the insurance company and talk to a physician or pharmacist and then I often win.
The people I call on the phone for an authorization aren’t the ones who made the rule, and I know that. I can’t take the problem out on them. I am trying to figure out exactly where I can take a complaint to the people who changed the formulary. Because it doesn’t make a lot of medical sense.
And people made the formulary.
Possibly people with experience prescribing medications, but probably not people with the experience of loosing access to a medication that was working, or spending hours on the phone getting approvals.
When I call, I have to enter my ID number, the patient ID number and the patient birth date before I am granted access to the phone tree. When I get to a person, they then need me to tell them both ID numbers and the patient birth date. They won’t have any access to what I entered into the system. So why am I required to enter it into the system?
People made that phone tree
There is a program that will provide transportation to medical appointments, for a child and a parent/caregiver. They won’t transport anyone else, even an infant sibling of the patient.
People made that rule.
And probably, people with cars and people who can afford baby sitters. People who have never had difficulty getting to a medical appointment.
People decided the income limits to qualify for medical assistance, and SSI and SSDI and SNAP and Section 8 housing. People who probably never needed food, housing, medication or other necessities provided by any of these programs.
The hotel has a shuttle that is not wheelchair accessible. Someone made that decision. They at least were up front about it on the hotel website. The sidewalk to the hotel from the nearest bus stop has curb cuts all the way – until it doesn’t. You have to cross two extra streets to get to the bus stop. Someone decided not to put in a curb cut.
Someone at the doctor’s office decided that you have to sign for your copay on a touch screen. Someone at the CVS pharmacy franchise decided that too. Someone at the Apple Store. And this restaurant. And that one, and the other one. They also decided to make all the tables high-tops. And to play music at decibels incompatible with most verbal speech.
People made these rules, and then left enforcement in the hands of people who didn’t. Often, leaving enforcement in the hands of people who don’t have the ability, within their rules, to authorize any changes.
People did that to other people, made laws, made rules to make life harder for them. They usually give money as the reason. Sometimes there’s another stated reason, one that usually affects people with less privilege disproportionately.
I understand the need for rules, for expectations, for order.
But my dominant sense of 2020 so far is one of rules made and imposed and then hidden behind in ways that create ongoing harm. And I have to assume, at some point, that the rule-makers simply don’t care about the harm. Probably because it isn’t them, or anyone they care about, who is being harmed.
People are being harmed.
By people. People did that.
I’ve had A Week. A Month. A Career.
And I’m a rules-following, might even say rules-loving autistic.
But I’m sort of at the end of my patience with some (many? most?) of the rules I’ve encountered lately.
Because The Rules are not some immutable provision of the universe.
Rules and laws are made by people. People did that.
The formulary for our state medical assistance changed at the start of the year. A medication I prescribe a lot was taken off the “preferred” list. And money doesn’t completely explain it, because some more expensive medications ARE on the preferred list. Patients now have to fail five medications off the list before they might be granted access to a new prescription for the one that was removed. And many of the medications on the list are different formulations of one medication. I’m glad they are covering these different formulations, now, because that’s new. But. . .they shouldn’t count as different medications for this purpose. People already on the medication are generally getting approved. After going through the prior authorization process.
I now have a script, verbal and written (for the medical record) explaining this process to families. A literal script every time I write a script. I like scripts, but this one has gotten old after the 20th time.
Another medication is covered in capsule and liquid form but not the tablet that can be cut in half for a smaller dose. Another now needs an authorization for patients under 18, even though it has FDA indications starting at age 6. I fill out the forms, giving all my reasons, and then I get a denial that suggests no one actually read the reasons, and then I call the insurance company and talk to a physician or pharmacist and then I often win.
The people I call on the phone for an authorization aren’t the ones who made the rule, and I know that. I can’t take the problem out on them. I am trying to figure out exactly where I can take a complaint to the people who changed the formulary. Because it doesn’t make a lot of medical sense.
And people made the formulary.
Possibly people with experience prescribing medications, but probably not people with the experience of loosing access to a medication that was working, or spending hours on the phone getting approvals.
When I call, I have to enter my ID number, the patient ID number and the patient birth date before I am granted access to the phone tree. When I get to a person, they then need me to tell them both ID numbers and the patient birth date. They won’t have any access to what I entered into the system. So why am I required to enter it into the system?
People made that phone tree
There is a program that will provide transportation to medical appointments, for a child and a parent/caregiver. They won’t transport anyone else, even an infant sibling of the patient.
People made that rule.
And probably, people with cars and people who can afford baby sitters. People who have never had difficulty getting to a medical appointment.
People decided the income limits to qualify for medical assistance, and SSI and SSDI and SNAP and Section 8 housing. People who probably never needed food, housing, medication or other necessities provided by any of these programs.
The hotel has a shuttle that is not wheelchair accessible. Someone made that decision. They at least were up front about it on the hotel website. The sidewalk to the hotel from the nearest bus stop has curb cuts all the way – until it doesn’t. You have to cross two extra streets to get to the bus stop. Someone decided not to put in a curb cut.
Someone at the doctor’s office decided that you have to sign for your copay on a touch screen. Someone at the CVS pharmacy franchise decided that too. Someone at the Apple Store. And this restaurant. And that one, and the other one. They also decided to make all the tables high-tops. And to play music at decibels incompatible with most verbal speech.
People made these rules, and then left enforcement in the hands of people who didn’t. Often, leaving enforcement in the hands of people who don’t have the ability, within their rules, to authorize any changes.
People did that to other people, made laws, made rules to make life harder for them. They usually give money as the reason. Sometimes there’s another stated reason, one that usually affects people with less privilege disproportionately.
I understand the need for rules, for expectations, for order.
But my dominant sense of 2020 so far is one of rules made and imposed and then hidden behind in ways that create ongoing harm. And I have to assume, at some point, that the rule-makers simply don’t care about the harm. Probably because it isn’t them, or anyone they care about, who is being harmed.
People are being harmed.
By people. People did that.