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sarahsweets
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Member Since: Dec 2018
Location: New Jersey
Posts: 6,006
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#1
I am pretty savy when it comes to finding coupons, rebates etc. I save so much money at the grocery store with my digital coupons they have to have the manager do an override usually. We all know that prescription pricing is literally the wild west and I have yet to have anyone explain the pricing of drugs, or those handy dandy patent rules or how patient assis / savings cards from manufacturer programs work. I have been down the prior auth road many times and most of the time it works out. I am relentless and have even made appts with my husband's HR and taken up their lack of coverage directly with them.
Today's insurance issue: I need this- ahem- 'ring' for inside me to help with menopause symptoms. It was sent to my local pharm. Its a 90 day thing- in on day 1 out on day 90. First I was told that if I want a 90 day supply I have to use mail order (its one ring not 90 pills!). Then the dr sent it to my rx company. I called them and after being on hold and disconnected for over an hour I was told that in fact they didnt cover it at all. So I googled and found out the company has a rx savings rebate. I could pay as low as 25$ per ring. I called my local pharmacy back and they said that the card is only good for people with insurance that DOES cover it but that has a high copay. Well if my insurance doesnt cover it why cant I get help with programs like these? I thought the manufacturers sort of had a fund for stuff like this, and the promotional value of more people using it- I thought would be a company incentive. One ring is between 500-690 according to goodrx. My highest copay is 40$ so I could really use the help. And if you have medicare or medicaid and need help? Forget it with the manufacturer coupons. you must have commercial insurance to qualify. My mother is on medicare and her inhaler isnt covered. She has to use an inferior one and even that is 300/month. So how does all of this work? Does anyone understand the savings programs, cards, patient assistance etc? __________________ "I carried a watermelon?" President of the no F's given society. |
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Crone
Nammu
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Member Since: May 2010
Location: Some where between my inner mind and the solar system.
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#2
Just want to let you know I sympathize but as for dealing with all this I’m at lost too.
__________________ Nammu …Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here. …... Desiderata Max Ehrmann |
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sarahsweets
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sarahsweets
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BeyondtheRainbow
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Member Since: Apr 2015
Location: US
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#3
There are patient assistance programs that provide meds for no cost. They usually have an income limit and say if you have insurance you don't qualify. However they will make exceptions and I've found they are quite generous with the exceptions. I'm on medicare and it just doesn't cover several of my meds and those meds are hundreds or over $1000 and I just apply, include a note explaining that I technically don't qualify but am asking for an exemption because there is no way I can afford the med on my income (I usually try to tell them what the cost would be). And I've always been approved.
I don't know that they will definitely make an exemption when you have commercial insurance but it's worth a try. And your mother's inhaler should be covered that way; mine is and has been for many years. __________________ Bipolar 1, PTSD, GAD, OCD. Clozapine 250 mg, Emsam 12 mg/day patch, topamax 25 mg, ,Gabapentin 1700 mg & 100-2 PRN,. 1.5 mg clonazepam., 50 mg Seroquel |
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sarahsweets
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Student of Life
WastingAsparagus
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Member Since: Mar 2014
Location: South America
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#4
There are certain medications that are just expensive, unfortunately (based on nothing, really). I had Latuda prescribed for me and there was literally no option to get it cheaply.
If I understand correctly, in this case, IF your insurance will cover it YET the copay is UP TO $400, THEN the manufacturer will give you a coupon to pay as little as $25. I did some research on this. I believe the key is getting your insurance to cover it (even if it is still a high copay). Then, after that, you can use the manufacturer coupon card. I hope this helps somewhat. Getting your insurance to cover it (this might be having your doctor call them, appealing it if they deny it, etc.) might be the hardest part. __________________ "Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it!” |
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Legendary Wise Elder
Sometimes psychotic
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Member Since: May 2013
Location: Chicago
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#5
So what you’re talking about I used with Abilify....my copay was super high and got reduced to 25 bucks.....pharma uses these programs because they can get hundreds to thousands from your insurance and then hand you some savings so they don’t really have a pool of money for these they’re refusing insurance cost directly to you.
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Threadtastic Postaholic
sarahsweets
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Member Since: Dec 2018
Location: New Jersey
Posts: 6,006
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#6
Hey @WastingAsparagus are you still dealing with the latuda issues? I will share this only because I just helped my daughter with it:
Copay Savings and Support | Latuda(R) (lurasidone HCl) Quote:
Quote:
__________________ "I carried a watermelon?" President of the no F's given society. |
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Student of Life
WastingAsparagus
is trying to enjoy life.
Member Since: Mar 2014
Location: South America
Posts: 4,641
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#7
Quote:
I appreciate it, @sarahsweets - this was a long time ago (like 5 months ago), and I had already decided not to take the Latuda at that point. My current meds seem to do the trick. Anyway, thanks. __________________ "Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it!” |
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sarahsweets
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