Hello Darkness, My Old Friend

A rant about health insurance fuckery

In the before times, COBRA kicked in at 22 years old. So, while there's never a "good time" to get cancer, I was 21.5 years old. So, I had to enroll in an individual policy one week after cancer treatment ended.

Life before the ACA meant $3600/month, thanks to United Healthcare.

That is until I got married in 2005 and fell under my wife's fantastic policy, which, at the time, was the fabled "GHI" gold standard of premium union-mandated policy for all NYC educators and associated professionals.

Tranquility went to pot during the pandemic when the union caved to BCBS, who pretty much forced us (and 132,000 others) to find new doctors and negotiate prior authorization denials ad nauseam.

But the seas calmed after weeks of crapness, and life went on.

Until this June, when BCBS was replaced with CVS/Aetna, and all hell broke loose again. We nipped early shenanigans in the bud thanks to our many past experiences and privileged relationships.

However, one thorn still exists in my side – and it's threatening to significantly impact my quality of life as a long-term cancer survivor.

My dad jokes that the secret to life is to 

1) Clean up nice

2) Make it look good

3) Never look under the hood

But "under the hood," at least for me, is a bag of cats held together by a MacGyver-level amalgamation of toothpicks, ball bearings, and Jello.

Twenty-seven years later, one of many invisible gifts that keeps on giving includes chronic GERD. (TMI alert) Irrespective of diet, weight, or lifestyle, my duodenum lacks the neurological capacity to do its job, so I've depended on the latest proton-pump inhibitor innovations (Pepcid, Prilosec, Nexium, and now Dexilant) for over two decades.

Note: Generics suck, and I've fought to stay on brand for years while not going bankrupt in the process.

Well, the fight just got worse.

CVS/Aetna didn't think my medical and prescription history mattered and decided to deny prior authorization for Dexilant (brand) and generic (even though it won't work anyway). They've decided on my behalf that OTC Nexium is the best thing for me. How nice of them.

I've called in a few favors to commence the Sisyphean formulary exemption battle while I have two weeks' supply of medication remaining.

No one is immune. Wish me luck.