Monday, August 20, 2007

Insurance Woes

I've gotten so far behind on blogging lately! It's the busy season for me, summer, with my kids home from school. We return to our normal routine next week when school starts, and then I'll have more time to write.

The past few weeks have been filled with one health insurance mess after another, mostly to do with our prescription drug coverage, which seems to shrink daily. It's so frustrating!

First, I stopped by the drugstore to pick up one of my allergy medications. It's a generic 12-hour decongestant/guaifenesin combination that I've taken every day for the past 8 years or so. The pharmacy clerk told me my insurance had stopped covering this medication, and it would cost me $100 (with insurance, it's $20). The insurance company never contacted me to let me know our coverage had changed. Phone calls got me nowhere - they couldn't tell me why it was no longer covered or what I could get as an alternative.

To make matters worse, it turned out that they are no longer covering any medications in this class. Both my younger son and I take two different varieties of this medication to help control our allergy and sinus symptoms. Since starting on these, my sinus headaches have almost completely disappeared, and Craig made it through last spring without a single sinus infection.

Then, weeks after sending my new Valtrex prescription to our mail-order pharmacy, I received a letter in return that they couldn't fill it because it was "beyond my limit." I guess they had a problem with the higher dose? Who knows. Anyway, I was in a panic, so I e-mailed Dr. Levine and begged her to call the insurance company and plead my case. She was understandably reluctant to get involved in a long battle, but she finally agreed to give it a try. After multiple phone calls and faxes, Medco finally agreed to fill the new prescription, but said they could not send it to me until August 30. No idea why? So, I had to cut back to just one Valtrex a day to make them last until the end of the month.

Meanwhile, I'm struggling to find a new, low-cost way to get the decongestants for Craig and I. I guess we'll have to pay for them out of pocket, so I'm looking for the lowest prices. So far, seems to be the best option. I'd appreciate any recommendations from other people who have to pay for their own medications. As frustrated and fed-up as I am with our prescription insurance, I also have a new appreciation for people who don't have any insurance at all. I can't imagine how difficult that must be. Any advice on low-cost prescriptions is welcome!


  1. sscape11:15 AM

    It's telling that when I pick up my meds the technicians remember me and remember filling my Rx. The printout states that were I to pay out of pocket the full cost would be $2,461.00 for one month.

    That's enough to make you feel sick.

  2. Anonymous2:12 AM

    Hi, Sue,

    Thanks for blogging about your experiences with CFS. As someone who has to pay for some meds out-of-pocket and who has a public health background, I would suggest calling around major pharmacies and asking for their prices. I have found discrepancies of several hundred dollars on out-of-pocket costs between pharmacies. Would suggest checking out Walmart as they have a good generic drug program right now ($4/month - see their website) and I have found they can negotiate for lower rates than CVS,etc. (They don't call themselves "America's top retailer" for nothing!)

    Also check out the AARP website and look for info on how to find a reliable Canadian mail-order pharmcacy. (Seniors have a lot of experience with trying to afford meds also.)

    Good luck and keep blogging!