Budget Buster- prescriptions

[ilovemk76]

I've already had all my rx turned generic. The Enbrel is not available generic. Right now I have a co-pay, but if DH's insurance changes, I'll have to pay over $1900 a MONTH for my once a week injection. This is simply not possible to do. I'll have to go back to cheaper meds that don't work as well. We've even thought of him trying to find another job for the benefits, but due to pre-existing condition, may not be eligible, especially if "Obamacare" is rejected. He already pays about $200/wk for insurance.

I would not have your DH change jobs for the specific health benefits. He could get a job with great benefits and the next January 1st they could change to another plan that was just as bad as the one you had when he switched jobs.

 

[disfan07]

According to my allergist, there will be a generic singulair coming out soon which means it will be cheaper. Thats why its so expensive...its only brand name.

For us, its only $40/month (actually...less for 3 month mail order) but it took 4 months to get it approved by the insurance company.

All o fmy meds are covered by my dads insurance but I'm on about 25 meds (not including the periodic meds) so even with insurance we hit about $4000/year

One of the big reasons I started allergy shots is so that we dont have to pay for OTC meds anymore!

Our insurance company screwed up big time once and would not refill my Methotrexate. To hold me over for the week, my dermatologist gave me a one week prescription (6 pills). I went to fill it but b/c the insurance woulndt cover it it was $780 for that one dose! My derm. spent 3 days fighting with the insurance company and threatening with a lawyer and they magically covered it! I love my doctors.

 

[garydeb]

I have both allergy and asthma and the price for meds are crazy. I always ask my doctor for samples. He always has at least one or two drug company people in his office wanting to see him. He usually gives me a month or two worth of samples to use.

Good luck,
Debbie

 

[wallawallakids]

If your insurance covers it, mail order is great. I get my Albuterol and Symbicort though the mail. Also my husband is on a really expensive drug called Embrel. It is an ejectable medication and runs over a 1000 a month. On the mail order we pay a fraction of that. It has really saved us a lot. Only thing is you need to be home to sign for it (I think that is only because his needs to be refrigerated though). But they have always been really nice and called to give us a time frame for drop off, so we can make sure we are home. Good luck.

 

[wallawallakids]

I've already had all my rx turned generic. The Enbrel is not available generic. Right now I have a co-pay, but if DH's insurance changes, I'll have to pay over $1900 a MONTH for my once a week injection. This is simply not possible to do. I'll have to go back to cheaper meds that don't work as well. We've even thought of him trying to find another job for the benefits, but due to pre-existing condition, may not be eligible, especially if "Obamacare" is rejected. He already pays about $200/wk for insurance.

Does your insurance cover CVS home delivery? My husband has been on Embrel for 9 years for his arthritis. (He has AS). We get a substantial discount ordering it. We were paying as much as you were for the first 6 years and it was killing us. On the mail order it is more than half that a month. It is really worth checking into if you can. Embrel has been an amazing drug for my husband. He has done so much better on it vs before. He had chemo therapy twice before starting Embrel to stop his progression, since starting it, only once. Also he has only had to do steroids 3 times since 2003 on the Embrel. I wish you a lot of luck in trying to find it for less.

 

[ssawka]

I agree with the others about shopping around. I was using the mail order one since it looked cheaper than others. Then I got a new prescription (same medicine, new level) and didn't feel like mailing it in so I went to my local store. Imagine my shock when it came out a lot cheaper. I think the savings will be over $100 a year! So shop around. I believe you don't have to be a Costco member in order to use their pharmacy. Just watch out. They gave me the wrong dose once and the wrong medicine another time. I stopped going there after that.

I guess it depends on what type of insurance you have. We have an HMO, so we still have fixed co-pays, so it's the same wherever we buy from. The mail order just lets us get a 3 month supply for the cost of 2 co-pays.

 

[Fire14]

my Dh takes a drug that is cheaper to get at walmart than it is thru mail order with his insurance for same amount of drug.

 

[tms295psu]

Have your doctor appeal it... with a letter of medical necessity. Doesn't always work, but if you and the doctor can prove that Singular is the only thing that works for you... they should cover it. We are in the process of that with Prilosec for my toddler. Insurance denies it... because its OTC. But a toddler can't take an ADULT OTC dose (so we need to have a prescription compound). Good luck!

 

[4shinystars]

Luckily the co-pays with the current ins. are only $40, and Enbrel also has a rx help. His insurance renews on May 1st and nothing has been said to the employees yet. His company is hq in the u.k. and this is the only us location with only about 60-70 employees.
I've had RA for over 11 years.Enbrel has seriously changed my life. Before it I couldn't do things like tie my shoes, open a jar, and was in pain all the time. I was taking up to 6 rx at a time to control my RA, now I just have the Enbrel self injection once a week and methotrexate. I've had some relapses, the last combined with other medical conditions and job stress caused me to resign from my job to get well again. I am on the road to doing much better and am looking for employment again, just not so stressful.
I'm going to think positively that no news is good news. He has been with the co. for 16 years and job security is very important.

 

[JoiseyMom]

Mail order isn't all taht great. Through mail order DH's meds were 50.00 more then the say 90 day script at Target. It will go down once we hit our 3k deductible .

DS has one med that is about 175/month. And there is one DH's doc wanted him to try, but it would cost about 800/month . The generic just came out, so I have to see what that is would cost us.

It is crazy though that these meds are so expensive here in the US but cheaper elsewhere.

 

[disfan07]

Have your doctor appeal it... with a letter of medical necessity. Doesn't always work, but if you and the doctor can prove that Singular is the only thing that works for you... they should cover it. We are in the process of that with Prilosec for my toddler. Insurance denies it... because its OTC. But a toddler can't take an ADULT OTC dose (so we need to have a prescription compound). Good luck!

That depends on the drug coverage. If you have an insurance policy that only covers generic prescriptions, it is my understanding that the insurance company most likely will not cover anything that is a name brand or formulary medication because technically, its not part of their plan and insurance companies definitely wont pay more than is required on a plan.

Thats interesting that you have problems with the prilosec. I am on Prilosec for GERD. We get it via mail order prescription even though it is OTC. We had no problems with getting it approved. And since it is a generic medication, it only cost us $10 for a 3 months supply. This is the problem with the insurance companies....too many differences in what is covered and what is not covered....it really needs to be more standardized across the board!

 

[ajh88]

Just some general advice (some of which has already been mentioned here) regarding prescription drug costs:

--Shop around - as already posted, prices aren't the same at every pharmacy. It won't matter if you have a flat-fee co-pay, but it may make a difference if you have a percentage-based co-pay.

--Ask your doctor or pharmacist about other drugs that may be less expensive but do the same thing - for example, Cozaar, Avapro, Micardis, and Atacand are all in the same drug class, but Cozaar and Avapro now have generics available (where Micardis and Atacand do not). For the OP (and other on Singulair), the only thing even close is Accolate (zafirlukast), which I believe does have a generic available. It is not nearly as popular as Singulair (has to be taken twice a day), but it may be something to discuss with your doctor

--Call your insurance company! Ask them why the medication you need costs so much and what you can do to control that cost. There is generally a "preferred" drug in every category and many times they will want you to try something generic before moving on to a more expensive brand-name only product. Or they will want documentation from your physician (prior authorization) that you require the medication.

--Check with the manufacturer. I believe nearly every manufacturer has programs in place to help with the cost of name brand medications. Yes, there are income restrictions, but it never hurts to check it out. My great-aunt just started on Aggrenox (pretty expensive and no cheaper alternatives) at over $200 a month. I checked out the manufacturer website, filled out a short survey, and they sent me a savings card in the mail for $100 off each fill for up to 12 months. This was not income based - just took a few minutes of time to search it out. Keep in mind that many (or most) coupons cannot be used in conjunction with Medicare, Tricare, or other government payors, nor can they be used in certain states.

I understand how frustrating this can be - I stand on the other side of it every day. Best of luck in finding some financial relief on Rx costs!

 

[disfan07]

Just some general advice (some of which has already been mentioned here) regarding prescription drug costs:

--Shop around - as already posted, prices aren't the same at every pharmacy. It won't matter if you have a flat-fee co-pay, but it may make a difference if you have a percentage-based co-pay.

--Ask your doctor or pharmacist about other drugs that may be less expensive but do the same thing - for example, Cozaar, Avapro, Micardis, and Atacand are all in the same drug class, but Cozaar and Avapro now have generics available (where Micardis and Atacand do not). For the OP (and other on Singulair), the only thing even close is Accolate (zafirlukast), which I believe does have a generic available. It is not nearly as popular as Singulair (has to be taken twice a day), but it may be something to discuss with your doctor

--Call your insurance company! Ask them why the medication you need costs so much and what you can do to control that cost. There is generally a "preferred" drug in every category and many times they will want you to try something generic before moving on to a more expensive brand-name only product. Or they will want documentation from your physician (prior authorization) that you require the medication.

--Check with the manufacturer. I believe nearly every manufacturer has programs in place to help with the cost of name brand medications. Yes, there are income restrictions, but it never hurts to check it out. My great-aunt just started on Aggrenox (pretty expensive and no cheaper alternatives) at over $200 a month. I checked out the manufacturer website, filled out a short survey, and they sent me a savings card in the mail for $100 off each fill for up to 12 months. This was not income based - just took a few minutes of time to search it out. Keep in mind that many (or most) coupons cannot be used in conjunction with Medicare, Tricare, or other government payors, nor can they be used in certain states.

I understand how frustrating this can be - I stand on the other side of it every day. Best of luck in finding some financial relief on Rx costs!

I was on this for a while....when I got it there was no generic available. From what my pulmonologist and allergist said, it also doesn't seem to work nearly as well as singulair which is one reason why it is not very popular with many physicians.

My pulmonologist said that about 95% of patients he has usually end up on singulair because accolate doesnt work so he very rarely prescribes it anymore.

 

[disneymarie]

Am I confusing you with another poster? I thought you recently won a huge insurance settlement over your oldest daughter's poor medical treatment. It would seem you should be able to pay for your meds with the procedes from that lawsuit.

That is vicious, I ended up with huge legal fees taken out from the secondary litigation of absent father, and have three disabled children that their future needs had to be provided for.

I am on disability working with my husband driving to try and keep some decor to maintain medical insurance for the family since his factory closed. My training working pt earns more then dh can as pt security guard. No one wants to hire a 64 yr old for decent work with benifits for us.

I budgeted two trips for the family that amount to 6 months of what my meds are billing. I walked out of Walmart without them. Guess I thought making new memories for the family was more important then my needs, as I usually do.....I have not even bought the new recliner I sleep in, rathering to use it for others.

THERE IS NO REASON FOR AN ASTHMA MEDICATION TO BE $500 a month!!!!

BTW, it was not poor medical treatment, it was a medication recall, that death was a side effect.....Thus I do not like to mess with medications.

 

[Judique]

I have Caremark CVS perscription as well. Now check with your own plan, but I dont have to go to CVS to get it filled. My pharmacist said that it is a common misconception that the CVS Caremark is only good at CVS.

No misconception. It is in effect for maintenance meds only and is part of my organizations plan. We go Oct 1 to Sept 30 and found out in Nov with no notification, so it is still being fought. They then extended to Dec for using any pharmacy.

I had to go back to my doc and get new scripts written as ones that weren't 90 days couldn't be filled.

You can get the first script filled anywhere on a one time basis. So if I just need amoxycillin for ten days, fill it anywhere. But, blood pressure meds, diabetes, asthma meds, cvs only. Now, the good thing is, it does save that money - you pay for 2 months get 3 months. And, my cvs doesn't make me use mail, they fill the 3 month supply in the pharmacy right here and charge the 2 month price.

I can't really complain a lot other than it was inconvenient the first time, as I had to get new scripts written, and put on file.

Liked my other pharmacy better - they had a drive up window and more personal service.

And, reading this thread I know I have an extremely good plan. My copays are so small as to be ridiculously small next to some of these numbers written.

 

[maxiesmom]

Do you take the singulair for asthma or allergies? Many plans don't want to pay for the singulair if it is for an allergy diagnosis because there are so many OTC allergy meds. DS just got on the chewable singulair and insurance denied it, but after the doctor explained it was being prescribed for his asthma (which it is), they approved it with a $35 co-pay/month for one year. Insurance paid $325 of it.

He used to be on Flovent (inhaler) and it was denied last year. After fighting insurance, they approved it for one more year. We got a letter this year that said DH could still be on it, but the co-pay would be $100 instead of $35. If he is in his yellow/red zone, we could go through two Flovent inhalers in one month. The allergist switched him to Qvar, which I don't think works as well, but only has a $35 co-pay.

We also pay about $50/month for his allegra OTC. It's sad that so much of our budget is used on his allergy/asthma meds. I am thankful for insurance, but they seem to be denying/fighting more and more meds that we NEED. So, we pay $120 for his meds and that doesn't count if we need his epi's or albuterol refilled or anyone else in the family. He's worth every penny, but it still stinks.

I just got in the mail yesterday my yearly letter that CVS doesn't want to cover Singulair for me anymore. Every year I get the same letter, and every year I have to call my Dr who then has to fax them and argue with them to cover Singulair for me. It is not an allergy med for me, I already take Claratin for that. As well as have a prescription for inhalors.

I am stuck to using the mail order refil program, in order to cut down on costs. I hate CVS and their drug coverage. But I am happy to know that a generic will be out soon for Singulair! Yay!

 

[floridascgirl]

I just got in the mail yesterday my yearly letter that CVS doesn't want to cover Singulair for me anymore. Every year I get the same letter, and every year I have to call my Dr who then has to fax them and argue with them to cover Singulair for me. It is not an allergy med for me, I already take Claratin for that. As well as have a prescription for inhalors.

I am stuck to using the mail order refil program, in order to cut down on costs. I hate CVS and their drug coverage. But I am happy to know that a generic will be out soon for Singulair! Yay!

It must be your particular CVS because I have no problems at mine. I pay $30 a month (each copay) for me & my DS's Singular, no issues. My phamacists are so nice that they even suggested internet coupons to help save money. The ones that I have found are $20 off...one use per lifetime.

I have recently tried to call around to other pharmacies to price out several of our family prescriptions. None of the pharmacies that I called (Costco, Walmart & Walgreens) were able to give me a quote. They said that I would have to bring in the prescription and then they would have to run it through to know the cost. How do ya'll get quotes?

 

[Judique]

It must be your particular CVS because I have no problems at mine. I pay $30 a month (each copay) for me & my DS's Singular, no issues. My phamacists are so nice that they even suggested internet coupons to help save money. The ones that I have found are $20 off...one use per lifetime.

She may be talking about the CVS Caremark prescription plan, not about the actual pharmacy itself.

 

[maxiesmom]

She may be talking about the CVS Caremark prescription plan, not about the actual pharmacy itself.

Yes, exactly! The CVS store in my neighborhood is great. The prescription plan has been nothing but trouble sense my company switched to it.

 

[momto4obkids]

I work for a primary care physician office. We have an entire closet full of samples and discount cards. Ask your doctors office for help.

Things like advair,flovent and singulair. We have drug reps in every few weeks.

Some of our diabetic patients that can't afford their victoza and Lantus are given samples every month.