Need counsel from people who know more about perscription coverage options than me.

I am a 23 year old male from WV. I have been taking Seroquel XR 300mg twice a day since around September 2008 at some point in the last few years 50 mg x2 was added to that. I do not work and I recieve SSI disability once a month since August 8/12/13. I have never worked. I have been diagnosed with schizophrenia. I live with my two parents who both work. For most of the time I have been taking the Seroquel XR I was on my parents insurance. Their insurance will now not pay for it anymore since I have been recieving SSI . Medicaid refuses to pay for the XR they will only pay for the regular seroquel because there is no generic for the XR. I have had terrible experiences with the regular seroquel in the past I refuse to take it. With my current dose of the XR my life is pretty enjoyable. If I were to have to stop taking the XR or take regular seroquel my life would almost certainly take a dramatic turn for the worse. My mom who knows the most about my situation agrees. When I had to take the regular seroquel I was having severe night terrors/sleep paralysis and I NEVER want to have to go through that again. That was about 2009. The last day I forgot to take my seroquel XR was March 8, 2011 and I had severe withdrawal symptoms it was the worst 2 days of my life. I also do not want to relive that again. So my question is what is the best way for me to pay for my seroquel XR. Who do I need to contact now ? Again Medicaid refuses to pay for the XR, I've tried to apply for Medicare that didnt work, Ive tried to apply for Aztra Zeneca to pay for it but my parents barely make too much money. The seroquel 300 XR x2 plus 50 mg x2 costs about 1100 per month. Thats almost double what I recieve for SSI so as of right now it does not seem worth me getting taken off my parents insurance for and I cerntainly cant afford 1100 per month. Thankfully the patent for the Seroquel XR end in 2017 so a generic should be avaiable then which may solve my problems but I need a solution in the meantime. Any ideas ? I do have about 2-3 months supply of XR left but the clock is ticking.

Hi, are you eligible for Medicare? If so, there may be a plan that will pay for the right prescriptions. Did you say you can't get on a parent's insurance?

Medicare told me I wasnt eligible because I have never worked. Which is the main requirement for my SSI. My parents insurance kicked me off when I started receiving SSI.

That's not good. But it's election time, have you thought of writing to a state politician and asking for a solution? I've read of cases where they do that sort of thing.

You may want to double check the Medicare though because I think it's automatic for anyone on SSI or SSDI.

Have you tried a whole different AP? There are many out there that now have a generic version available? What does your Pdoc say? Can they not get you samples?

I'm sorry your in this situation

I would see where it is available and if you have a relative or friend in that state and can somehow get it filled there? States have a lot to do with whether Medicaid will fill it or not; I'd maybe write your congressperson too, see if they can do anything for you?

Coupon and Savings for Health Care Professionals | SEROQUEL XR® (quetiapine fumarate)

If you're 23 why is your parents income relevant? Shouldn't it be your income? Sometimes it makes a difference if you're paying rent to stay there whether you are considered an individual rather than a family group.

My husband is on a nonpreferred antipsychotic and is on medicaid. His Pdoc had to contact medicaid directly and get authorization for him to be on it. They can approve meds not on their list but your doc has to prove that you NEED that particular med and nothing else will do. Good luck to you.

As Raindropvampire states, if the pdoc/provider indicates in a letter or files a form to get in touch with Medicaid that it is a medical necessity showing how with their preferred other meds that there were reactions/did not work etc, why this one does, and then it will typically be covered.

You guys are exactly right. I used to work for an insurance company, coordinating prior authorizations for mental health meds. It's an easy process if you can get your pdoc on board.

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Astra Zeneca has plans to help folks who cannot afford their meds. The following link will give you information on how to ask them for assistance and apply for it as well. They do have a toll free phone number to call as well.

AstraZeneca - AstraZeneca patient assistance programs

Those laws are so backwards and stupid. Makes zero sense. SSDI is based on your age and work experience. I am on SSDI and have Medicare A & B and I picked up a Medicare Advantage plan in 2005 which is being discontinued in 2015. It was great and covered meds, dental, vision, hospital and doctors for $75/mth. I am going to pick up Medicare Supplemental Insurance for meds, dental in 2015.

You should get a lawyer to get you Medicare for your SSDI because you deserve Medicare just as much as others on SSDI. There are private insurance plans out there for prescriptions I believe - try Humana, Cigna, USHealthcare, Blue Cross.

Quote:
Medicare told me I wasn't eligible because I have never worked.

Cool09- I think the OP has SSI, not SSDI. You do have to have worked and have a work history to qualify for SSDI and Medicare; if have not worked, that is why SSI is there to help if have not worked. Medicare is not available with SSI, only with SSDI, but Medicaid is a possibility with SSI instead of Medicare.

LifeIsGooD4- Hopefully you will be able to get coverage with a prior authorization through Medicaid for your prescription, so will have a continuous script for your med. Ask your provider to start this. Will be hoping so and that it goes through.

Your PDOC just has to call for the prior authorization. It took my PDOC 2 min and I was in the room while doing it.

Not so sure about that. My son works part time and recently started to get SSI benefits but we don't know what prescription coverage he has if any.

I get SSDI and have Medicare part D for meds but I was not eligible for the Medicare coverage until I had been on SSDI two years.

It is all very confusing.

Yes, thanks for the info.

ugghh my PDoc swears up and down that they were on the phone with medicaid for hours about this but they say medicaid wont do it no matter what but my pdoc speaks poor english and I doubt she tried real hard anyway

is there some kind of lawyer or anything that knows how to figure out what my medicaid/insurance rights are ? its so hard going through all the information and figuring this out

Medicaid typically does have a "list " of medications they will cover..

Pdocs really don't make actually calls like this.. Medicaid requires a form to be filled out and reason given for the need for this "exact med" and all your Pdoc has to do is sign it.

The pdocs staff handles all of this except for the pdocs signature.

If you can still not get anywhere maybe you need to contact your local congressman to get involved.

Hope you get a solution soon

Make friends with one of the clerks/nurses that work in your doctor's office that speaks better English and see if they can help you sort it out.

I would contact Medicaid or rather your prescription coverage through Medicaid; ask what your doc needs to file a prior authorization, where they can obtain the form or can you get it for them explaining they had trouble getting through, AND find out where it needs to be sent, typically a fax number, or sometimes a mailing address, or even an email address. This way you can get the information in the hands of your doc that is having trouble with the system to help him or her out and to get it sent in sooner rather than later; it has to come from your doc but that does not mean you cannot do the legwork to get your doc what they need to do it.

I have had to do this in the past as well; there are a lot hoops that have to be gone through sometimes to get the info, making it difficult especially on those automated phone tree systems, so I am not surprised when your doc said they had trouble getting through. You might have a better chance especially if a language barrier might be an issue as well.

Good luck and hang in there.

Prior Authorization Criteria Lifeisgood check here and see if you can find the form. good luck to you.

quick update

my mom wrote a letter to all the congressman and our govenor like a few here suggested apparently our govenor office put us in touch with someone from WV medicaid and it looks like we are approved

crossing my fingers that this is the end of all the troubles

thanks for the advice everyone!!!