...Or You Could Pay $4,150.00 Out Of Pocket

Every new year I go through the same game of trying to get my leukemia medication.

The game goes something like this:

It's time for me to pick up my prescription---
     However, I am stalled because the insurance needs to re-approve it for the new year.
The insurance re-approves it (which usually takes a week or two)
     However, they only re-approve it for the first month
I pick up my medication
     However, I need to have my doctors fill out more forms and fax them in over the month so I can hopefully get my medication the next month without any hassle.

This year the game was changed up on me.

It's time for me to pick up my prescription---
     However, I am stalled because the insurance needs to re-aprove it for the new year.
The insurance re-approves it (which took about a week and a half) BUT ONLY IF I RECEIVE MY MEDICATION FROM THEIR MAIL IN SPECIALTY PHARMACY

"Okay, Fine." I think to myself

So I call the specialty pharmacy who tells me they do not have my prescription and need my doctor to re-fax in all of the information including my co-pay assistance card.

My doctor faxes in all the information, insurance/copay cards in on Wednesday of last week and I am assured by the new pharmacy that everything will be ready to go within 24 hours.

On Friday morning I call, because I haven't heard anything and I figure I better check in.

I speak to a woman who informs me my copay is $4,150.00.

I tell her my co-pay assistance card helps with that and she tells me they do not have my co-pay assistance card on file. Frantically I give her all the information over the phone and she tells me she has put an "emergency" note on the file to get this shipped out to me.

I hear nothing.

So Monday morning I call to check back and am told they have all the information in the system and to check back at 4pm (Pacific Time) to make sure the medication goes out tonight.

I call at 3:50pm (Pacific Time) and a new person tells me it will take another 7 Business days for them to "verify" my co-pay assistance--- OR I COULD JUST GIVE THEM $4,150.00 AND THEY WILL SHIP IT OUT TONIGHT


I hope each and every one of you has that kind of money laying around for one month's worth of medication--- but I'm guessing I'm not the only one who does not.

The only way to get any of my Daily Leukemia Drug for the month of January is to have them over-ride the system and allow my regular pharmacy to go ahead and fill the prescription.

I ask them to do this--- and they tell me they are only open for another half hour so I need to call my local pharmacist, have her try and run the prescription through the system, get a denial number, call them back with that denial number, and THEN they can release it to her so she can order the medication for me to receive before February 1st.

I hate to make assumptions--- but isn't it convenient that the insurance company doesn't have to pay anything for January if they can't have the drug approved until February?

My local pharmacy originally tried to re-fill the prescription on January 10th. The December prescription ran out on January 14th. Today is January 28th.

Anyone else see a problem here?

This Drug is More Expensive---Therefore It's Better

I read this article the other day:

http://www.bloomberg.com/news/2012-10-25/novartis-cannibalizes-gleevec-to-boost-new-cancer-drug.html

Basically what it comes down to is that a drug company who makes a very expensive medication to save lives of those living with Chronic Leukemia is about to have their patent run out. Therefore, before the patent runs out and the drug is allowed to be made generic, they are attempting to raise awareness of their second line drug which has a longer patent in place.

I have no problem with making patients aware of another drug available to treat the same condition. What I struggle with is that the first drug (that is about to go generic) is a powerhouse that has saved hundreds if not thousands of people from an early grave.  What this company is doing, in order to make sure their profits continue to soar is they are attempting to sway doctors to the more expensive drug by saying that first drug is less effective.

Both of these drugs have been around for a decade. I feel like money is driving care in this scenario, and that makes me uncomfortable.

Truthfully, if a person is unable to take a generic for whatever reason then their options are limited--- but if there is an option to save your life by paying $500 a year for a medication that used to cost $5,000 a month prior to generics. My vote is save yourself from bankruptcy and stress--- stick with what works, and don't play health games over profits.

What do you think?