My Medication Is Too Expensive. Advice?
Hi. This is my first time posting on this forum, but I am an avid reader. This problem may have already been addressed. I was diagnosed with COPD in 2007 and quit smoking in 2009. I am disabled (from another condition) and my only source of income is SSD. My COPD has progressively been getting worse in the years since. My problem is that every medication that my doctor has prescribed to manage my symptoms is not covered by Medicare or my prescription drug plan, so I am responsible for paying the full price, roughly $400 give or take. I don't expect the cost of these medications to go down because big pharma always renews their copyrights before they expire, just to keep generic medication from becoming available. $400 is approximately 30% of my monthly income so I cannot purchase it, given my other living expenses. I am living from hand to mouth, but I am in that little area where I do not qualify for other government health programs (one person household, owned home, etc.). As a result I can only afford generic albuterol which alleviates my symptoms but does not manage them as most of you probably know. My doctor is very generous and provides me with samples of "the good stuff" when I visit him.(Spiriva, Brevistri, Trelegy, etc.), but due to the risk of seizures brought about by my other condition, I am unable to drive and see him when my samples run out. I live in a rural area and am dependent upon others to bring me to town. My doctor once gave me a coupon for $100 off, but of course Medicare does not honor it. Does anybody have the same problem? I am at my wits end. I even considered foreign pharmacies despite the warnings that the drug I will buy are knockoffs, I may be ripped off, the feds may arrest me, or even death. What other recourse do I have?
Thank you, Tiee. I appreciate your advice.
My pulmonologist switched me from Spiriva, and Symbicort to Trelegy recently. I knew Medicare won't pay for it. In the past it often cost me $800.00 for the inhalers a month in the Donut hole. I got an email from the Dr's staff indicating they were working on approval for the Trelegy. I thought it kind of futile, but I got notification from the Rx Plan, and the Dr's office I'm approved for a year. I have to pay $149.62 a month, but it's not the $600.00 I've seen it listed for. If it works well, I can donate the inhalers (unopened) to my doctor's office, and they will be used by an agency that helps the poor get inhalers. Can your doctor do that for you?
That’s fantastic about that amount of savings. These inhalers are so expensive. I have heard good reviews about Trelegy so I hope it works well for you. Please keep us updated.
Carol (Community Advocate)
Thank you. You have piqued my interest. I have a brand new doctor. Although I have only seen him four times, I trust him implicitly and will definitely call him. I seem to remember seeing in my plan how to file for an exemption or partial exemption.
I'm having the same problem with Trelegy but my Medicare Advantage plan covers it for 7 months a year and it only costs $47 during that time. You might look into changing plans? I live about a hundred miles from Mexico so when my drug coverage switches to a higher rate I ask my daughter-in-law to get it for me. She and my son live here but cross the border at least monthly to see her mom and other family. It's only $65 there, no prescription or insurance needed. I don't like to ask but the medication is the same with the same results and it's the only way I can afford it from August through December. Do you have friends near or over the border? Can you switch to a different Medicare Plan? Call a Medicare insurance broker and explore some possibilities, it certainly can't hurt and might save you a lot of money. Good luck! Thank you for your suggestions. I have no friends or family near the border, so I don't have that option, but I often see these infomercials and commercials regarding Medicare Advantage plans. If you don'r mind me asking, what is the ballpark figure that I can expect to spend if I do enroll in a Medicare Advantage plan? I'm on Social Security with no other income so I don't pay any premiums. I have small co-pays and most of my drugs are free. They even provide free rides to and from doctor appointments if I need it. (I can still drive and my 16 year old car runs great!) Don't call the infomercials or commercials. Look up insurance brokers and find one that specializes in Medicare. My broker came to my house, asked what I needed and showed me plans that suited those needs. Doesn't cost anything, they get their fees from the insurance companies that administer the plans. Since their fees are the same no matter which company, as I understand it, they have no incentive to talk you into something you don't want or need.
I see now that it looks like you got a new doctor. You might need better insurance too. Hard to say without more info. I'm new to this life too, and struggling to learn how to navigate these kinds of issues, too, as I have only SS to live on. However, I don't put up with negativity from doctors, insurance providers, or Medicare. Luckily I've been able to find the answers I need so far. What I do know is that Medicare should be providing you with all your needs as far as anything oxygen-related, such as albuterol. My insurance does not come into play on that or my blood pressure meds. I do have a $35 monthly co-pay on my Symbicort. That's it - Medicare (so far) provides 100% of whatever else I need. Even so I am considering changing insurance providers as my Plan G costs me $168 a month! That's besides Medicare. A close friend of mine has a different plan and provider, and his insurance costs him nothing - apparently Medicare covers it! Not sure how that works but I'm looking into it. I would check with any advisor I could find on this stuff, there has to be a better way! We just have to keep searching, eh? Kind of makes me feel like a rat in a maze!
