File this one away in the ‘I Don't Think They Love Me Anymore’ drawer.  Here’s how a recent phone call went:

“Thank you, Mr. Murray. I will be sure to mark this request urgent. Is there anything else that I may do for you?”

“Yes, there is, actually – and thanks for asking. According to my notes, there have been one, two, three, let’s see, at least six people who have told me that they’ve marked my request urgent and yet, after three months, my problem still isn’t fixed. I am beginning to suspect that you all neither listen to me, nor do you care in the slightest about helping me with this issue. No offense intended.”

Yikes! Although I was using my ‘indoor voice,’ as my elementary school teacher wife would call it, the poor person to whom I was politely giving both barrels had no trouble sensing my unmistakable frustration.

She was an exceedingly courteous and cheerful customer service representative for the ‘specialty pharmacy’ through which I receive my monthly supply of Revlimid ^[1] (lenalidomide), a drug used to combat multiple myeloma.

Revlimid, or Rev as we cool cats who hang around the myeloma water cooler like to call it, is one of the main drugs I’m using – along with Velcade ^[2] (bortezomib) and dexamethasone ^[3] (Decadron) – in my three year myeloma maintenance regimen. Truth be told, I also call it Rev because saying lenalidomide makes me sound pretentious, and nobody likes a pretentious myeloma patient. That and the fact that I have to repeat it two or three times because I can never remember how the heck to pronounce lenalidomide.

Because of Revlimid’s potentially significant toxicities, it can only be prescribed by physicians and dispensed by pharmacies that have been approved as participants in Celgene Corporation’s RevAssist Program.

In other words, you can’t stop in at Jim Bob’s Drugstore and Smoke Shoppe, conveniently located on Main St. next to the High-Watt Tanning Studio and Leather Outlet, to pick up some Revlimid. You have to go through a specialty pharmacy.

My health insurance company contracts with one of the thirty or so specialty pharmacies registered as of February 2012 in the RevAssist Network.  In my three years of taking Rev, my insurance company has mandated which pharmacy I needed to use.

For those of you who haven’t gone through a specialty pharmacy to obtain such a highly restricted drug such as Revlimid, the process is rather straightforward:

First – get myeloma.  Check!

Second – engage a doctor who is registered and approved to write a prescription for Revlimid. Check!

Third – figure out how you are going to pay for it.  Gulp… Check!

Fourth – when the specialty pharmacy receives the prescription from your doctor, you contact them (or if they’re on the ball, they’ll contact you) to arrange delivery via a service such as UPS or FedEx.  Check!

Fifth – one of their staff pharmacists reminds you not to donate blood or sperm, not to engage in unprotected sexual relations with a partner that ‘still has her womb,’ and not to share capsules with anyone. Check!

Sixth – you call the automated Celgene Revlimid Survey phone number and ensure them that you are using Revlimid safely and as directed.  Check!

Seventh – you wait for the delivery person to bring the Revlimid sometime between 8 a.m. and 8 p.m.  Check!

In all seriousness, Revlimid has many serious side effects and should only be used as intended.

“Mr. Murray, rest assured that I will see to it that attention is paid to your request and that it gets in the right hands.”

”Thank you! But what I’d like to do today, if you don’t mind, is to speak to the head of your department, the highest ranking person in the office on site. No reflection on you at all. I’ve enjoyed chatting with you. I’ve enjoyed chatting with more than a dozen of you very nice folks over the last three months regarding my issue. But today I need to speak with someone who will be accountable to finally helping me get what I’ve been requesting. Did I mention that I have an incurable form of cancer and time is of the essence?” Oh, yes, I did play the cancer card!

The good news is that my issue had nothing to do with getting my Revlimid prescription filled and delivered. Although each of the three specialty pharmacies that my insurance company has mandated that I use through the years have had different operating procedures, the Rev has always shown up on my doorstep when I needed it.

So what is my problem? I have a cancer insurance policy (not associated with my health insurance) that pays me directly for chemotherapy medications like Velcade and Revlimid, various cancer-related procedures, travel, hospital confinements, and more.

They pay, that is, when I submit the proper paperwork.  As an example, my infusion center provides me with the documents detailing the Velcade information I need to satisfy my insurance company claim.

My first two specialty pharmacies had no problems immediately providing me with the Revlimid documentation. My difficulty with this third specialty pharmacy was that they seemed not to be at all motivated to help me.

I began receiving Revlimid through Pharmacy #3 in January of this year and after several requests and being sent the incorrect information twice, they finally put what I needed in my hot little hands. I sent the info to the insurance company, and they quickly sent me the payments.

Great! It was a hassle, but now the pharmacy knows what my insurance company requires. All is good, right? Wrong!

As I began writing this column, I still hadn’t received the paperwork I needed for February’s Rev order, or for March’s, or April’s Rev order.  In trying to get the right documents sent, I have talked with nearly a dozen people at the specialty pharmacy, including customer service reps, billing department staffers, and department supervisors.

One supervisor read me the form he was sending. I stated that it was exactly what I needed, send it on. Ten days later, I received the same incorrect form that I had been sent several times previously.  Another supervisor said that she would be happy to handle my problem and would call me as soon as the paperwork was prepared. Let’s just say that I’m glad that I didn’t wait by the phone – she never called and I, once again, received the paperwork that I knew my insurance company would not accept.

Who needs dexamethasone to ruin your day? Just use a service provider that seems to conspiratorially take pleasure in your misery.

Thus, here I was telling the nice lady on the phone, “I need to speak with a manager or whoever is the highest ranking person in your office to get this thing settled.”  When they finally tracked down the manager, she was apologetic like they had all been. Here we go again, I thought to myself.

However, this department manager took the bull by the horns, got an account manager on the phone with us, and asked that I once again explain my situation.  She assured me that the matter would be taken care of and asked me to call her directly if it wasn’t handled to my satisfaction. Though I’ve learned to live with hope through my precarious myeloma journey, dare I dream that the specialty pharmacy was going to come through?

And don’t you know, just as I was putting the finishing touches on this column, my postman dropped off the documents I needed to submit for my cancer policy. The correct documents. I think that I may have even kissed them.

I don’t have a single clue as to why this large specialty pharmacy couldn’t help me sooner with what I view was a very simple request. Maybe it’s a process problem. Maybe it’s a people problem. I don’t know. While they have handled the Revlimid fulfillment and deliveries beautifully, they have delivered as poor a customer service experience that I’ve ever been subjected to.

Nobody’s perfect, I suppose. All I can say is that someone either finally got tired of hearing me complain, or perhaps they cared enough about me to help solve my problem.  Or maybe a birdie told them that I was writing a column about just how much I have enjoyed working with their company.

In any event, the overarching lesson that I have learned in this situation is that I should never give up. While there will be times in my ongoing struggles with myeloma and life in general, I don’t have to kowtow to the lunacy that sometimes abounds. If an issue is important to me, I have to stick to my guns and stick up for myself. There is no shame in asking for help and no dishonor in demanding that I be heard.