The story you’re about to read is true.  Only the names have been changed to protect the innocent.

Tess Durberville is 83 years old. She’s been a resident in a Seattle senior living community for five and a half years. Tess is a cancer survivor and is living with diabetes and heart disease. Like many seniors on Original Medicare, Tess purchased Medicare Part D coverage to pay for her prescription drugs. More than 67 million Medicare beneficiaries have Part D plans.

Tess is an AARP member, and selected a Part D plan from United Healthcare, the company that AARP promotes.

It was a prudent buy, something that would give Tess some peace of mind and help her avoid huge out-of-pocket expenses for her prescriptions. Or so she thought.

Tess had been prescribed Victoza to control her diabetes. Unlike some brandname drugs, Victoza is not available in any generic form, and therefore is very expensive for patients who lack Part D coverage.

Tess took the Victoza shots once a day, and was satisfied with the results. Then, one day, she got a letter from United Healthcare informing her that Victoza was no longer on their approved list of medications. Tess was advised to look at a list of five medications that United Healthcare would pay for and choose one from there.

“I was scheduled to have cancer surgery,” Tess told me, “and my doctor thought it would be best for me to continue on the Victoza till I’d gotten through that crisis. But United Healthcare said no. They wouldn’t budge on that.

“It made me angry they were so hard-headed about changing from Victoza,” she added, but nevertheless Tess and her doctor decided that Ozempic would be a good fit for her. An added advantage was that Ozempic only requires one shot per week instead of a daily injection.

“I was on Ozempic for eight – almost nine – months,” Tess said, “and then I got a letter telling me I need prior authorization for the Ozempic.”

Even though it was on the list of approved meds that United Healthcare furnished? Yes, indeed! “They wouldn’t budge on that either.”

“It took almost three months to get them to authorize the Ozempic,” Tess sighed. “And I had to pay out of my own pocket.”

Was it expensive? “It was expensive. My pharmacy was very cooperative. They tried Good RX and all the coupons they could find to make it as cheap as possible. But it was still expensive.

“And the thing that really makes me mad,” Tess added, “is that it’s only a one-year authorization. Now I have to go through it all again. It’s bad enough they make you jump through the hoops once, they want you to keep jumping!”

Tess told me she didn’t feel so bad for herself, but for her doctor who had to navigate the prior authorization system. “All that expense,” she said. “All that time and effort!”

Because Tess has pre-existing conditions – her diabetes and heart disease – it’s almost impossible for her to switch to another Part D plan.

“I don’t think it’s going to matter anyway,” she told me. “They all do the same thing. And I take a lot of medicines. That’s a lot of prior authorizations.”

Fortunately, Tess’ day-to-day health is good in spite of her chronic diseases. Unfortunately, her story is not unusual. It's the story of a health care system that centers private insurance companies' profits rather than patients' health.

If you also have a story you want to share, email organizer@psara.org