Dispatches from the Middle Circle

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So, my insurance has been trying to not cover my SNRI because it is new on the market and no generic available yet, so pricey.

I apply for a refill and the request gets locked for review. Again. For the 3rd time.

This time I call and immediately ask to speak to the actual doctor making these clinical decisions. Very politely. Must be a slow day because they allow it.

ME: [Teacher voice] I'm calling in regards to the SNRI you have placed a lock on. Why was this decision made?

DOC: Well, there are dozens of other medications on the market in that tier, and far cheaper for you and [insurer]. We have sent a request to your doctor to consider alternatives.

ME: I am aware of that. So, can you do me a HUGE favor and look up my prescription history really quickly and tell me how many SSRIs and SNRIs were only filled once in 2022 for me, showing they were poorly tolerated?

DOC: It looks like eight.

ME: Great job! Now, can you please look at my genetic test for psychiatric drug tolerance and tell me how many medications are listed in the safe category?

DOC: Two.

ME: Awesome! Now, can you tell me what type that other drug is that I'm not taking?

DOC: Yeah, totally, it's an MAOI.

ME: That's correct, you're really knowledgeable! Should I be taking something as dangerous as an MAOI with my other medications, or even just in general?

DOC: It's contraindicated for sure.

ME: It is! So true! So, last question since you've been incredibly smart and helpful. Is it less expensive for [insurer] to pay out for the medication knowing they already get a huge manufacturer discount anyway, or is it more expensive for them to pay for me to need potentially long-term inpatient psychiatric care?

DOC: I'll clear the code, ma'am and flag it as medically necessary. I'm sorry about this.

ME: I appreciate you SO MUCH. You have a great day now.

Now they're interesting, but the REAL star of the show is one of his villains, John Doe the Generic Man, who's this guy in a stark white suit with flat pink unshaded, untextured skin with no features or anything who talks like chatGPT and has black text over his face that explains what he's feeling at the moment. That guy is fucking fascinating.