See, our Congress Critters have allowed the civilian contractor company that takes in $24 Billion in revenues, Express Scripts, to decide that my man (who has military pharmacy benefits) can have 6 Cialis or Levitra pills per month. Now if we are feeling a little frisky on the 7th or 8th day per month...say every Friday and Saturday...well, too bad. He'll just have to get over his PTSD-caused ED some other way.
This isn't exactly my story, but it sure as hell is somebody's story...follow me over the fold for more details. (Not on my sex life, you voyeurs, but on the company that is screwing over the love lives of active and former military folks...
OK, here's the deal. I am fortunate enough to have a sigoth (contraction for that detestable phrase, significant other), who is both brave and passionate...yes, lucky me. He has an enlarged prostate, and has to take medication for it that causes some level of ED. So he got a prescription for Cialis. Yay!!! Does it work? As the doc said...diamond cutter. Way cool (no wait, way hot).
Worked so well, he sent away for a 90-day supply. That is when this $24B company started screwing us instead of allowing us to take care of it ourselves. For the past three weeks, Express Scripts has lied to my sigoth (OK, made mistakes and contradictory statements), insulted him, jerked both him and his busy doctor around, refused service, and ultimately interfered with our planned activities.
The doctor has faxed Express Scripts the medical justification for his prescription for generic Cialis (tanadafil) 3 times. He has called. In addition, my sigoth has spent several hours on the phone, calling numerous times.
Now the dosage my sigoth wants to use is one that requires one 5 mg pill a day. But ES (and probably some uptight nincompoop, perhaps a member of a fundamentalist religious group, has determined that 6 pills a month are enough. Not so...the appropriate dosage is actually 5 mg per day, every day. Sigoth could take 20 mg...and ES would send him 6 of them as well. One telerep said they don't care about dosage, they just send 6 pills. Go figure.(We think, heck, let's just split 'em 4 ways...then we'd be good to go 24 days a month.) So far, we haven't found a reliable way to split these tiny pills up. Ratz, they're just too damned small.
So here we are, our sex life hemmed in by military regs, government sloth, and corporate greed. You'd think that this is what bugs me...but you'd be wrong.
Here's why: If this inconvenience and interference is happening to us with such petty consistency, it is likely that it is happening to others. Although it is never pleasant to spend money that should not have to be spent, our relationship is important enough to us to buy the stuff.
But consider returning vets from our war zones. Many of them have head injuries or PTSD or both. Both conditions can cause ED. For relatively young men, the loss of a healthy sex life is a serious issue that, taken with all the other stresses of returning to a marriage or other close relationship from a war zone, can lead to depression and even suicide. I do not believe this is a trivial issue. For many men, normal sexual functioning is a key element of identity. When it is lost, personal stability is threatened, and the well-being of marriages and families may well hang in the balance.
Do you think some guy in his 20's or 30's will sit on the phone and be insulted and jerked around, trying to talk to some corporate pencilneck, defending his right to be treated for ED? I don't think so.
And, not surprisingly, there is a time-consuming, paper-laden process for appealing a decision, but there is no complaint process or ombudsman to take on the behemoth.
So what about this company that is estimated to net $2.8B from the Department of Defense contract for handling military pharmacy benefits? Express Scripts is a civilian contractor based in St. Louis, MO company. Here's an excerpt from ESs' Annual Report that describes what they are doing for DoD:
While we have provided services to the DoD since 2003, this new contract combines the pharmacy network services, home delivery and specialty pharmacy under one program. The DoD’s TRICARE Pharmacy Program is the military healthcare program serving active-duty service members, National Guard and Reserve members and retirees, as well as their dependents. Under the new contract, we provide online claims adjudication, home delivery services, specialty pharmacy clinical services, claims processing and contact center support, and other services critical to managing pharmacy trend.
I'd like a little help finding out more about how ES is operating, and if they are establishing policies to deny coverage like all the other insurance scumbags. I'm thinking that if they are keeping military from getting generic Cialis, they might well be jerking people around in other ways with other medications.
If you know of anyone who is having trouble with ES, or you can tell me anything more about the company, please post or have them send me an email at roadette@roadette.com.