Wednesday, October 26, 2011

Guess What? I am an Inspiration!

Apparently my last post regarding the obituary of my energy inspired my sister to make her own announcement. This was just delivered to my email:

"Brigid Laurito is pleased to announce, after years of trying, she gave birth to a healthy sense of humor.  Labor came on with a smirk and grew into a giggle until it reached its pinnacle with guffaws.  She was unable after hours of pushing down her feelings to contain her sense of humor.  A gut busting C-section of thunderous laughter brought the sense of humor into her world.  We are so happy we can stop laughing at her and begin laughing with her."

Props to Kara Sheftel. Glad to be your big sister and your inspiration.

Monday, October 24, 2011

Energy Obituary

Brigid's Energy departed from this earth June 2009. Energy was a lifelong resident of Brigid's body starting June 1975. Brigid's Energy impacted many lives fueling several of Brigid's team sports. Energy made playing basketball, softball, soccer, Irish step dancing, and running track enjoyable. Energy opened the door for Brigid to meet her soul mate at a late night party up at UCONN. After several years of marriage Brigid's Energy was spent on her growing family. Energy allowed Brigid to attend her daughter's concerts at school, her theater productions, her soccer games, dates with her husband, and family vacations with ease.  Energy was a contributing member to society giving Brigid that push she needed to go to school and become a successful massage therapist and pharmacy technician. Energy leaves behind Brigid, her husband Joe, and their 8 year old daughter.  Energy will also be missed by many of Brigid's family and friends. There will be no calling hours and memorial services will be at the convenience of the family. In lieu of flowers please offer your taxi, babysitting, cleaning, or cooking services to the family.

Monday, October 17, 2011

Little Known Insurance Tid-bits

Right now I am going to share with you some things that I learned while working in the pharmacy to help you better understand how the insurance companies work.  Because of this understanding I have been able to get my insurance company to pay for things they normally wouldn’t have.

BRAND VS. GENERIC
First off I am going to explain brand named drugs versus generic.  We know those people, as you might be one of them, that say brand and generics do not work the same.  Then you have those people that say that they are all the same quit your whining. Well you are both right.  How?

The drug companies apply for a patent for a specific drug and they start their research and clinical trials. This process takes years and years to complete. The FDA then approves said drug so it can be dispensed to the public. This drug is called your BRAND named drug. Once the patent expires any other drug company can buy the recipe for this drug and dispense it as a GENERIC. Because the drug companies don’t have to pay for all the years of research, salaries, clinical trials, and equipment they can charge a lower rate for the drug and still turn a profit.

Now there are two components that go into a drug, active ingredients and inactive ingredients. The active ingredients make the drug do the specific job it’s assigned to do and the inactive support the active ingredients.  The inactive ingredients in a GENERIC do not have to match the inactive ingredients in a BRAND to do the job. This is why some generics work and some don’t. 

Here’s the breakdown…

Drug: BRAND           
Active Ingredients: A, B, C, D   Inactive Ingredients E, F, G, H


Drug: GENERIC A   
Active Ingredients: A, B, C, D    Inactive Ingredients E, F, G, H


Drug: GENERIC B    
Active Ingredients: A, B, C, D    Inactive Ingredients I, J, K, L   

When a GENERIC works just like the BRAND you are receiving GENERIC A. The pharmacy lingo is that the drug is biochemically identical.  When a drug doesn’t work the same you are receiving GENERIC B. 

I do know from working at CVS that it is their policy to not replace a BRAND drug with a GENERIC unless it is a biochemical match.  I don’t know about any other pharmacies.

A DIRTY LITTLE SECRET
Aside from the reasoning above that I gave for brand name drugs to be so expensive I have something else to throw in the mix.  Of course the insurance companies encourage you to go the generic route because it will be at a lower cost to them.  If your doctor writes the prescription for a brand name drug then you have the choice of getting the brand or generic. However if the doctor writes the prescription for the generic then you must get the generic. The insurance company and the pharmacy are not being difficult, it’s the law.

Now let’s look at your insurance co-pays.
generic $10.00
common (or formulatory) brand name $25.00
uncommon brand name $50.00.

Here’s the scenario, you bring a prescription to the pharmacy that is written for a brand name drug. The pharmacy has to tell the insurance company one of three things and this helps determine the out of pocket cost to you. 1.) you want the generic drug 2.)  the doctor is requesting brand name 3.) the patient is requesting brand name. All of these are specified on the prescriptions.

You choose to get the generic and you pay $10.00
The doctor says you need to only get the brand name $25.00
You insist on getting the brand name even though your doctor didn’t specify $65.00
$65.00! Where did that come from?!?! That would be your brand name co-pay of $25.00 plus the difference between the brand name co-pay and the generic co-pay which is $40.00. So $25.00 + $40.00 = $65.00. Now again if there is no biochemically matched generic you will be given the brand and only pay the $25.00 regardless of what the doctor writes.

STEP THERAPY
Another obstacle is what is called step therapy.  This is a big reason insurance companies deny payment and you have to fight with them.  If you only take one thing from this post take and remember these two words PRIOR AUTHORIZATION. Insurance companies want you to start out with the least expensive and least potent drug obviously. To give you an example please see below.

Drug A            least potent and least expensive
Drug B
Drug C
Drug D
Drug E             most potent and most expensive

You have been going to your doctor and he gives you Drug A to try.  He gives you a sample from his closet. A few months go by and Drug A is not working so the doctor looks at his supply and gives you Drug B. A few more months go by and Drug B is not working so the doctor writes a prescription for Drug C. You go to the pharmacy and the insurance company denies the claim and refuses to pay for the medication.  Why?  Because the insurance company does not know that you received samples of Drug A and Drug B, they just assume you are jumping right into Drug C.  They want you to try Drug A and Drug B first understandably. The first thing you should ask is if the insurance will cover the drug with a PRIOR AUTHORIZATION. Most cases they will. You or the pharmacy will call the doctor and notify them. The doctor will then tell the insurance company that you have indeed tried other therapies then BAM! It’s covered!  The insurance company just has to update your profile in the computer so when your pharmacy re-bills the drug it’s covered. I hope that this post has made you more aware of how things work because of course you are always your biggest advocate.

Saturday, October 15, 2011

New resource

A new resource has been added to the blog.  A doctor check list. I have seen in many groups and forums on the web, questions about what should be brought up during a visit with the doctor.  Below you will see a link to the check list which you save to your computer, print, fill out, and bring to your appointment. You can also find this link on one of the tabs at the top of this blog labeled Doctor Check List. Here's to worrying about one less thing when we meet with our health care professionals.

Friday, October 7, 2011

The Idiot's Guide to RA - no I'm not calling you an idiot!

It occurred to me that I haven't really explained what rheumatoid arthritis is and why it's so dangerous. If you are reading this and you have RA please keep reading because I think this might put a different twist on things.

In summary RA is an autoimmune disease where the immune system attacks your joints mainly but can move on to other tissues and major organs through out the body. This can cause inflammation, swelling, pain, and over all fatigue. Now here is where we get to the good stuff! I know you can hardly contain yourself!

*

Now look at the above diagram. This is your basic weight bearing joint. Most joints have a synovial membrane (shown as synovium above) and those particular joints are constructed so no rough surfaces ever touch. If only they would stay that way right? Inside this cavity you have synovial fluid to ensure this does not happen. The fluid is made up of water and chondroitin sulfate. The cartilage that you see at the tops of each bone have collagen fibers that catch the fluid to allow the ease of use of the joints. Think of the fluid as food for that cartilage to survive. Having RA means that your immune system is trying to kill off your synovium and/or fluid. Compromising that area will lead to unhealthy cartilage, deterioration of, then bone rubbing on bone, which will lead to being curled up in a fetal position crying from the pain. Interesting huh? It gets better.

Lets go over why your immune system even starts to be so nasty and mean in most cases of RA. We start with a healthy body invaded by a pathogen (a virus or a microorganism). Your body produces T-cells, B-cells, and antibodies to fight this pathogen. You win the fight! Yay! The pathogen is gone! Would have been nice if your immune system got the memo because now you have memory cells made up of these antibodies searching for remnants of the pathogen. These antibodies get confused because the proteins in your synovium mimic the makeup of the pathogen. A pathogen's protein coat has a bunch of amino acids. Amino acids are also found in normal healthy parts of the body. All you need is for your synovium to mimic 5 amino acids in a row as the pathogen and BAM those antibodies get to work and start destroying the good stuff. You also might be genetically predisposed to these antibodies too. Now in defense the synovial membrane swells and thickens. This causes the fluid to accumulate and that's when you feel pressure and pain. The inflamed tissue releases an enzyme that will erode the cartilage right down to the bone. Remember we said the fluid was like food for the cartilage? Well imagine those enzymes being released into the fluid and them being nothing but unhealthy fatty fast food. We all know how our body reacts to that. So with no cartilage, and a sub par synovium, the joint starts to deform. A fibrous scar tissue will accumulate and then the joint bones are fused together. Can we say OUCH?

Now seeing how confused the antibodies get we understand why we can get complications secondary to the the joint issue. Every tissue in our body is in danger. That includes lungs, heart, blood vessels, the list goes on and on. This is why you NEVER say to someone with RA "...but you look great". Yeah I look like a super model I'm sure but my insides are at war! What makes this even more serious is that the drugs used to treat RA are also used to fight MS and Cancer. Yes cancer folks! Did you know that the when the chemo, that we put in our body, is prepared the person has to wear protective gear as not to hurt themselves. But hell, at least you look ok right?


photo credits
*http://images.rheumatology.org

The information in the post is based on A Massage Therapist's Guide to Pathology Third Edition by Ruth Werner