Δαφνη Ευτυχια Αρθουρος

"No, I don't think shows should do more meta-jokes that cater to the online bloggers, and I'm sure that everyone at televisionwithoutpity.com agrees with me." -- Josh (aka 'whojackie' on TWOP), one of the people Earl has to try to make things right with, on the NBC television show My Name Is Earl, in the episode "Kept a Guy Locked in a Truck" (aired 2007-01-18)

Yesterday I saw two rheumatologists -- not covered by the state health-care-for-poor-people plan, so I had to borrow money from Mom -- and today I go back to see my regular doctor at the clinic. Apparently not much has changed in the treatment of fibromyalgia since the last time I saw a rheumatologist, and most of the usual stuff has already been tried, so they ordered blood tests to make sure I hadn't developed anything they could treat in the meantime, wrote me a referral to a pain management center, photocopied a couple of pages from my old rheumatologist's records just in case I do wind up becoming their patient, and told me it was nice meeting me, they were sorry they couldn't do more, and there was no reason to come back unless my blood tests show something abnormal. So it kinda sounds like a poor use of that $50 on the surface, but hey, one step of the "we gotta do things in the right order" process done, the aforementioned referral (though I've no clue how much that's going to cost), and a prescription for a drug I've wanted very badly for about ten years: extended release tramadol.

I mentioned that the drug I wanted didn't seem to exist, and one of the doctors said, "oh, that exists now." Apparently it came on the market within the past two years (which would be a little while after the lat time I pestered a pharmacist asking whether it existed yet. The catch: they didn't think the state's prescription plan would cover it.

So I took the prescription to the pharmacy just in case, and asked them to check whether it would be covered or not, figuring that if it wasn't, I could just hold onto it until I came up with the money to buy it out-of-pocket. I expected this to be a quick computer query, but it turned into a half-hour telephone-and-computer-and-fax process where the person working on it kept having to call the pharmacist over to put his finger on the fingerprint scanner attached to the computer, and the final answer was that it would be covered after all. *whew*

Except that when I got it home and looked at the bottle, it said "Tramadol HCl - Acetaminophen Tab (subst. for Ultracet)", which sounded ... well, not quite what I expected. And I didn't see any of the expected warnings about "must be swallowed whole, do not crush". I went online and found Ultracet described, and there was nothing in those pages about extended release -- it's just a third as much tramadol as I usually take combined with a drug that has no effect on me. Getting to the Ultram ER information took a little longer (some pages didn't want to load), but there I found all the stuff about it being extended release and do not crush or chew and no mention of acetaminophen.

Oh boy. This doesn't look good.

Wish me luck getting this straightened out.

I've been back to the pharmacy that gave me the wrong drug, and a different pharmacist was on duty. He checked the computer, and the correct drug was listed for me there, Ultram ER, and he agreed that the [generic] Ultracet was not what I had been prescribed. It only took him a minute or two to find out that Ultram ER is not covered by the state pharmacy assistance plan, as opposed to the thirty minutes it took to find out that the wrong drug was covered last night (which makes me just a wee bit suspicious of that whole thirty-minute effort, wondering whether somebody was playing a game to see what they could get reimbursed for that I wouldn't notice -- or maybe it was just a typo along the line ... am I being paranoid? I wish I could've seen the computer screen last night). But apparently they can't just hand me back the slip of paper I'd brought in, to fill sometime when I come up with the $114 it'll cost, so it'll be filled and just sit behind the counter until the day I walk in with $114 and say, "You've got a prescription waiting for me since early February ..."

This pharmacist did try (repeatedly) to tell me to just ask the doctor to write me a new prescription for regular Ultram, since "it's the same stuff, just not extended release" (exactly -- and what I've been asking for for years is just that: extended-release tramadol) so I should just get the cheaper stuff, which is covered. Well duh, I already have a prescription for ordinary tramadol to take as needed during the day; this was to solve the problem of being woken up by pain when the Ultram wears off before I've slept long enough. If the ER version were covered by my pharmacy assistance -- the very question I went in with yesterday at the start of this mess -- I'd definitely want it. I still want it, but just don't know when I'll be able to pay for it, so "is it worth it?" is a valid question, yes, but telling me to get the rheumatologist to change it to what I've already got (the rheumatologist did also write me a prescription for normal Ultram taken a little more often than I've been taking it now, as well as the Ultram ER one) isn't helpful ... and basically just pisses me off.

There's a chance that I won't find the Ultram ER useful after all, that my other sleep problems may wind up waking me about as often, or that trickling into my bloodstream gradually it might not hit useful concentrations for me, but I won't know that until I've been able to do the experiment. I'm not just being manipulated by advertising to believe that The Newest And Most Hyped Version must be the best, and ignorant of the usefulness of the cheaper version; I was asking for this drug a long time before it finally came on the market, and had investigated whether it was feasible to concoct a delayed-release coating for the normal tablets in my kitchen because the manufactured extended-release version didn't exist yet. I don't need to be told about the existence or ordinary tramadol; I need to know whether or not I can afford to fill this particular prescription. Grrrr.

So, obviously, this has all put me in a ranty mood. (And here's this convenient ranting-space on the web...) And further complicating the financial question, now that I know the price of a month worth of Ultram ER (not that I've gone comparison shpopping yet, but this gives me an idea) is that I won't know how much the pain management center I'm being referred to will cost until they call me to schedule an appointment.

Whee.