Day 1: Drug cost runaround

05 Jan

So yesterday I found out I have MS, right?  I’m still feeling relief.  But I am also feeling big-time annoyed because I’m getting sympathy emails which for me  I just translate to pity emails.  Why the hell is everyone so sorry?  What are they sorry for?  Nothing has happened to them.  Get over it people!!!!  There are lots and lots of people like me dealing with MS or some other disease that has all sorts of ways it can manifest.  I’m the same person as I was the day before.  YES, I know you care.  YES, I know you love me.  But PLEASE don’t smother me!!!!   I’ve never liked being smothered with affection.  (I’m a person that avoids hugs.  Ick!  Too much in to my personal space!!!).

So what has today held for me?  Well,  I have had to figure out what medication I want to take.   Yea, the doctor gives me a couple of suggestions based on what my insurance probably will cover but then it is up to me to pick.  ????  I left her office thinking “Okey dokey, I’ll just research it on the web and figure it out. ”

I’m leaning towards a drug called Copaxone because its daily ( and that is easier to remember if it becomes a daily habit) and you don’t have to get blood tests done all the time to monitor stuff.    The other one (Betaseron  (no idea if I spelled that right and I’m not going to find out if it is right so there!) )is every other med, but it does require blood tests every so often.  I kind of just ignored that one when the doc was describing it once I heard it had blood tests.  I don’t mind blood tests but just another thing to try to fit into my busy schedule.    So, I’m all pumped up to go with Copaxone.

Well, dear doc tells me I need to call my insurance company and find out the costs so that I can also put that in my decision.  Hmm, okay….that would be a good idea.

Me:  “He, I need to find out how much a couple of medications will be”.

Insurance Company (IC):   “Let me put you on hold”

Me:  *sigh*

IC:  “You will have to call Walgreens Specialty Drug Services to find that out”

Me:  “Um, okay”.

I then call Walgreens.

Me:  “I need to find out how much a couple of medications will be”

Walgreens:  “We can’t tell you that.  It varies.  I can tell you the cash price for it if that would help”

Me:  “Well, Okay”

Walgreens:  “$4000”

Me:  Silence on the phone as I’m thinking OMG OMG OMG OMG OMG

Me: “Okay, thank you.”

Can you imagine what I’m thinking now?  I’m thinking there is no way I’m taking medication and I’m just going to suffere and let the disease progress.  Then my brain starts back up and I remember there are drug company financial aid.  So off I go to the drug company sites and sure enough they have programs to help with copays.  (THANK GOD!).  I call the one for Copaxone and find out from them that my portion of the cost would be about $700 a month and they have assistance max of $500 a month.  That would leave $200 a month for me to pick up.  Still a big OUCH to the ole income / budget / non-existent cash reserve.  My brain starts to churn and well I guess I’ll have to look into the other drug too even though I doubt there is a difference in cost.

I decide to call my insurance company again thinking maybe I’ll get a better service rep that can help me.  This leads to a deeper conversation than the first jerk, I mean Customer Service rep, and I find out there is a site I can look up drug costs at!.  WOOT!  How come I didn’t know that.  She decides to look while I’m on the phone.  We are patiently waiting for the results to return and guess what?  It returns that a pre-auth has to be done before they can give a price!  CRAP!

For the other med, a remember that a co-worker was diagnosed several years ago.  I ask her if she has the same insurance as me and what drug she is on (which is the other one…Betaseron).  After a brief discussion I find out from her that there is minimal out-of-pocket expense after the deductible is paid out yearly.  Whew!  I guess I’m going with this one.

Here is the problem with this whole process.

1.  I must decide on a medication before the doctor sends in the pre-authorization to the insurance company

2.  You cannot get a price for the medication from the insurance company until you have a pre-auth.

3.  Totally forget trying to get a price from the pharmacy until you have the pre-auth.

4.   You are totally screwed and can’t find out the cost of a drug (which for me is a HUGE DECISION FACTOR) until you get the pre-auth which requires you to pick a drug.


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Posted by on January 5, 2012 in Multiple Sclerosis


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