Insurance Company Vent

[anonymous]

So I have been on my current anti-depressant for over two years. I have actually stabilized in the last six months by combining it and another older mood stabilizer. On December 1st my employer changed insurance carriers and my AD is considered to be a non-preferred brand drug. What that means is you either have to pay full price each month for the medication ($367 is the cash price) or you have to go through step therapy which means trying several other medications unsuccessfully first and only then will they partially cover it meaning I would pay $100 a month. My Pdoc submitted the paperwork stating that I had already tried the meds that I have to try first which I have but as they are new to me in their minds I haven't tried the CHEAPER medications. When we first started on this plan I tried weaning off the medication. In less than 6 weeks I was suicidal and on the verge of attempting suicide.

The issue here is I have only been seeing this Pdoc for a little more than two years. I was on Pristiq when we first started meeting and then we transitioned to the current me and later yet added the mood stabilizer. The insurance company says that I can appeal but they want the medical records showing I tried the other medications. That is a major issue as those records are 1,000 miles away where I used to live and with another doctor. I don't know what to do and I am terrified of running out. My Pdoc gave me samples to last this month but I know he can't keep doing that.

 

[ladee]

Your new P doc can request your records from the other Doctor.
Try your best to stay in the present moment. They, your Dr's have time to get this done for you. And if your present Dr can help by giving you meds in the meantime..it will work out.
I understand how the insurance companies can send us into panic mode.
Appreciate you sharing..hope you come back and let us know how things are going.

 

[anonymous]

@ladee thank you for the advice. You are right when ever insurance companies send me something I do go into a panic because I never know how to deal with them.

 

[ladee]

You have help and support from your Dr's. They are simply doing thier job, which makes no sense to us how they go about things.
It can feel intimidating and threatning.
But Dr's are used to dealing with these situations and they will do all they can to ensure your meds stay the same.
You did great by reaching out and allowing yourself to face your fear. That is good self care.
Gentle hugs. And come back and share if it gets overwhelming.

 

[Panda Bear]

Some companies offer discount drug cards that can often bring down the cost of medication to $20 or so $$. As long as your insurance carrier isn't state or federal funded(Medicare or Medicaid)

I don't know what you're taking, but it's worth a looking in to. I've used them before for my asthma medication and a medication my so needed that wasn't covered by our insurance.

 

[anonymous]

I looked into the discount card for my med. It will only work if I get co-pay down to $100 then I can get a further reduced price. What sucks is this company was supposed to be better for the employees and it is my job to sell that idea to the other employees. Rather difficult to do when I am thinking that just simply isn't the case.

 

[ManagerWife]

Have you tried an app/website called Good RX? It shows you which local pharmacy has the lowest price and gives you a deep discount coupon code to give your pharmacist. I have used this at Walgreens and found out thru this app how much cheaper Costco pharmacy is too!

Peace and Light to you.

 

[FauxLiz]

Thank you no I haven't yet I will give it a try hopefully the OP can as well

 

[Justmehere]

If you are in the US, check out needymeds.org. They might be able to help. But perhaps you have already explored the patient assistant programs other than discount cards or there isn't one. I'm so sorry you are dealing with this. It stinks.

 

[Justmehere]

The insurance company says that I can appeal but they want the medical records showing I tried the other medications. That is a major issue as those records are 1,000 miles away where I used to live and with another doctor. I don't know what to do and I am terrified of running out. My Pdoc gave me samples to last this month but I know he can't keep doing that.

Your current doc should be able to call that doctor and have them sent off to the insurance company pretty quickly. You could also contact the pharmacy where you got meds filled and they could possibly provide records quickly as well.

This actually come up quite a bit and the doctors office should be able to get it resolved.

Because you have already been on the step therapy meds and the doctors offices can prove that, this hopefully will be resolved quickly. If just plan to call up the current and previous doctors offices Monday morning and explain your concerns and what the insurance needs, and they will hopefully get it sent right off.

You could even ask your pharmacy for help where you get meds filled.

I had this happen once to me, and my pharmacy contacted my old pharmacy in another city, got the records, sent it off to the insurance themselves in conjunction with the doc sending their records and it was resolved in a few days.

 

[anonymous]

@Justmehere thank you for all the ideas. I hadn't thought about contacting my old pharmacy. One of the issues with having my Pdoc sent the records to submit is that the prescribing doctor in the past was my PCP. I didn't have access to a Pdoc due to the location where I lived and I don't want my current Pdoc to have full access to all my records. I like to keep my care as compartmentalized as possible.

I have checked with the pharma company but they will only help when the price is down to $100/month.

 

[Justmehere]

One of the issues with having my Pdoc sent the records to submit is that the prescribing doctor in the past was my PCP. I didn't have access to a Pdoc due to the location where I lived and I don't want my current Pdoc to have full access to all my records.

You can sign an authorization requesting that just the medication records be sent and absolutely nothing else. It's your right under HIPAA to have only medication records sent to the new doc or to the insurance, if that's all you want passed on from the old doc to the new one.

You can also obtain it just via the pharmacy too.

I hope something works out soon!