MM and Medical Advice

[explorer2001]

Short version of the long story, I was having some GI issues, got referred to a specialist, had some tests done. Today they got the test results back and the doc calls me to give me the run down. Turns out they know what's wrong. It's totally treatable. Treatment usually take 10 days of XYZ medicine with ABC medicine. After that I should be back to my normal eat-whatever-I-want self. The doc calls in the Rx.

I go to the pharamacy to pick up the prescriptions. One is $5. The other is $538.16 for the 10 day supply. It also has to be special ordered. Yes, I have insurance. However it is high deductible, so I'm out $540 today if I do this now. I won't qualify for an reduced cost programs. I can technically "afford" it. It's just a sucky liquidity strain.

I'm trying to figure out what I can do at this point. I am a bit surprised that a Rx that expensive and special order, didn't merit mentioning in the phone call earlier in the day. Is it reasonable to ask for an alternative medicine? Can anyone give me any suggestions? I plan to call my doc back in the morning and tell him that I can't get the meds at this point because of the above. What else should I be prepared for/with?

[MadamePresident]

I'd ask if there is a generic or another form of the drug. Sometimes there are similar drugs that do the same thing, but work in slightly different ways.

But if you're in pain and they know this will fix it that doesn't seem like a terrible price to pay. Plus, you still have 358 more days this year to have medical expenses and hit your deductible.

[rikki]

Is it a PrevPac? I needed one last year and although my insurance paid for it, I remember being shocked by the price. If so, it really, really worked though and I would suck it up and pay to feel better.

Sorry I don't have any advice on affording it.

[Deleted]

I would either ask for a generic or contact your doc (or his nurse) and ask if there is an alternate medication.
If not, I would. It is unfortunate that it costs to much but it can really cause struggle in other areas of your life if you don't feel well.

[hlke]

Definitely call your doc to see if there is an alternative, and call another pharmacy or two for pricing as well. I have one Rx that I've been charged anywhere between $3 an $60 for depending on the pharmacy.

[ijack]

How much have you spent on tests and stuff so far? Based on what you've said about this whole thing, I'm surprised it's even a question. Yeah, $500 is a lot, but you said yourself you can afford it.

[audry80]

My insurance deductible isn't tied to my RX plan and I only pay a co-pay for covered drugs. Is the $5 on the other drug your copay? I would question if the $538 drug is a drug covered by your insurance and that is why it's so high. Each insurance provided a list of covered drugs. I would talk to the Dr. They can look up what is covered by your plan and if its the only drug that cures your issue that can appeal on your behalf or call in a new prescription. Hope you are better soon!

[Deleted]

DH had this issue a few years ago. It was around $725 for a prescription that he needed monthly, there were no alternatives and our insurance wouldn't budge. We normally have a $15 co-pay so it was a shocker.

Since it should be a one time thing, I probably wouldn't put a whole lot of effort into fighting it.

[explorer2001]

I should clarify. The new calendar year means a new deductible. All the tests were done in Decembee last year after meeting my deductible for 2012.

Thanks for the ideas. I hadn't thought to check other pharmacies. I will definitely call the doc in the morning. I'm guessing he didn't know the Rx was epi expensive. I know the $5 one was a generic. So I would expect him to be ok with generic if it was available.

[ijack]

My point about the tests is that you've already spent money to get to this point, why wouldn't you spend the final $500?
And if your rx coverage has a website, you can do all the pricing there. Do they have a mail order option?

[hbomdiggity]

sure, ask if there is an alternative or whether the pharma has any coupons/assistance. maybe the doc can supplement with sample? but at the end of the day, your health is worth the $540.