TX One Month Insurance Maxed Out

[MrsOckert]

After getting pre-approval from the insurance company I started TX.  When the pharmacy sent me the 2nd month's meds I found out my insurance benefits were maxed.  Why wouldn't they have told me that to begin with?  Has this ever happened to anyone else?

[MrsOckert]

Commitment to Care accepted me into the free meds program.  They are going to supply my meds to me thru Sep 2006!!!

I guess this is the classic case of good news/bad news  LOL

the good news is you're poor....the bad news is you're poor!  :)

Thanks for all the comments and help!

[vegas777]

Oh I thought your shot was on Sunday nights, sorry...Is your husband gonna do it or are you?

I didn't know that the Canadian trials use the US labs, interesting.....When I had my PCR and genotype done the labs here in North Bay sent it to TO and they made the comment that the "testing was so sophisticated that they were not sure if they would allow it", they meaning OHIP..Ontario Health Insurance Plan...That kind of made me nervous...One of these days I think i will repeat it in the States and see if it is the same...

Glad to hear you're still okay, I worry about you and when I didn't get any emails from you this weekend I had to post here...

Beth

PS:  we had out first snow fall, but it was just a slight dusting, didn't even stay on the ground...But, it's on it's way I am sure...I am so NOT ready for winter...

[go-girl]

Hi Beth, Rocker is with Schering Ploughs study as am I in Vancouver, because its their study they want all info to keep track of results etc; is what I was told, it may be the same for rocker. #2 shot later tonight, so far all is good, am a little anxious about tonight, what to expect???????

Rocker is going to re-check about his getting Eprex for anemia, will be anxious to now, take care

[vegas777]

a got a question, why would a TO study send your blood to a US lab?  all my blood draws, for PCR, genotype and liver panel were sent to TO...lol  Just curious....

Beth

[cuteus]

If you get infections while on tx, antibiotics might be necessary. No where does it say that you can't or should not have them while on tx. We definetely do not need the residual antibiotics given to the cows in today's industry or the non vegetarian diet they get, that's for sure. There is always organic milk...

[go-girl]

#1 on Monday, had shivers for 3hrs and a mild naggy headache thats it, not a thing since, i drank a ton of water the day before as someone on here suggested that probably helped imensely, and I've been drinking 80-90 ounces a day since. I'm 65 geno 1b, portal gr 3, lobular gr 2, fibrosis at least gr 3 with feaures suggesting of evolving cirrhosis, have fatty liver and am 25lbs overweight, VL 903000. wasn't told to lose weight, wish I could. Still have a good appetite, I'm wondering how long it takes when food starts to taste like metal, maybe someone can tell me, thanx. I'm on 1000/riba and 148ug to be mixed with water, what would my actual dosage be, if someone can tell me, never thought to ask? I go for labs evry two wks for a month unless I have a problem I can call my RN 24/7.

London Drugs pharmacist said it would cost $1800 a month for low dosage of eprex, pharmacare doesn't cover it, I also thought she told us extended medical didn't cover it, but don't quote me I may be wrong, will ask when I  go again.

That must be a wild and crazy life living on Granville, huh? i live in North Van minutes from the chairlift, can see it from back yard, lots of snow, they opened last week, its a record never opened that early before. This is our first winter home in 15yrs we go to California for 5mo, the disease put a stop to that,  oh well anther time. Its much warme here than Toronto, guess you found that out!!!!!!!!!!!!!

yes keep me posted re' eprex, take care

[kpj49]

Same here.  Mine maxed out after $1000 so that was quick. I contacted Committment to Care and had them send an emergency month's supply until they could process me.  It is very important that you do not miss any doses.

[go-girl]

Hi,I told you I was in a study in Vancouver, had shot #1 monday, so to early for me to tell, LAIRD who I'm with is also a research org my gastro is well known. My understanding is they really monitor you well, time will tell, the care from the two RN's is wonderful. I asked about the eprex for free was told Canada Health said no such thing, I am going to get in touch with the CEO who wrte me from the "Anemia Institution" again. I didn't end up getting the redipen they gave me the syringe instead, oh well, the shot was a piece of cake I was nervous about the mixing have to use two needles. Forgot when you start is it Dec? Let us know how the study treats you, good luck

[bobbyullc]

YOU MUST HAVE BC/BS. THEY TOLD ME THEY DO NOT COVER INJECTABLES ALSO. THEY DO COVER MY RIBA WHICH IS $1278 A MONTH.I HAVE A 77 PAGE POLICY AND ONE LINE ON PAGE 38 SCREWED ME. RIPOFF.
COMMITMENT TO CARE DID PICK IT UP FOR FREE. THANK GOD FOR THE BIG DRUG COMPANIES.
MEANWHILE THAT DRUGSTORE . COM IS HALF PRICE ON THE RIBA AND $98 LESS A SHOT ON THE PEG. GOOD LUCK.
WE REALLY DO NOT HAVE TO WORRY ABOUT PAYING FOR LIFE SAVING MEDS.
PS BC/BS WILL PAY FOR A LIVER TRANSPLANT?

[crushed]

OOPS posted the same link twice here's the pegasys...

http://www.drugstore.com/pharmacy/prices/drugprice.asp?ndc=00004035239&trx=1Z5006

[crushed]

after checking again all i can say is that the first form that was sent to me to fill out and send back listed a price of $1684 per kit and said the patient was responsible for 0 (which is all i needed to see). being both riba and peg are comming from the same supplier i "assumed" the price was for both but written on top it just said pegasys. i didn't send it back though i was supposed to so four months later they sent me another form with a total of $7057 but on top of the form was written ribavirin/pegasys so now i'm really confused as to what costs what...the company is optioncare in NJ. i looked around the internet and although i couldn't find info newer than 2003 there seems to be a great spread in prices. there was one link (around 2000) that put the price of riba at $5 capsule saying they had slashed the price 43%. here's some links that "may" be of some use.

http://www.drugstore.com/pharmacy/prices/drugprice.asp?ndc=59930152303&trx=1Z5006
http://www.drugstore.com/pharmacy/prices/drugprice.asp?ndc=59930152303&trx=1Z5006

sorry if i gave you bad info.

[avidreader]

I am required by my insurer to buy my meds mail order from Curascript. When they come there is a bill attached (I only pay a $30 co-pay for each one) but the Copegus (ribavarin) is priced at about $1,400 for 180 pills and the Pegasys is also about $1,400. I don't think there is a generic for pegylated interferon, but I seem to remember reading on the boards somewhere about a generic for the copegus. Lots of insurance plans have RX caps these days--as an employer I'm in the process of reviewing what plans I'm going to offer my employees next year and I am having no trouble understanding why my premiums are "only" going up 8-10%--they are going to be sticking my employees with higher co-pays, fewer visits, and more limited rx plans. Health care in this country is a disgrace. No one should be denied life saving meds due to inability to pay and/or private for-profit health insurer greed for profit but it happens every day

[MrsOckert]

The pharmacy is charging  $2179.00 for the Peg-Intron and $2038.30 for Ribavirin for a monthly total of $4217.30.  How did you get both for $1700?  What pharmacy are you going thru?

[crushed]

from the receipt that was sent with my first set of tx it stated that the total cost was around $1700 for the riba and peg so i don't see where they are charging $2000 just for the riba. also this was for 184 200 mg capsules (you probably get less)...now the Epogen is big time pricy, bout $500 a ml. man am i thankful for decent medical coverage.

[MrsOckert]

Carolyn,

I did contact Commitment to Care (Schering Plough) and am waiting for the paperwork.  They said they are hearing that a lot these days....insurance prescription plans maxing out with these high dollar drugs.  

If I had been told from the beginning this is what would happen I would never have started tx.  We can't afford $2,000 per month for the co-pay.  

The woman I normally talk to at the ins co is on vacation till the 15th.  I plan on calling her on the off chance there is a mistake somewhere.

Valorie

[MrsOckert]

I believe the Peg-Intron is falling under major medical.  My policy says it does not cover injectables - so since it was approved initially I think that's why.  They are saying my Prescription Plan has a calendar benefit of $2,000 and the Ribavirin is $2000 for a one month supply.  At first I was told my copay for Peg-Intron was $436 and the copay for Ribavirin was $10.  The second month they say I have to pay 50% from now on.  When I called to find out what was going on, the woman I spoke to said all they do is give certification approval it's my responsibility to know my benefits.  I agree with her, but I never dreamed a generic pill would cost that much for one month.

[PasoPerson]

I have not had the problem you are having, but I do have a suggestion.  Both major drug companies have plans in place whereby patients without insurance are given their meds gratis, or greatly reduced price.  Check with your doctor, NP, or contact the drug company's "assist" plan - that phone number should have been in your introductory materials or on shot box.

Carolyn

[suzieq2]

There has to be a grave mistake. If they approved your treatment,that means they cover the treatment for as long as your Doctor says you need it.1 month makes no sense. What part of your policy are they saying is maxed out.My coverage has no presciption coverage,but interferon is considered a life saving treatment so it falls under my major medical of 5 million limit.They do not cover pain meds ect.My business is health insurance. If I had some more detailed information on your policy, I may be able to help you a little better.It may have just been a mistake by a claims processor,or an attempt to see if you let them get away with this.