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Unemployed, uninsured... how do I get my medication?
December 7, 2009 4:09 PM   Subscribe

So, I recently lost my job and, by proxy, my health insurance. I'd been seeing a psychiatrist for over 2 years, when I was employed and insured. Together, we found a good combination of medications that worked for me and my particular brain chemistry. Now, I am running out of medication and don't know what to do or where to look for assistance. (I'm 23 and live in New York City.)

I take an SSRI and a benzodiazepine daily for depression and anxiety/panic attacks. I am worried about running out of the medication as sudden discontinuation of benzodiazepines can cause potentially life threatening seizures, as well as the discomfort of sudden discontinuation of the SSRI. What can I do to avoid having a seizure and causing even more medical bills to worry about? Both of my parents are deceased and I have no family to speak of and most of my friends are in similar situations. My googling has turned up nothing of use. Much thanks for any responses.
posted by Pleadthefifth to Health & Fitness (17 answers total) 4 users marked this as a favorite
 
I don't have any experience with this, but I do know there are programs in which drug companies give reduced cost or free medication to uninsured people.

Check out RxAssist.org, a nonprofit informational website designed to help people get the medication they need when their insurance doesn't. Take a look around that site - seems like there's a lot of potentially useful info. Good luck.
posted by Salvor Hardin at 4:24 PM on December 7, 2009


It depends on your employer, but you might be eligible for COBRA, which would allow you to pay to extend your health benefits for some months. Here are some links that could help you to determine eligibility. There is talk of extending some additional COBRA subsidies passed in the stimulus package last year that might make this cheaper for you.

I'd also consider asking your psychiatrist to see if they have any ideas on how to proceed.

Best of luck, Pleadthefifth.
posted by MidAtlantic at 4:25 PM on December 7, 2009 [2 favorites]


My suggestions are:

-Ask your therapist to lengthen the amount of time between monitoring appointments, since you are well established on the medication. That is, if you have an appointment every month to check in, try making that every 3 months.

-As far as I know, every one of the big pharma companies has some different financial options to help afford medications. Without knowing which meds you are on I can't point you specifically, but for example:

Pfizer Patient Assistance
Astra Zeneca Prescription Assistance
Partnership for Prescription Assitance (multiple cos)
GlaxoSmithKline For You

If you don't know who makes your meds, you can usually look them up in Wikipedia or on CrazyMeds by brand or generic name and find out. Some of the benzos have been out so long that generics are really cheap.

In addition, Target and some other companies have $4 prescriptions for some generic drugs. Often, multiple drugs in the same class aren't covered, so you may want to bring the list (that is Target's list) to your Psychiatrist and ask for help. Which brings me to my final point - ask your psychiatrist for help. He or she will want you to stay stable medically, and will likely have some advice.
posted by bunnycup at 4:29 PM on December 7, 2009 [2 favorites]


It may not be the best long-term solution, but ask your doctor about substituting a cheaper (i.e. generic) benzodiazepine for now. You'd have to pay out-of-pocket for a doctor to write the prescription, but 100 tablets of 10mg generic Valium (diazepam) are available for under $20.
posted by jingzuo at 4:31 PM on December 7, 2009


Docs is pretty good with the sliding scale if you are broke (or even if you can afford the price but can't find a doctor who doesn't take insurance). However, given your medical condition, it might be best to find a sliding scale psychiatrist or even see if your therapist can work something out or recommend you- I'm not sure if this is a case where PCP kind of doctor would prescribe you anyway.
posted by shownomercy at 4:33 PM on December 7, 2009


Two points, and the disclaimer that IANALawyer, Doctor, or Pharmacist.

First, the ARRA included some ungodly awesome COBRA premium adjustments - Basically you can keep COBRA for up to 36 months, and for the first 9 months (very likely to get extended in the next few weeks) your former employer covers 65% of it.

Second, and perhaps more useful, the drugs you mention have a lot of off-patent members of that class. Even if the particular ones you currently take don't have generics available, you can talk to your doctor to get switched to very similar drugs that will literally cost your $2-3 per month's supply (probably less even than your copay with insurance).

Fortunately, people tolerate most benzos comparably - You just adjust for onset and duration. Unfortunately, people tend to have much more unique responses to SSRIs, and it might take a few tries to find one that both works and doesn't give you some nasty side-effects.

Good luck.
posted by pla at 4:49 PM on December 7, 2009


Also, your former doctor might be willing to write an extension prescription for your meds that you currently have without charge. Can't hurt to ask, and will at least give you some more time to solve the problem.
posted by Vaike at 4:59 PM on December 7, 2009


A friend of mine has used the generic of Prozac - fluoxetine, I think? - and said that it was less than ten dollars US for a month's prescription and she didn't have health insurance so I believe that was the total price. So I don't know about the benzodiazepine, but maybe switch to a different and less expensive SSRI?
posted by XMLicious at 5:06 PM on December 7, 2009


This is not written explicitly (conveniently also not addressed yet), but having been in a similar situation, I am reading in between the lines that the issue here is the appointments and not the drug cost. In that case, bunnycup has part of it: push for longer times between appointments, and pay cash [maybe others will advise on cheaper upkeep of the prescription]. If you call now, perhaps you will get a refill if you promise to sort out future appointments with him or another office soon [ask to speak to the doctor].
posted by gensubuser at 5:08 PM on December 7, 2009


Call your doc. He or she may have samples on hand that you can go pick up and use while you're examining the other options folks in this thread have presented.
posted by fairytale of los angeles at 5:10 PM on December 7, 2009 [2 favorites]


Short term: I'll repeat what everyone else said and say to call your psychiatrist.

If he/she is not helpful, call your primary care doctor. I feel like there's this big myth that only mental health specialists can prescribe and administer SSRIs/benzos. I took an SSRI with an emergency side of Xanax for a couple months when I was suffering from anxiety; they were prescribed by my primary care doc and he gave me the first month or so in samples.

Your situation is not uncommon and a good doctor will be looking to help you get through the next few months with some of the workarounds described above.

Long term: I recommend this in like, every NY health insurance thread, but go check out HealthyNY. The basic idea is that every HMO operating in the state is required to offer an affordable plan offering comprehensive coverage for a variety of common and catastrophic health care needs. There are eligibility requirements, but it's usually way cheaper than COBRA.

It does not cover mental health services like psychiatrist appointments and medication, but it will ease your anxiety to have some type of coverage.
posted by lalex at 5:27 PM on December 7, 2009 [1 favorite]


My friend was in a similar situation in New York City.

Get thee to the Costco in Brooklyn. I had a card (membership) through my mom, and would help him this stuff. First of all, most SSRI's have a generic version that is extremely cheap. Make sure you get prescribed the size that is mass-produced. Prozac generic 20mg costs about 2c/pill at Costco, though if you get an odd size (like a 40mg) it will go up.

Benzo's, at least my friends, were also in generic form and extremely cheap. I believe it was something like 10 dollars/month for 2mg daily of ativan (whatever the generic one was).


If you don't have a Costco card, try another wholesale store like Walmart. They have similar deals: you can probably cost shop by cost.

As for the psychiatrist, perhaps since you have established a working situation with medication, and aren't changing/altering it, they would be willing to provide you with a longer term prescription?
posted by HabeasCorpus at 5:51 PM on December 7, 2009 [1 favorite]


Regarding Costco:

1) You don't need to be a member to use their pharmacy (at least this was the policy two years ago - call your local one to confirm.) Go to the front desk, tell them you are there to use the pharmacy only. They will take down your information and give you a pass which specifies that you're there to use the pharmacy.

2) You can also order from their online pharmacy, which has fairly good prices. You do not have to pay the 5% non-member surcharge for the online pharmacy as you do for the rest of the site. I'm not sure if you can order benzos by mail, though.
posted by needs more cowbell at 7:09 PM on December 7, 2009


Yeah, call your doctor's office and ask to speak to him or her. (the office-types will probably try to deflect you away if you try to get them to arrange it) Tell them your troubles (succinctly) and ask what they can do to help, or what they can recommend. Not sure if you are worried about the doctor's visit bill or the meds bill, but either way, they are probably more experienced at it than you are.

(And, this is the kind of thing that it probably IS a good idea to go into debt for. It's a known problem and a known solution that's been working. It seems like being in a little bit of debt after being out of work for a while is better than having to suffer being out of work and a return of depression. Probably wouldn't lead to getting a job any quicker, either.)

(And a few months of prescriptions will be wayyyy cheaper than an ER visit if you have some kind of discontinuation freak-out. It's unlikely, but not something I'd bet on.)
posted by gjc at 8:32 PM on December 7, 2009


In this order:

--Call your doctor and explain the situation. They can't call in prescriptions for benzos (well, they can kinda, but it's a huge pain in the ass), so offer to come to the office and pick up the prescription, or leave enough time for them to mail it to you.

--Pay cash, keep all receipts.

--COBRA, you need it. If you need more details let me or someone else here know and we can help. Your HR people are required to provide you information about COBRA, if they don't, ask them.

--IF YOU DO RUN OUT OF MEDS: when you still have one day's supply left, call your doctor again. There are emergency psychiatrists that you can call at Cornell Weill, I think, try to contact them instead of going to urgent care or walking into an ER. If you have to, walk into an ER. At Bellevue, you will be seen in the Pediatric ward, go straight there instead of waiting in the regular ER (a bit of a mess). Everyone there is very nice.
posted by kathrineg at 8:53 PM on December 7, 2009


BTW, I suggest Bellevue because they're nice and they're public and very good about working on payment arrangements.

You can always pay shrinks in cash but ask for a signifigant discount from their insurance prices. Your insurance, when you get COBRA, which you should, will reimburse your prescription/visit costs.

I have always been shocked at the kindness and generosity extended to me by the medical community here in NYC.

If you need further help, memail me. I've been in similar situations.

I am not a doctor or a pharmacist or anything else.

Good luck.
posted by kathrineg at 8:57 PM on December 7, 2009


You probably qualify for Medicaid, and possibly "Emergency Medicaid", which will cover you first and hash out the details later.

http://www.nyc.gov/html/hra/html/directory/public_health.shtml
http://www.health.state.ny.us/health_care/medicaid/

Even if you don't look like you qualify based on the tables on the page, go anyway. They do these things on a case-by-case basis, and your expected medical costs do factor in. If you don't understand what they're talking about, go anyway. Explain what your situation is (which is what they expect), and they'll see what they can do for you.

You may be asked to show up to multiple appointments at different offices. But, at the end, there's a good likelihood that they'll cover your medical, at least for a short period of time.

Good luck!
posted by Citrus at 10:03 AM on December 8, 2009


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