Question about health insurance

I’ve swapped emails with a reader of this site for about a year now.  She is anorexic and has made tremendous strides in getting better.  She saw a doctor, got meds, and has been doing great.  Props to her for having the gumption to get help, it’s not easy.

However, she just sent me this email and I don’t have an answer.  Perhaps one of you will.

I need some advice, if you’re able to provide it. I recently turned 26, and am no longer on my ‘rents insurance…meaning I can no longer afford my meds?  What can I do?  I’ve noticed how much my anxiety about food (and overall) is getting and I’d really like to not stop progressing.

Thoughts?

  • http://www.facebook.com/ziztur Christina

    Ask doctors about generic alternatives to the meds she is taking.

    Also check out the four-dollar prescription lists that most major pharmacies have, i.e. walgreens, walmart, and target.

    Ask your ‘rents to generously pay for your meds?

  • Coragyps

    I have had one of my kids on a “temporary” insurance before – she was out of college but not yet into a job with benefits. Expensive as hell, though. And if your correspondent has waited too long after being off her parents’ policy, she will get all kinds of grief/expense/exclusion of coverage due to “pre-existing conditions” – namely, the anorexia that she needs treatment for.

    Tell her to ask/google around some “brand-name” insurance firms to see what’s available. Even though insurance is state-regulated to some extent, I’d stay away from “internet-only” people and look for companies that have, like, at least one office with people in it.

  • E

    I’m Young lady the gentlemen JT speaks of. I would appriciate any advice. I had a friend suggest contacting the drug company for help, has anyone tried this? Is it effective?

  • neatospiderplant

    I was going to suggest looking into a generic drug, but I see Christina has beaten me to it. Instead I shall just second that idea.

  • E

    I’m taking Abilify and really like it, largely because it is weight neutral, which is very important for me.
    I’ll call the pharmacy and see how much it is, my family may be able to help for a while until I can find something.

  • Moe

    Folow the teachings of Darwin, and read more Bertrand Russel books…then you will realize everything is for nothing.

    • Ray

      Please allow me, for every caring person here, to tell Moe to fuck off. Read a book on compassion asshole.

    • Makoto

      Hi, Moe,

      No. What you do is what you do. If you feel your life does nothing, that’s your choice, not your circumstances. You can choose to do incredible things within your life, which will impact many others (both human and not) around you. It doesn’t matter if you live 1 year, 20, 50, or 500 years. You can still do great things.

      Or not. If you choose to believe that your life has no impact, that’s your choice, not something that Darwin imposed on you.

  • http://twitter.com/nicoleintrovert Nicole

    When I was working part time/going to school I went to my county’s mental health office for therapy and prescriptions. They worked on a sliding scale with my income/expenses. It ended up being $10 per prescription and $20 per each therapy session. Perhaps your county/city government mental health office has a plan like this.

  • Parse

    E, though I haven’t done it myself, I found this link that may help: Help affording your medicines > Other resources. It’s from Astra Zeneca, but it points towards other organizations that try to help with this problem. Check the manufacturer for your specific meds to see what their terms and conditions are.
    As for other courses of action, here’s what I’ve got:
    – As Christina suggested, see if your medication has a generic version available. The med I’m on (Venlafaxine (Effexor)) went generic, and as a result I’m paying a lot less (about 25% of what I was paying before, I think). In my state at least, pharmacists are required to give generics, unless the prescribing doctor explicitly states not to.
    – See if there are any low-cost clinics in the area around you. Even if you don’t go to them for standard health care, I’d give them a call to ask them about low-cost meds for those without insurance. They probably get that question a lot, and would know where to point you.
    – Shop around. Before placing a prescription, call different pharmacies around you, to find out how much they’d charge for it.

  • Emu Sam

    Because I am legally disabled, I’m still on my parent’s insurance. Anorexia nervosa is listed on the Social Security site, noting

    12. Eating disorders. In cases involving anorexia nervosa and other eating disorders, the primary manifestations may be mental or physical, depending upon the nature and extent of the disorder. When the primary functional limitation is physical; e.g., when severe weight loss and associated clinical findings are the chief cause of inability to work, we may evaluate the impairment under the appropriate physical body system listing. Of course, we must also consider any mental aspects of the impairment, unless we can make a fully favorable determination or decision based on the physical impairment(s) alone.

  • neatospiderplant

    E, It looks like Abilify has a few years before it goes generic.

    I vaguely remember something about doctors sometimes having samples of certain drugs. I don’t know if they still do that or if it’s only certain types, but maybe worth asking if you can get some samples until you get this sorted out?

  • http://www.facebook.com/profile.php?id=1445648838 kimlemoon

    I clicked through on the Abilify website and found this:
    Bristol-Myers Squibb Patient Assistance Foundation: This non-profit organization provides assistance to qualifying patients with financial hardship who generally have no prescription insurance. Contact 1-800-736-0003 or visit http://www.bmspaf.org for more information

  • Anonymous

    Good luck, I don’t have any recommendations myself. I have been on a waiting list to see a doctor through the local clinic (run by medical students) for a month or so for severe anxiety and suicidal depression. I have a pretty good idea of what medications could possibly work (since my mother and maternal grandfather both take the same medication for the same conditions and have really good success through them).

  • Anonymous

    [...]

    I preemptively hit enter and must have tabbed leading to a comment submission before I was finished.

    Was just going to say, I know from borrowing their medication (with permission) what seems to work fairly well for treating the symptoms, I just need a legitimate Rx for them. =V

    Best of luck, check to see what you can for low income clinics, these are usually run by medical students from universities and overseen by doctors….

  • Trebuchet

    Just to state the blindingly obvious, this is why we need REAL healthcare reform, not an individual mandate that E may not be able to afford anyhow. Otherwise, some good suggestions above.

  • Some Old Programmer

    For US residents, don’t neglect to check out online Canadian pharmacies–it can be an eye-opener. Particularly for a generic substitute, 3 month supply, I’ve found some scripts will actually beat US insurance co-pay costs.

  • Makoto

    I’ve got a preexisting condition (cancer when I was 25, I’m now 32) – technically I can get insurance now, but I can’t afford it, even with a fairly decent salary, so really I still can’t get insurance. I hope she can get insurance through her employer, because that’s really the only decently affordable option as far as I know. Personally, I live in Texas, one of the states fighting the ACA, so even if I could afford the insurance exchange that is set up for now, I don’t think it’ll last past when Texas can put a stop to it, which is well before many of the cost savings measures would go into action.

  • http://www.facebook.com/msmith1 mattsmith

    It’s not the cheapest route, but it might be worth looking into: as a dependent child who loses dependent status, you should be eligible for COBRA. Yeah, you’ll pay 102% of the premium, but you’ll be fully covered by the same plan you were already under.

    http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html has a list of FAQs. And you can contact your parent’s benefits department for more info.

    I hope you can find a solution soon.

  • MikeMa

    E,
    While it still may be an expensive option, many states have an insurance pool for low income residents. Contact your state government to see whether it is available, reasonable and covers what you need. Good luck.

  • hopeevey

    E, there’s almost certainly resources out there. Your doctor, pharmacists and pharmacy techs, and the online resources mentioned above.

    Good for you, for seeking the support you need!

  • Art

    Many, most?, drug campaniles have give away programs run as feel-good advertising. Helps to buy good will so they can keep screwing us over. Doctors get ‘samples’ to, again, buy good will and get their pharmaceutical foot in the door. Hard to be too cynical about how all that works. It is a smiley face put on a BOHICA business model.

    Yes, you might get a discount from one of the drug company programs but, as I understand it, most have to be reapplied for annually and you get to sweat it out year-to-year. Samples are great but you can only get what the drug reps give. Supplies are likely to be inconsistent.

    A stable and long term job with drug benefits would be ideal but those are few and far between. If the unions were stronger it would be better for everyone but they aren’t and are unlikely to be any time soon.

    Similarly, a generous helping of wealth would help. Money, used well, makes everything easier. Find a sure-fire method of obtaining wealth and you could get rich selling the secret. Wait … aren’t here people who do that … The first million is the hardest.

    Anorexia is certainly a life threatening issue and because it is so serious I suspect half measures are not the way to go. I would seriously consider moving to Canada or the UK. It is a major life change. Not something to do lightly. But anorexia can destroy a life. Logically, if there is no likely and reliable way to get what you need here then it only makes sense to move to a place where you can get what you need to survive.

    It is a hard choice but the healthcare and drug delivery systems in the US are broken. They no longer work. Pounding on and begging the rusted and broken machinery of our medical systems hoping to have it drop enough pills to keep you alive day-to-day is a poor way to live and a sad way to die.

    Reform of these systems is a pipe dream. Too many people are invested in how it is structured now. The people with power and money like it the way it is. Perhaps in twenty, or fifty, years the US will get its act together but you can’t wait that long. Seek out greener fields.

    Few nations are going to like the idea of you moving there solely for medical care and drug benefits. But you wouldn’t be the first and there are other, more palatable, reasons. Tourism and business are usually acceptable. Even if you put down roots.

  • yellowsubmarine

    When I was without insurance, I let the pharmacy where I get my prescriptions filled know and they gave me some forms to fill out and a card for much cheaper prescriptions. I went from paying something like 120 per script to 20 per script. I don’t know how many states have something like this, but I’d definitely check with the pharmacies in that area and see if there’s a program like that in place.

  • Anonymous

    If she happens to live in South Carolina there is a company called Welvista that provides about 200 brand name medications at no cost.

  • http://www.facebook.com/msmith1 mattsmith

    I just got an update on this from my partner. Apparently COBRA isn’t applicable. But many companies are offering stop-gap coverage. I hope this helps more: http://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html

  • Kat in AZ

    E,
    I work for a Medicare Part D prescription Drug Plan, And when people would call in to apply without having Medicare. We had to turn them down, but we would refer them to Partnership for Prescription Assistance. They are one of the places that you can apply to get assistance from the manufacturers for your medication, especially when it is not available as a generic.
    Good luck!

  • rycuda

    This same topic surfaced recently elsewhere, produced some collected advice on getting drugs free, direct from the manufacturers: http://epochryphal.tumblr.com/post/18054189439/free-and-cheap-drugs-yall

  • http://healthunsurance.bangordailynews.com/ Linda Riddell, MS

    You do not mention whether you considered continuing your coverage from your parents’ plan by COBRA. They should have offered COBRA continuation coverage to you.

    Assuming that was not affordable and you are uninsured, then I would suggest going to the drug maker’s website. They will have an assistance program to help uninsured people get their medications. You may qualify for their program.

    Failing that, the ideas about finding a generic drug that is similar may work. (Abilify does not have a generic currently.)

    I have listed your question on my Health Unsurance blog and will forward any comments or suggestions that I receive.

    Good luck!


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