Take Control of Your Healthcare
When did we lose control of our own health and health care? I ask myself this question a lot, especially over the last 6 months as I received a diabetes diagnosis. I know in my case it was not intentional. Life got in the way. Between family, career, and lack of extra hours in the day, I let the one diagnosis I had hoped to avoid creep up on me. But, in the last 6 months, I have learned a very important lesson. I have learned how to advocate for myself, for my health, and equally as important, for my pocketbook.
THE SPIRAL
I have to be honest and share that my health journey has been a struggle my whole life. As a child I was overweight, not athletic, or really into sports at all, and a perfectionist. Type A does not even begin to describe the level of unrealistic expectations I put on myself. As a young teenager, I succumbed to an eating disorder, an issue I struggle with to this day.
My childhood struggle continued into adulthood. Like many Americans, I have been a lifelong yo-yo dieter and struggle with anxiety and depression. But, the real spiral started about a year ago when I got the opportunity to work on a project that has been a passion of mine since starting in policy and politics. The job was exciting and probably the most stressful job I have ever had. I was traveling and away from my children more than I cared, and I barely had time to sleep, even less time to think about how I was treating my body. Before I knew it, I was 30 pounds heavier.
Long story short, during an OBGYN visit that I was about 2 years late scheduling, reality hit. What was supposed to just be an annual exam turned into over a dozen orders for blood work. A week later my doctor’s physician assistant called letting me know that I was pre-diabetic, my A1C was at unacceptable levels, my cholesterol was sky high, and I needed to make changes ASAP.
NOW WHAT?
This is where the fun really begins. I was prescribed a new drug on the market to bring my A1C back down into the normal range and lose weight. What I didn’t know was that my insurance would not cover this medication for this purpose (I did not have a full-blown diabetes diagnosis yet) and the medication can run up to $1300 a month. For my family, that would have been a crippling expense. Luckily, because of my job in health care policy, I knew to check the pharmaceutical company’s website for a coupon which allowed me to get my prescription for just $25 a month.
I was able to find a way to pay for my medication, but what about the thousands of Texans who don’t know how to navigate this complicated system? Or, the Texans who don’t have time to wait on the line to talk to doctors, insurance companies, and pharmacists? It is no wonder that two in five Texans skip medication doses in order to cut costs, according to the AARP. In fact, I just helped my father navigate this same system when he was put on a similar drug.
ADVOCATING FOR MY HEALTH
I wish I could say that my health struggles ended with the prescription drug affordability, but it didn’t. As mentioned before, my OBGYN made the diagnosis and got me started on the right path. She and her staff were great. They called to check in and made sure that they increased my dosage at the right time in the process (this drug requires incremental dosage increases). But, I wanted my family physician to take over the process. He is a great doctor, but his office is not great at communicating. After multiple attempts to follow-up with his staff and difficulty getting an appointment, an incorrect dosage was submitted to the pharmacy. After that, I made the difficult decision to find a new doctor. As sad as I was, it was the best decision I have made in my health journey.
My new doctor took an hour and a half with me on my first visit. We went through a full health history, and she took the time to explain why this new drug I am on was so effective and how it works. To that point, not one health care professional had taken the time to explain this to me. She connected the dots with my mental health and my eating disorder history to what was currently happening to my body. Her staff calls back the same day and checks in on my progress regularly. In fact, in December, the drug I am on was in a major shortage because of overprescribing for weight lose by doctors across the country. Now with an actual diabetes diagnosis, I needed the medication, and the medication cadence has to be strictly adhered to. Both my new doctor and her staff helped me track down the dosage I needed.
As I get my health back in check, I cannot help but think about the thousands of Texans who don’t know how to navigate this complicated system, who don’t have time to wait on the line to talk to doctors, insurance companies, and pharmacists. Who is looking out for the Texans who cannot take 4 hours off in the middle of the day to go to a doctor’s appointment without a day’s wage? Certainly, part of our goal at Texans for Affordable Health Care is to advocate for their needs and help to build a system that is friendlier, more accessible and more affordable for these men and women.
LESSONS LEARNED
A few tools to help navigate the health care system if you find yourself in a similar situation:
Get familiar with what your health insurance covers. Insurance companies are required to keep directories updated online. And, you should be able to check items like copays, deductibles, and in-network/out-of-network coverage. Remember, you are paying for premiums, and you have the right to know what is and is not covered.
Find a doctor that listens to you and has a staff that shares their commitment to patient communication. Don’t be afraid to ask questions. And, don’t be afraid to push back if you do not agree with or have concerns about a diagnosis, and don’t hesitate to walk away when you are not receiving the care or communication you deserve.
Talk to your pharmacists and know what pharmacies are in-network. I go to “big box retail” pharmacies for my medications- and the pharmacists have been communicative and incredibly helpful. Their pharmacy technicians have gone out of their way to make sure that I get the lowest price available on the several pricey medications that I am on.
Look for discounts- there are sites like GoodRx, CostPlus Drug Company, and Amazon’s new RxPass that can track down the lowest prices or offer generics at lower prices, especially if you don’t have health insurance. I have used GoodRx during a gap in my insurance coverage and was able to keep my costs down during that period. Check the pharmaceutical company’s website to see if they offer coupons. And, finally, see if your health insurance offers mail-in services. Not only can they offer a larger quantity of the prescription drug at one time, but it often helps keep people on schedule for medications that require a regular cadence.
Finally, help your neighbors! Let’s be Texans and help each other out. Advocate for yourself and for those who may not have the ability or time to advocate for themselves.
Now is the time to send in your stories! House and Senate committees are meeting, and we want to share your stories. What has your health journey been? Do you have advice to share on navigating this complicated system? How can we advocate for you at the Texas Legislature? Contact me at info@texansforaffordablehealthcare.com to let me know what we can do for you.