I'd pay for the pdoc. From what I can tell, your current doc has you on a TON of medications at high doses and wants to put you on a high dose of lamictal, even though it's been shown that the optimum dose for bipolar is 200mg with no additional benefits at a higher dose. Isn't this the same pdoc who shares your cousin's personal info with you? It might be a good idea to "shop" for a new one. It may be more expensive now, but it might be better in the long run.

I've never visited a nurse practitioner, so I don't know if it'd be worth paying a visit to one.