Friday, February 9, 2018

In a lather about prescription hand cream

The other day when I sat in my car a long time before coming into the house, Katie asked me what I was doing.

A few weeks ago, it would have been that I was frantically playing Words With Friends. I enjoyed the way it allowed communication with people I don't usually see, but I was getting obsessed with it, playing in almost every possible spare minute, to the point where I began to wonder how much reading or work I would have done in the period that I was trying to get the highest scoring word.

I looked up Words With Friends and addiction and my suspicion was confirmed. I was addicted. I'm tempted to go back because I miss it, but it wasn't good for me.

No, I was looking at my hands and getting worked up about my inability to get a prescription that I need. I got it before, not easily, so was hoping to I get it again. I've been squeezing the last little drops from my old tube.

As directed, I applied Efudex (trade name florouracil), a chemotherapy-type cream, to my hands, nightly for three weeks, wearing gloves to help the drug do its job which, to tell the truth, I'm not sure I'm explaining correctly. It activates precancerous spots so that my hands were filled with raised red blotches. Some have faded to brown while others are still red.

To calm my skin down and smooth over the remaining little annoying and (to me) unsightly bumps, I'm supposed to apply Retin-A (tretinoin), which increases skin cell turnover and is used to treat acne. The rub, so to speak, comes into play because it is also used to smooth over wrinkles. You can buy it over the counter for a tidy sum.

Therefore you have to jump through hoops to get a prescription even if you really need it.

The first time through, the insurance company rejected it, bouncing it back to the doctor for Prior Authorization. Which could otherwise be called PITA (Pain in the ass). The doctor must provide a compelling reason for the insurance company to grant approval. This often happens with an expensive drug. It is a way for insurance companies to minimize costs. Some see it as a way for them to get out of paying; doctors and patients often give up.

I inquired Wednesday at the pharmacy and learned that after they sent it back to my dermatologist for prior authorization in September, they hadn't heard anything. They assumed that meant it had not been sent.

I sat down right there and emailed my dermatologist and my nurse practitioner, Melissa, who seems to magically fix things that other people are unable to take care of. This was taking so much time that I was frustrated almost to the point of tears.

Melissa wrote that she would send in the prior authorization again. She asked for a diagnosis, which my dermatologist said was actinic keratosis. These can turn cancerous, so my concern is not just cosmetic.

Yesterday afternoon, the dermatologist's nurse called and told me it was rejected. She also told me some over-the-counter alternatives.

Later that day, Melissa emailed to say it had gone through.

So the nurse must have been talking about the rejection on the first go-round without knowing that Melissa had succeeded on the second try.

Today I picked it up my new tube. It is strong stuff, and so to start with, you apply it only every three days, soothing with Aquaphor in between.

"Success!" I exclaimed, waving my precious treasure in the air.

Pharmacist and technician grinned.

"They just want to make you give up," I said.

He nodded his head in agreement.

But I didn't give up.

It's the little things.

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