Insurance Companies Suck

[Laura91]

 

[Ltl89]

Amen.

Usually insurance companies will not cover medicine if there is "an adequate substitute".  The problem is that some of these substitutes don't work for people.  I understand when they will only cover generics if that is available, but it makes no sense when they refuse to cover certain drugs when there is a similar but different drug available.  Sometimes different drugs don't work as well for whatever reason. 

One thing you could try is to ask your doctor to override this and send a letter to the insurance company explaining why you need to be on this specific drug.  This isn't guaranteed to work, but you may be able to get coverage if your doctor can prove that the other medicine isn't therapeutic for you.  If that doesn't work, many drugs that are patented have prescription plans to help people pay for their drugs.  They usually do this as a way to continue to make profits when the insurance companies start to refuse coverage of their drug.  It's not great, but it could work.

Good luck

[Shodan]

At least your insurance will cover something. Mine won't cover anything at all for me.

[LordKAT]

I have a super large rainbow trout waiting for you when you need it.

My ins gave up on me for once.

[Jamie D]

I'm in the process of doing all of that stuff now. The ironic thing is the idiots said, "Uhhh, duuuhh, why don't you try Trazadone?" even after I rattled off a laundry list of side effects that I had from that drug. The current one I am taking in place of that hasn't done anything to me as far as bad stuff goes and that is why I am so irritated with these idiots for screwing things up for me.

The thing to do is have your doctor contact the insurance directly, and state the XYZ is the only med that works for you.

[mrs izzy]

Well, this has been done and they are still refusing to cover it.



Now they are saying that I need a diagnosis of "Bipolar Affective Disorder, Unspecified Episodic Mood Disorder, Depressed Mood Disorder, or Psychosis"!!

Idiots!!!

And they are STILL suggesting that I "try Trazadone" when I have already told them that it does not work!!

This is really getting old.

Maybe you can ask your doctor for a little help with some free samples until you can work on getting things settled with the insurance company.  I had pn the past "one of them there drugs" that i had to fight months to get covered and my doctor gave me enough for half of what i needed in samples to help out..

Luck
Izzy

[mrs izzy]

I've been doing that but I can't count on that forever.

Take what you can to help and keep fighting.

Izz

[Ltl89]

There are prescription plans that most pharmaceutical manufacturer provide for those without coverage.  From their standpoint it would be better to provide a subsidy or discount to their patients and increase sales then it would be to have no one buying their meds.  Ask you doctor if he is aware of such a plan or how to contact someone to get on it.

Samples are a lot easier to get away with then you think.  The pharm reps love to shower doctor's offices with wonderful "gifts" to ensure they all have a good "relationship".  Though that is nothing compared to the nice "gifts" I have personally seen in political offices before.  Oh well, they have lobbyists of all kind for a reason.

[Ltl89]

Well you don't have coverage for that medication.  So it's likely that they will do something.  Believe me, they want as many people on their drug as possible.  They inflate the price knowing the insurance company will take the biggest hit.  When the insurance fails, they offer a discount, which in reality is a more reasonable price for these meds as possible.  It sucks and is unfair, but this is the best option you have to get the meds.  They have a monopoly on the med until their patent is up.  Once that happens then you can get generics.  Do you know when this drug's patent expires?  Maybe you can get samples until that point in time?  As of now those are your two options besides getting off the drug.   

P.S.  Keep in mind it can take up to a year to develop a generic and sometimes patents get extended.