Antibiotics hazardous to your health? Who knew?

Turns out there's a particular class of antibiotics that can be extremely hazardous to your health. My wife and I learned this the hard way this past week. It was much, much harder on her than it was on me though - she's the one whose health was affected - I was just consumed with worry. The class of drugs is fluoroquinolone antibiotics. The particular one that my wife was on is called Avelox. They're very powerful at killing bacteria, which is what you want an antibiotic to do. But, according to what I've read about them during the past week, they're also apparently extremely harsh on the healthy parts of your body, and can cause serious damage to your body, sometimes life-long damage. I'm working on a more detailed post that describes exactly what my wife went through, as well as some of the info that I've read about these drugs. Hope to have that up in the next day or two.

My wife has allergies. Not your typical allergic-to-a-certain-few-things-at-certain-times-of-the-year allergies; it's more of the allergic-to-seemingly-everything-under-the-sun type. One example: when she was a child, a doctor told her mother that she was allergic to nighttime air. I'm not an expert on allergies, but I don't believe an allergy to nighttime air is very common. (Please correct me if you know otherwise!)

Her doctor has her on Zyrtec-D, a prescription allergy medication that includes a decongestant to help with nasal congestion caused by allergies. She's been taking it since mid-2006, at least - possibly longer, but that's as far back as our prescription records are available online. We've been with the same prescription insurance company (Caremark) the entire time she's been taking Zyrtec-D. Our prescription coverage copay for a month's supply of Zyrtec-D was $21.46 at a retail pharmacy. If you choose to utilize our insurance company's mail-order pharmacy then you can get a 3-month supply of your prescription for the cost of a 2-month supply at a retail pharmacy. So we were looking at paying roughly $172 for her Zyrtec-D for the entire year. Calculating the estimated costs for the year is fairly significant when it directly factors into how much you contribute to your Flexible Spending Account for the year, since you have to set your FSA election before the year starts and cannot change it once it is set.

We had been getting all of our prescriptions locally at a retail pharmacy. This year we decided to switch most of them to the mail-order pharmacy to save money. My wife's Zyrtec-D was one of the prescriptions that I tried to switch to mail-order in January. A little more than a week after I mailed in the prescriptions, we received an envelope in the mail from the mail-order pharmacy. I opened it to - surprise! - a letter informing me that Zyrtec was now an OTC drug and no longer available by prescription. There was also a coupon of some sort that I saved somewhere, not really expecting it to ever be useful.

My wife still had one or two refills left on her Zyrtec-D prescription at our local pharmacy, so at that point I just requested a refill from them, curious to see if it would go through. Somewhat surprisingly to me, the pharmacy did fill it and the insurance covered it at the usual rate. When I queried the pharmacist about Zyrtec switching to OTC, she informed that Zyrtec-D was indeed available OTC now, but said to continue trying to fill it via prescription in the future since our insurance wasn't fighting paying for it (yet). I didn't think much more about it until today.

I did a little bit of research today and discovered two key facts:
1) The manufacturer of the prescription version of Zyrtec-D has stopped producing it. Thus, the supply of prescription Zyrtec-D is limited and will likely be exhausted before too long.
2) The cost for the OTC version of Zyrtec-D is $19.99 for 24 pills. Each pill is a 12-hour pill, so 24 pills will last for just 12 days.

So we've suddenly gone from paying $21.46 for a 1-month supply to paying $19.99 for a 12-day supply. Factor in the mail-order pharmacy price that we had planned on getting, and it's a $14.31/30 days to $19.99/12 days difference. In other words, our yearly costs for Zyrtec-D just skyrocketed from the $172 that we had planned on up to $608. That's a significant jump, and it threw a huge monkey wrench into our FSA plans that were already in massive disarray from some other unexpected medical expenses early in the year.

This bothers me on two different levels. The first is all of the advertisements and news stories that talk about how consumers will save money because Zyrtec is switching to OTC. Just about every ad and news story that I have read about the switch likes to trumpet the fact that this is a big win for consumers because 1) they will save money on Zyrtec, and 2) Zyrtec will be easier to buy. Lost in all the hubbub is the fact that people with insurance that covered Zyrtec with a modest copay are probably not saving much money, and in many cases are actually losing money on the deal - sometimes substantial amounts. Ads/stories that tell me I'm going to save money really rub me the wrong way when in reality my costs more than tripled.

The other aspect that bothers me is that our insurance company did not notify us of this change until late January when we tried to order Zyrtec-D from their mail-order pharmacy. Were they obligated to inform us earlier? No, certainly not. But they knew about this change months in advance, and their records clearly reflect that my wife has been taking Zyrtec-D very consistently for more than a year and they've been paying for most of the cost. Couldn't they have informed us of this back in October or November? "Hey, we know you've been taking Zyrtec-D consistently for more than a year, and we thought you'd want to know that in a couple of months you'll only be able to get it OTC and we won't be covering the costs any more. We don't know what the OTC costs will be exactly, but it's safe to assume they will be higher than your current prescription copay. You might want to plan accordingly for the coming year." I still would have been very unhappy with the switch, but at least I would have been able to plan accordingly when figuring out our medical expenses for this year.

You could make the argument that as consumers we should have been more aware of the news about our prescriptions, and on some level you'd be right. As I said previously, I don't feel that our insurance company was obligated to warn us about this. I don't think it was necessarily their responsibility to give us advance warning, but as a company that likes to pride itself on customer satisfaction I would have thought they would have given advance warning to their customers that would be seeing a price increase once they stopped covering the prescription version.

I'm happy for all of the people that now have easier and supposedly cheaper access to regular Zyrtec. Really, I am. But no matter how hard I try I can't shake the feeling that we got royally screwed in this process.

I take a couple of prescription medications for my narcolepsy, to enable me to be awake enough to drive, work, etc. The company that handles our prescription insurance coverage (Caremark) also has a mail-order pharmacy that they run, and they will fill prescriptions in 3-month supplies for the price of a 2-month supply. I decided to transfer my prescriptions from our local pharmacy to the Caremark pharmacy so I could get them at a lower cost.

Because my medications are considered controlled substances, they cannot be called into the pharmacy; they have to be written on a paper slip and then mailed to the pharmacy. I obtained the written prescriptions from my doctor's office, filled out the necessary forms for the Caremark pharmacy, and sent the prescriptions and order off to Caremark. After receiving the prescription slips from my doctor's office, I waited too long to send the order to Caremark. By the time I sent the order I was getting very close to running out of my existing supply. Caremark's website says that customers can expect to receive their order 10 to 14 days from the date Caremark receives the order. I sent the order via USPS Priority Mail on January 14, so they had to have received it on January 16.

Late in the afternoon of January 18, their website was still not showing my order in my account section. I called them to inquire about it. They were rather unhelpful, although they did offer to call my doctor's office to obtain the prescriptions over the phone - that effort quickly fizzled into thin air once they realized my medications are controlled substances. They had no answer to my question of why my order wasn't yet showing in their system if they had received it 2 days prior. Towards the end of the phone call I finally directly asked them, "How long does it take for an order to show up in your system once you receive it?" They answered that it sometimes takes a couple of days. Well that would have been nice to know 20 minutes ago when I first asked why my order wasn't showing up in your system!

When I filled out the prescription order form I selected the 2-day expedited shipping option, since I knew I would be running out of my current supply very quickly. I figured if 10 to 14 days was the normal delivery timeframe, then 2-day shipping would surely bring the timeframe down to 8 to 12 days, if not better. They eventually shipped my order on January 26 - 10 days after they received it. Since it was a weekend, the 2-day shipping actually resulted in a delivery date of January 29 - 13 days after they received my order. So much for trying to get the order quicker by paying extra for faster shipping.

Anyway, that brings me to the FedEx part of the story. The tracking page for the shipment showed that a signature would be required. It was scheduled to be delivered at my home on January 29. Unfortunately, nobody would be home to sign for the package. I would be at work, and my wife and son would both be at school. On the morning of the 28th, I noticed that the package was at a local Kentwood facility, just minutes away from where I work. I decided to call them and see if there was any way I could possibly just pick up my package from the FedEx facility. I wasn't really expecting this to be an option, but I was getting desperate and I decided it wouldn't hurt to at least ask.

I called their toll-free number, selected the appropriate options to get routed to a representative, and my call was answered after less than 1 minute on hold. (Pleasant surprise!) I briefly explained the situation regarding my package, that it required a signature for delivery, wasn't scheduled for delivery until the following day, but that it was waiting at a nearby facility.

"...so I was wondering if there's any way I could..."

The representative interrupted me with, "just pick up your package from the facility?"

"Well, yes!"

"I don't see why not. Let me check and see if the package is off the truck and available to be picked up."

Come to find out, the package wouldn't be available for pickup at all that day, but it would be the following day (the scheduled delivery date) if I wanted to pick it up then. I confirmed that I wanted to do that. She proceeded to put a note in the system instructing that the package was not to be put on a truck for delivery, but held at the facility for pickup. Then she asked for my phone number so they could contact me if there were any issues, confirmed the address of the local facility, and gave me their hours.

At this point I'm feeling very positive about FedEx. I was expecting my request to be denied. Instead, it was not only granted, but also anticipated, and processed in a prompt, smooth, friendly manner.

The following morning my cell phone rang as I was getting into my car to leave for work. It was an automated call from FedEx. "Is this [my name]?" "Yes." "You have a package waiting for you at [this facility]. You may pick it up anytime during normal business hours, which are 9am - 8pm. Please bring a government-issued picture ID with you."

Well, I certainly wasn't expecting that! That was a very helpful call! (Ok, so it wasn't all that helpful because I already knew all of that info, but I still thought it was a rather impressive feature. It would have been extremely helpful had I not already had all of the information about the shipment.)

I stopped by the FedEx facility later that afternoon to pick up my package. That also went very smoothly. The lady staffing the counter was very cheerful and friendly, and she retrieved my package within a minute or two.

This was quite a different experience then my previous FedEx experience with their SmartPost shipping option. This experience left me feeling very satisfied and impressed with FedEx' customer service and their willingness to allow customer's to intercept their packages at a FedEx facility. Huge kudos to FedEx for this one!