fourcatmom Posted July 30, 2014 Share Posted July 30, 2014 So frustrating...after over two and half years the Doctor finally put me on a new medication that is actually helping me breathe better and I found out today that the insurance doesn't cover it and it's only $900 each and that would be a monthly cost. I hope there a way for the doctor to fight or prove that I need this??? Not sure how it works. Every other medication has not helped. Feeling frustrated! :glare: (I know I am lucky to have good insurance as many people don't and I have gotten a lot of great medical care but it's just frustrating to know that something finally can help and that not have a way to get it). Why does medication even cost that much? :sad: Quote Link to comment Share on other sites More sharing options...
Mommyof4ks Posted July 30, 2014 Share Posted July 30, 2014 You can appeal. We had to do that for a med that my ds needed, and we won. Insurance paid all but our copay. I hope it works out for you, and yay for finding a med that works. Quote Link to comment Share on other sites More sharing options...
zoobie Posted July 30, 2014 Share Posted July 30, 2014 -Find out what the appeal process is for your insurance. -Look into rebates (or whatever) from the drug manufacturer. -Check whether you have a prescription out of pocket max. Our insurance has been ornery with meds, but we have an OOP max that eventually kicks in. Quote Link to comment Share on other sites More sharing options...
fourcatmom Posted July 30, 2014 Author Share Posted July 30, 2014 Okay, thank you. I think the dr. knew it might be a a fight so he gave me another sample for next month and put the prescription in to see if they would approve it. I felt so hopeful after so long to finally have some relief so it was just really disappointing. I have been on enough, hoping they can prove a need. Quote Link to comment Share on other sites More sharing options...
ThisIsTheDay Posted July 30, 2014 Share Posted July 30, 2014 Call the drug manufacturer too, or look at their website. Some offer financial assistance programs. Gosh, that just stinks. I hope something works out for you. Quote Link to comment Share on other sites More sharing options...
Soror Posted July 30, 2014 Share Posted July 30, 2014 :grouphug: :grouphug: :grouphug: :grouphug: :grouphug: Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted July 30, 2014 Share Posted July 30, 2014 You might also talk to your pharmacist. Some of these new drugs are actually combinations of a couple of drugs. I had one drug denied but was able to get the individual drugs prescribed and covered. It meant a couple of pills instead of one but gave me the same benefit. Quote Link to comment Share on other sites More sharing options...
Lizzie in Ma Posted July 30, 2014 Share Posted July 30, 2014 You can appeal. Also, perhaps GoodRx would be of help? Quote Link to comment Share on other sites More sharing options...
Twigs Posted July 30, 2014 Share Posted July 30, 2014 :grouphug: :grouphug: :grouphug: Quote Link to comment Share on other sites More sharing options...
Ann.without.an.e Posted July 30, 2014 Share Posted July 30, 2014 So frustrating...after over two and half years the Doctor finally put me on a new medication that is actually helping me breathe better and I found out today that the insurance doesn't cover it and it's only $900 each and that would be a monthly cost. I hope there a way for the doctor to fight or prove that I need this??? Not sure how it works. Every other medication has not helped. Feeling frustrated! :glare: (I know I am lucky to have good insurance as many people don't and I have gotten a lot of great medical care but it's just frustrating to know that something finally can help and that not have a way to get it). Why does medication even cost that much? :sad: Your doctor will probably have more luck convincing them, medically, to cover it than you. Good luck. :grouphug: Quote Link to comment Share on other sites More sharing options...
kewb Posted July 30, 2014 Share Posted July 30, 2014 Good luck. Some days I think insurance is a big old scam. I pay a large premium and get little on return.I pay $1500 a month for my husbands iv drugs because the cdc says he doesn't have lyme. So frustrating. Quote Link to comment Share on other sites More sharing options...
Cinder Posted July 30, 2014 Share Posted July 30, 2014 :grouphug: Quote Link to comment Share on other sites More sharing options...
Ewe Mama Posted July 30, 2014 Share Posted July 30, 2014 You have gotten lots of great advice. I just wanted to give you this. :grouphug: Quote Link to comment Share on other sites More sharing options...
fourcatmom Posted July 30, 2014 Author Share Posted July 30, 2014 Thank you everyone! I feel a bit more hopeful knowing that it can be appealed. My dr is contacting them, there is no other generic or substitute meds he wants me on so we will see. I will look into the other options as well. Thank you for the advice, support and hugs! :001_smile: Quote Link to comment Share on other sites More sharing options...
ljpisme Posted July 30, 2014 Share Posted July 30, 2014 You can appeal. Also, perhaps GoodRx would be of help? My DH saves LOTS of money each month using GoodRx when purchasing his migraine meds. I would highly recommend them. Quote Link to comment Share on other sites More sharing options...
umsami Posted July 30, 2014 Share Posted July 30, 2014 Just wanted to add, that they may deny you on the first appeal. Keep appealing. Squeaky wheel and all. Quote Link to comment Share on other sites More sharing options...
G5052 Posted July 30, 2014 Share Posted July 30, 2014 Yes, don't give up. I've done it over and over, and nearly always I get it approved or get it discounted enough that it is manageable. Call, write letters, what ever you need to do. I once wrote a surgeon a personal letter about how much we appreciated him and how we would pay his bill no matter what, even if was really difficult and would take me a year or more. He was out-of-network, but had truly made such a difference on a difficult surgery. What I was hoping for better terms than I had been told by the billing office. They called me a week later to say that he told the billing department to write off half of his fee and to put us on a zero percent, one-year payment plan. I took that! Quote Link to comment Share on other sites More sharing options...
Mrs Mungo Posted July 30, 2014 Share Posted July 30, 2014 Sometimes of you can show that you unsuccessfully tried two cheaper drugs, then they will approve the pricier drug. That is partly how our insurance works. Quote Link to comment Share on other sites More sharing options...
QueenCat Posted July 30, 2014 Share Posted July 30, 2014 Every insurer we've ever had, for decades, not just the past couple of years, has had a process for covering non-covered drugs due to medical necessity. Once the covered, less expensive drugs have been tried, the physician goes through a process with the insurer. Often, they are successful at getting the medication covered at the covered rates. Quote Link to comment Share on other sites More sharing options...
QueenCat Posted July 30, 2014 Share Posted July 30, 2014 Do call all the pharmacies in the area and get their price without insurance. They may also have another price under their discount plan. For ex, my with insurance price for one med recently, 20 tablets, was $95. Without insurance, under a discount plan from a chain pharmacy, it was 19.99. The pharmacist wasnt aware that the savings could be that much, as we are all getting used to the price hikes that came with the obamacare plans.the discount plan was free to sign up for on the spot. Huge price differentials between prices with insurance and without have been around eons before the ACA was implemented. Quote Link to comment Share on other sites More sharing options...
BlessedMom Posted July 30, 2014 Share Posted July 30, 2014 :grouphug: Quote Link to comment Share on other sites More sharing options...
Leav97 Posted July 30, 2014 Share Posted July 30, 2014 So true. But for me and my circle, paying less by not using our insurance is brand new, with Obamacare. I started on metformin ~6 years ago. Target never runs it through my insurance because it is cheaper without. This isn't something new. Quote Link to comment Share on other sites More sharing options...
zoobie Posted July 30, 2014 Share Posted July 30, 2014 Huge price differentials between prices with insurance and without have been around eons before the ACA was implemented. I agree. I helped my mom call a zillion pharmacies back in 1998-2001 for her then husband and my grandmother. Quote Link to comment Share on other sites More sharing options...
JumpyTheFrog Posted July 30, 2014 Share Posted July 30, 2014 Try Costco. I needed something a few years ago and the generic everywhere else was about $1000 per month. At Costco, it was $330 for the first few months, then the price dropped to $240. Quote Link to comment Share on other sites More sharing options...
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