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Lessons from ME/CFS: Finding Meaning in the Suffering
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Frustrated with Insurance Not Paying for My Meds

Discussion in 'Finances, Work, and Disability' started by Carrigon, Aug 29, 2010.

  1. Carrigon

    Carrigon Senior Member

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    PA, USA
    I hate my insurance so much. First, my doctor fought with them for months and months to try to get them to pay for my Aciphex prescrip. She wrote letters, I had been on Aciphex for many years and it was the only one I could tolerate. They still said no, they won't pay for it.

    They have consistently refused to pay for my tylenol/butalbital combo that is the only thing on this earth that helps with my nerve pain and doesn't give me bad side effects. And the pharmacy said the medication doubled in price, so I actually had to ask my doc to give me half of it, even though I seriously need the entire thing.

    And now it's the Tirosint Gelcaps for my thyroid. They said no. My doc wrote to them and said I cannot take any of the other thyroid meds cause they give me bad side effects and make me worse. They still said no, they won't pay. So, I have to pay for this one out of pocket, too. And as long as I can do it, I will. I need med with no weird fillers and this one doesn't have them.

    But I am just beyond sick of this insurance company. I can't switch right now, I can't afford any other insurance and it's what my doctor's office takes and I'm not switching docs right now. But IMO, they are the worst company ever.

    I did try to find patient prescript assistance for my meds, but no one covers butalbital and no one is covering Tirosint. I sent a letter to someone who works for the Tirosint maker and I'm hoping they have a program to get it paid for, but I doubt it.

    It's just so frustrating. And it's very hard for me to afford anything out of pocket. The insurance will only pay for cheap generic drugs that don't even work. Which is a whole other issue, the generics.

    Years ago, generics worked. Now, all I've had is hell from generic drugs. They don't work on me or they give me bad side effects and make me sick. Then if I happen to get to try the real brand, lo and behold, the drug will work on me. But I can't afford any of them.

    It's just all frustrating.
  2. caledonia

    caledonia

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    Cincinnati, OH, USA
    Dump the insurance and then you'll have the money to pay out of pocket?
  3. Carrigon

    Carrigon Senior Member

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    Can't, they pay for my hospital stuff and doctor stuff. And it wouldn't help me pay out of pocket.
  4. urbantravels

    urbantravels disjecta membra

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    Los Angeles, CA
    Who among us could possibly switch insurers anyway? Until the law changes, we'd be refused new coverage with any insurer owing to our pre-existing condition - unless we had employer-provided coverage, which is somewhat difficult to obtain when you're disabled.
  5. dsdmom

    dsdmom Senior Member

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    Do you have AAA? I only recently found out that they actually have a prescription discount as part of thru membership. I think what they cover depends on the medication but for example I had something filled for my cat at CVS and it was supposed to be $38. It ended up being $22. The tech told me spmetimes they cover as much as half. So its not as good as just a copay but its better than nothing.
  6. caledonia

    caledonia

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    Cincinnati, OH, USA
    Which reminds me, I believe Walgreen's has some kind of prescription discount card. It also wouldn't hurt to call around and see which pharmacy has the cheapest price on your meds, although I understand if you're sick you can't be driving all over the place for prescriptions.

    So anyway, it sounds like there isn't much wiggle room on the insurance/prescription end of things. Which means you have to figure out how to save money elsewhere so you can afford to pay out of pocket.

    What you do is track your expenses for a month, then review areas of waste that can be eliminated. Get a copy of Your Money Or Your Life by Joe Dominguez and Vicki Robin, and it will walk you through the process, and also give you lots of creative ideas on how to save. Your first lesson is to get it from the library for free.
  7. Carrigon

    Carrigon Senior Member

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    I don't get enough money in to eat on my disability, there is no place to tighten up there. So far, I can probably make the cost of the med doing surveys during the month, but I'm going to keep hunting for a way to get that med free or cheaper. A big problem is, these insurance companies insist the doctor force you to try every single med they do cover before they will even consider letting you have the one you want. And I can't do that. I need this one and they don't care if they make you sick for six months forcing you to try all the others first. And that's why I'm going to pay for this med this month. I can't wait forever fighting with them. The current med gives me acid reflux so badly that I almost vomited in my sleep today. Absolutely cannot wait months trying others that will do the same or worse. I've had enough suffering with it all year.

    I did know about the AAA card, just not sure how much it would take off with this drug. It's a newer drug that's why no one wants to cover it.
  8. Victoria

    Victoria Senior Member

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    I don't blame you for using a drug that you know works & doesn't give you any side effects.

    I would do the same.

    In Australia, generic brands have exactly the same ingredients & would have to be approved by the FDA (as I understand our laws).

    Sometimes I find that certain drugs stopping working after a certain amount of time. I have an anti-inflammatory drug which I rarely use now. I found after 3 weeks continual use, it stops working & my body becomes immune to it's affect (this was years ago when I used it regularly).

    So, what I do now is keep if for emergencies or severe situations, & use it for courses of 5 day use only, once per month.

    Fortunately, I've only had to use it twice in the last 6 months (since stopping full-time work). So even that monthly 5 day course has been reduced dramatically.

    I don't know your laws in the US, but I wouldn't give up on generic brands completely. After a suitable length of time, give them another go to see if your body will tolerate them for a while.

    Our bodies change over time & what works once may not work now, but the reverse might also be true.
  9. forgottenstar

    forgottenstar

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    My current scripts are covered under CVS-Caremark. I dont know the cost of it (because I pay for it through Cobra) but my meds are very cheap. I also know that they also have a refill program where you mail them the script and then they mail you your meds, and the cost difference is relatively large. The BC I used to be on- I could only fill it 3 months at a time and it would cost $80 for the 3 months. If I went through the mail program, the cost would have been $50 for the 3 months. I just switched to the generic version (only difference is amount of days of placebo) and my cost went down to $7 for 3 months. HUGE difference.
  10. caledonia

    caledonia

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    Carrigon, it sounds like your options are to either go to a food pantry so you don't have to pay for food, or to move to cheaper housing. If I remember correctly, you had mold and really needed to move anyway, but there was some obstacle to that. Other than that, figuring out a way to make a little money each month working from home.

    How much money are you talking about to cover your meds each month?

    A few more thoughts - are you getting all the discounts that are due to you for being on disability? For example, I get a discount on my phone bill (like $10 a month). My cable/internet company doesn't have an official program for disability, but if you call them up every 6 months and give them a little story about how money is so tight and is there anything they can do for you, they give me a $10 discount for the next 6 months. This last time, I got the discount for a year.

    If you could get the same, that would be $20 a month.

    Let's say you had food allergies and needed special organic food, but you could get half of your food for free from the food pantry which would still fit in with your diet. That would save $100 or more a month?

    Every little thing adds up.
  11. Carrigon

    Carrigon Senior Member

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    I filled the prescrip today and for some reason, it was cheaper than what the pharmacist quoted me on Friday. He had said it was going to be about twenty two dollars. But when I got there today, it was only $16.71. That is alot more reasonable. I still have to make it doing my surveys, but I can. I also got a new prescrip savings card that should make my butalbital pain med cheaper, they cover it. And I only get that one every two months or so. Really a main expense for me has been all the heartburn stuff for the acid reflux. But maybe I won't need as much of it now, since the Tirosint isn't giving me heartburn. Total miracle. I knew that generic tablet junk I was on was killing my stomach. The Tirosint gelcaps are a life saver from that burning acid.

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