I Can't Afford My Meds

January 26, 2013 4:06 PM

NYS Health Insurance Filter: I live in New York state. I am between jobs. I just enrolled in Healthy NY because I can no longer afford my monthly COBRA payments through my former employer. The good news is that my monthly premium with my new insurance is reduced by 50% from what I was paying for COBRA. The bad news is, I just realized that in all likelihood none of the prescription medications I take regularly are covered by this plan. Please help me figure out what, if any, my options are at this point.

I have bipolar II. I was diagnosed six years ago, have been taking medication for it since, and have been managing just fine.

I just received my enrollment letter from Healthy NY and was filling out the mandatory HIPPA form when I thought I should go back to the website and double-check their pre-existing condition clause. But before I even got that far, I discovered this page on the benefit package, which somehow I completely missed when I was filling out the application for this program because apparently I am a HUGE FUCKING IDIOT. Here's the relevant part:

Because Healthy NY has a streamlined benefit package, certain services are not covered. Examples of these services include: Mental health services and prescription drugs relating to mental health conditions, including but not limited to treatment and medication for ADHD, depression and anxiety.

So basically I am fucked, right? Pretty much the only reason why I need health insurance is so that I can have prescription coverage for the three medications I take to keep my mental health under control. Now it looks like I won't have that coverage anymore. There's no way I can afford to pay out of pocket for this medication.

I have no idea what to do at this point. I'm really upset and scared and I'm sort of all over the place at the moment, so apologies for incoherence. I am going to call the insurance carrier on Monday morning just to clarify, but it hardly seems worthwhile since it says in plain letters on the Healthy NY website that prescriptions for mental health conditions are not covered, so I doubt that somehow they will magically have something different to tell me. I am still covered by my former employers' health insurance plan till the end of January, so I'm going to call my psychiatrist ASAP and ask him to call in new prescriptions for me before the end of the month.

Slight snowflake detail: while my bipolar II prescriptions have been covered thus far by my insurance coverage, I have been paying out-of-pocket to see my psychiatrist. I don't know if this actually has any bearing on anything I have mentioned thus far, but thought it would be worth mentioning.

After that wall of (con)text, here's my real question: what the hell does someone like me do in this situation? Even if I pull out of Healthy NY, I cannot afford to remain covered by my former employer, so no matter what I'm SOL when it comes to my prescriptions. I don't qualify for Medicare or for Family Health Plus (my UI payments put me beyond the maximum income eligibility for those programs). I turn 28 this year, so I'm long past the eligibility to go back on my parents' insurance plan. I don't have a partner who can put me on their insurance plan. I'm busting my ass to find a new job, but until that happens, here I am. Now I'm freaking out.

Is there something else I'm missing somehow? Or do I need to start selling my plasma to pay for my medication?

Needless to say if I go off my meds, I will not be able to function properly, which will make the already disheartening job hunt even more difficult. Not to mention the likelihood of me falling into a major depressive phase, which would be a nightmare. I cannot even begin to explain how scared I am right now. If it does turn out that I am as fucked as I think I am at this point, please be nice. I know I'm a moron for not noticing that my prescriptions wouldn't be covered by Healthy NY when it says right so on the website. I feel so fucking stupid. But as I said, it hardly matters when I am no longer able to afford COBRA, so no matter what I would be asking some version of this question at some point.

posted by thereemix to health & fitness (20 answers total)

I think calling your psychiatrist ASAP is a great idea, and in addition to making sure your prescriptions are refilled, he might be able to help out with samples or some other ideas to help extend your meds supply. He's the first person to ask for help on this.

Going forward from that, you might find some useful info at NeedyMeds -- there are patient assistance programs for a lot of drugs. Check on what paperwork is required before you call your doc, too, since his office may need to help you submit them.

Good luck, and try not to get so down on yourself about insurance issues -- they are complicated and awful.
posted by asperity at 4:13 PM on January 26

Talk to your psychiatrist about getting some samples, and seeing if there's any type of prescription discounting plan you can get into. My old shrink was very helpful with this sort of thing.
posted by sm1tten at 4:14 PM on January 26

It looks like there is a discount prescription card available to everyone in NY. Here is the information about applying. . Here is a second organization that can help you find prescription drug assistance.

I'm so sorry you're having to deal with this stress. All the best to you.
posted by goggie at 4:18 PM on January 26

Do you have any support groups available to you? I've found that my local bipolar/unipolar support group is full of people who've been through any insurance nightmare you can imagine, and know exactly where the free or cheap help is, and how to help you navigate it. Might be worth reaching out to a NAMI group or some similar resource. And definitely your psychiatrist too.
posted by Stacey at 4:49 PM on January 26

You mention parents. In New York, being unmarried (you mention no partner, don't know if that's no partner, or no partner with insurance) and under 29 can leave some eligibility to remain on a parent's plan.

http://www.dfs.ny.gov/insurance/health/S6030_Age29.htm

I think it's plan dependent, but it should definitely be your next step.
posted by mhz at 5:01 PM on January 26

I typically refer folks who can't afford their medications to a social worker, so that's another resource who might be able to help you.
posted by treehorn+bunny at 5:38 PM on January 26

Something I've been thinking about a lot with medications is the tricks that drug companies have been playing to keep meds patented and therefore expensive. A lot of times, a new "better" drug will come out which is only a minor reformulation of an existing drug. Do you really *need* that $3/pill time-release version or would the generic $.10/pill non-time release would work well enough? This is not a short-term solution to your problem, but if you are economically vulnerable to this happening again, it's something to think about.

Fucking with your meds on bipolar is probably going to be a careful dance and you know your tolerance better than me, but if you're on, say, lithobid instead of generic lithium, that's a change you might consider trying. If it doesn't work, well, now you know, but I suspect that only a small percentage of people actually *need* the fancy time release version.

Another option if you're on fancy newer meds is to get a month's worth of samples from your doctor. Would buy you some time to figure it out. Also, call healthy New York and ask if bipolar is specifically excluded, since it isn't mentioned by name.
posted by zug at 5:56 PM on January 26

ty;dl, but I take a very expensive medication and I called the manufacturer and they enrolled me in their assistance program. They didn't even ask about my income! So now I pay just $10/month as opposed to ten times that much or more.
posted by michellenoel at 6:15 PM on January 26 [2 favorites]

Just like michellenoel says, here is the page for Astrazenica to enroll in their assistance program. I hear it every time there is a drug commercial on TV: Can't afford your medications? Astrazenica can help.

I don't know which meds you take or if they are Astrazenica meds, but if not, the manufacturer may have a similar program.
posted by CathyG at 6:28 PM on January 26

I recently helped a patient reduce her monthly prescription bill from $1500 to $90. After a few hours on the phone and researching stuff online, I found that for whatever reason, Costco has absolutely ludicrously low pharmacy prices.

For example, lamictal / lamotrigine the difference was like $400-600 at her Walgreens/Target/Walmart for a 30 day supply .....vs $30 for a 90 day supply at Costco.

So once you are able to get a prescription, if it's not covered by your insurance (or even if it is) be sure you call around and make sure you're getting a good deal rather than just walking into your local pharmacy and assuming there's some kind of logic and consistency behind their pricing.
posted by hobo gitano de queretaro at 6:42 PM on January 26 [1 favorite]

Try going through a Canadian pharmacy, if you are in the United States. I'm in the process of finding one for myself because my crappy insurance makes me pay $10 per tablet for a life-saving medication whose generic doesn't work for me. According to the websites I've seen, the Canadian cost for my drug is something like 20% of what I would have to pay through insurance.
posted by corey flood at 6:55 PM on January 26

You may be able to get a primary care physician to prescribe the same medication to you and claim that it's for a non mental health related issue. Years ago I got Lexapro this way for "menstrual issues". If you have a primary care doctor you like and trust, call him or her up and make an appointment, then ask - you want to do this in person, not over the phone. And I'm going to nth talking to your shrink - this is a problem they come up against frequently, so s/he may already have a work around in place.
posted by mygothlaundry at 7:59 PM on January 26

I have worked with people before taking extremely expensive medications for issues like cancer. There are 3 places I would look for assistance.

1) The manufacturer of the meds would be a first start. Almost every company has some form of assistance program.

2) the needymeds website is good. Keep in mind that even if they show a program as closed, still contact them. The site is a directory and may not be up to date for current status.

3) Support groups for your particular conditions. If there are national or local organizations as support groups or advocacy groups, their web sites frequently have advice on getting meds at least with a discount.

BTW- I don't know if you are close enough to the border, but you could also check to see what your medications would cost if you were able to pick them up in Canada.
posted by slavlin at 8:54 PM on January 26

I live in NY, have bipolar II, and am taking three medications to treat it. I have no prescription coverage. Currently I am able to get generics of Lamictal and Prozac quite cheaply--about 4 bucks/30 pills at Target. My Wellbutrin generic is still somewhat ridiculously expensive but it's much more manageable than it once was. (It used to be almost $200, so Canada got my business then.) You don't say which drugs you take, but it may be worth it to find out if your pharmacy has cheaper generics for any of them before you take to panicking.

I have had some luck in the past with programs through the drug companies themselves. I was on an anti-psychotic that was $350 a month and I was getting it for $25 from the manufacturer.

Samples might get you through for awhile but you can't count on them. Lots of drug companies stop providing samples when their drug opens up for generic manufacture, so there can be a year lag time between your last free sample and the arrival of cheap generics.
posted by xyzzy at 9:12 PM on January 26

When I didn't have insurance, I was able to get my $300+ asthma drug for a much more affordable $60 from India through this pharmacy. It's technically illegal but unless you're abusing the drugs I think they generally turn a blind eye because this is America, what else are you gonna do?

I did try getting help through the manufacturer but you have to be pretty much destitute for them to help you, not merely someone who can't afford the drugs that keep them alive.
posted by Jess the Mess at 9:15 PM on January 26

I'm not sure what sort of payments you are looking at or what you do, but could you potentially look at other health insurance options such as the Freelancers Union in NY? They seem to cover a pretty broad range of disciplines/professions and perhaps that could be an option? It looks like one of their PPO plans is around $345 with prescription coverage if you are eligible....
posted by This_Will_Be_Good at 12:36 AM on January 27

A ton of good advice, still my 2 cents.

Approaching manufacturers is your best bet. Start it quickly because their processing time may vary. Meanwhile, if you can borrow money, give a shot at goodRx. My insurance plan is so lousy that the prices with goodRx are lot better than my prescription card's (but I can not use it because I have to meet the deductible).

A tip for future,
Always have an extra month supply of your meds anytime with you. I learned this really hard way. Now, I have convinced all my docs to write prescriptions in such a way that in an event, I may not be able to refill my meds for various reasons, I have meds with with me (at the same time, my meds are not for mental health or narcotic pain killers).
posted by zaxour at 3:39 AM on January 27

My anxiety meds would run $450 a month out of pocket, and I have no prescription coverage. I got enrolled in the drug company's prescription assistance program, and I'm set for free meds for a year. There's a income ceiling, but I'm well under it.
posted by nonasuch at 6:59 AM on January 27

In case anyone stumbles across this - I have applied to Patient Assistance Programs with the three pharmaceutical companies that make my medications. If all goes well with my applications (and I see no reason why it shouldn't given that I more than meet the [lack of] income requirements) I should be able to obtain two of my meds for free and one for about $30. I'll post another update here once I have confirmation that I've been properly enrolled just so future broke people with life-sustaining meds can have a resource.
posted by thereemix at 6:46 AM on March 15 [1 favorite]

Last update - been approved for all 3 PAPs for my meds! Yay! Affordable meds! Yay! Meds are in the mail on the way to me now. What a relief.

Thanks for your support and advice, everyone. :)
posted by thereemix at 2:51 PM on March 28 [3 favorites]