My girlfriend's insurance ended, how to get psych meds?
April 15, 2014 11:50 AM   Subscribe

My girlfriend just recently found out that she was dropped from her insurance. She signed up for an ACA plan, but coverage doesn't begin until the first day of May. This is a problem, because she's on several psychiatric medications that are either pivotal in allowing her to function, have terrible withdrawal symptoms, or both.

My girlfriend was dropped from her insurance without warning, since her father removed her from his plan abruptly. These are the current medications she's taking:
  • Cymbalta (duloxetine), the generic formulation of which runs about $400 (since her 90mg dose requires buying a full bottle of both 30mg and 60mg sizes)
  • Abilify, which has no generic and runs about $900
  • Trazodone, which is actually in the realm of affordability and less of an issue
The Cymbalta especially is a problem here, since it's both very important for her overall mood and has a brutal withdrawal. She's called her psychiatrist to ask for advice, but assuming that the (admittedly notoriously shitty and inept) administrative staff were correct in telling her that they have no samples for her meds on hand, and that the psychiatrist doesn't have any better suggestions when she calls back, what the hell do we do for these two weeks? We can technically afford this if we pool our resources, but we have some expenses coming up that we then won't be able to pay for, and my girlfriend is of the opinion that she'd rather endure the two weeks without medicine than endure the fallout that would result from us not paying those later bills. So, my question is basically: is there any way we can get a temporary supply of these meds at a reduced cost?

As a side question, she's had three separate doctor visits over the past few weeks where the attendant took her insurance card, ran it, and then didn't tell her that it had expired. She's probably going to get hit with the full cost of those visits, but is there any recourse for disputing those charges based on what seems like egregious negligence on the part of the staff?
posted by Two Stranger to Health & Fitness (23 answers total) 4 users marked this as a favorite
sent you me-mail.
posted by theora55 at 11:55 AM on April 15, 2014

Can she get info from her father about COBRA? That can cover her retroactively for all of April.
posted by the young rope-rider at 12:03 PM on April 15, 2014 [4 favorites]

Also, if her father isn't cooperative, she's entitled to get the information from his employer.
posted by the young rope-rider at 12:10 PM on April 15, 2014 [3 favorites]

Best answer: Their are patient cost assistance programs put in place by the pharmaceutical companies:



As noted, Trazadone is $7.00, so you should be able to cover that.
posted by Ruthless Bunny at 12:11 PM on April 15, 2014 [1 favorite]

Best answer: You should shop around at different pharmacies, especially for generics. In particular, check with Costco, Target, and Walmart. You can also check out the website GoodRx. It should allow you to compare prices and may show available discounts for these meds.

Also, I would visit the drug manufacturer's website, especially for Abilify since it doesn't have a generic, and I believe it's one of those drugs that they're pushing really hard (or at least they were relatively recently). They often will have coupons or some kind of prescription discount, especially for low income/no insurance patients.

(I recently had an issue where my insurance wouldn't cover a medication which didn't have a generic, and I was able to get a free 30 day supply by just filling out a form on the manufacturer's website. It wasn't any of these three medications, but it's still something to keep in mind.)
posted by litera scripta manet at 12:11 PM on April 15, 2014

Hi, I was without insurance and needed psych meds. If you are located in Los Angeles, there is a place called Exodus near USC hospital that will see your girlfriend for free. They are contracted with a pharmacy down the street to dispense medication free of charge as well. The only downside is the wait. Be prepared to wait all day. I only found out about this place during a psych breakdown at an ER hospital. If you don't live in LA, perhaps you can call your local hospital for a referral?
posted by squirtle at 12:32 PM on April 15, 2014 [1 favorite]

is there any recourse for disputing those charges based on what seems like egregious negligence on the part of the staff?

Probably not. Health care providers frequently don't actually ping insurance companies until the bill is sent out. It's pretty standard practice.

You can almost certainly negotiate providers about visits and appointments. Negotiating about drugs is a lot harder.
posted by valkyryn at 12:42 PM on April 15, 2014 [2 favorites]

It's possible their system showed the insurance as valid when/if they ran it. Insurance coverage is frequently cancelled retroactively. I would try to pursue COBRA coverage with the father's plan (you could call the insurere directly if you don't want to deal with him); you might also call the federal or state exchange you used to gain ACA coverage to see if they can help with gap coverage or help with the outstanding bills. I only mention it because I was asked once on a call, did I need help with previous medical bills, so it must be something they can offer in certain situations.
posted by ThePinkSuperhero at 12:55 PM on April 15, 2014

If she has a good relationship with her psychiatrist, she could always explain the financial situation and ask if he knows any psychiatrists that might be willing to give her a sample if he vouches for her... No idea if this would work though.
posted by matildatakesovertheworld at 1:10 PM on April 15, 2014

Cymbalta is part of a group of meds called SSRIs. There are dirt cheap SSRIs that act as great substitutes for any interim period.

I'm not saying it's ideal, but it isn't comparable to a withdrawal. She literally wouldn't withdraw. Prozac (flueoxtone) (sp) is one of those medicines. It's like $10-20 a month without insurance, and Is a robust and potent substitute.

This is something her doctor could tell her over the phone. I do not know as much on abilify.
posted by jjmoney at 1:20 PM on April 15, 2014 [1 favorite]

Here is the list of Target's $4 generics (for future reference for anyone else who might find this thread). Unfortunately, I only see the Trazodone. But really, for two weeks, with any luck at all she can find a doctor or clinic which is loose with samples (a friend goes to a migraine specialist who let her know she is rolling in comp'ed blister packs of Topomax for exactly these situations, for example, and you might try calling 211 or whatever your equivalent is to see if you have a community mental health center that can assist).
posted by blue suede stockings at 1:20 PM on April 15, 2014

Will her doctor write a slightly different prescription? Playing around with litera scripta manet's link, I see 60 tablets of 30mg duloxetine for $167 with the coupon. That would get her through two weeks of taking three a day.
posted by teremala at 1:27 PM on April 15, 2014

Response by poster: Just to clarify some things: I may be mistaken, but I don't think COBRA is a possibility, since her father's plan isn't COBRA-qualifying (it's an individual plan, not a group plan).

jjmoney: "Cymbalta is part of a group of meds called SSRIs. There are dirt cheap SSRIs that act as great substitutes for any interim period.

I'm not saying it's ideal, but it isn't comparable to a withdrawal. She literally wouldn't withdraw. Prozac (flueoxtone) (sp) is one of those medicines. It's like $10-20 a month without insurance, and Is a robust and potent substitute.

I am not trying to instigate a fight in my own question, but I want to note for posterity that this is dangerous nonsense. Cymbalta is an SNRI, not an SSRI, and while they are roughly similar in function you absolutely cannot depend on one being a useful substitute for the other in this regard since withdrawal symptoms are not only a function of their serotonergic effects.

Otherwise, thank you for the suggestions so far.
posted by Two Stranger at 1:35 PM on April 15, 2014 [8 favorites]

Coming in here to correct jjmoney:

Duloxetine (Cymbalta) is an selective serotonin and norepinephrine reuptake inhibitor (SNRI), not an SSRI (selective serotonin). These are considered two distinct drug classes, although what they technically bind to may overlap some. The SNRIs are a newer generation of medications with a generally smaller side-effect profile than fluoxetine/Prozac. Also, it is possible to have withdrawal symptoms when on SSRIs, including fluoxetine.

I would not recommend randomly trying new medication without professional assistance. I realize that jjmoney is trying to save you money, but some of what they've said is factually inaccurate and thus possibly harmful when you are talking about prescription medication. If your girlfriend wants a cheaper alternative, she should discuss that with her psych. In the meantime, getting a sample of fluoxetine? BAD IDEA.

That said, aside from wrestling with insurance like trying COBRA, I am seconding the advice to contact the manufacturers of Abilify (Otsuka America/Bristol Myers Squibb), to see if they have any assistance programs.

Good luck.
posted by the_wintry_mizzenmast at 1:51 PM on April 15, 2014 [3 favorites]

Are the prices you cite for a 2-week supply or a 1-month supply? If you can get her pdoc to write a separate 2-week script so you don't have to pay for a full month's worth out of pocket, that would certainly help. If her Abilify dose is a splittable multiple of the available presentations, she may also be able to save some money by having the pdoc write a script for half tabs so she would only need to buy 7 of those ridiculous motherfuckers and she could then split them to cover the 2 weeks.
posted by drlith at 1:56 PM on April 15, 2014 [1 favorite]

Best answer: There's unfortunately no recourse with the doctor's office. They always say that it's up to the patient to verify their insurance ahead of time. They don't "run" your insurance before the appointment unless it's something that requires prior authorization (usually that's only for certain procedures and such).

If the pdoc doesn't have samples, he might know another provider who does. Generally it's only the newer drugs that push samples.

That said, contact your dad's insurance (or his employer) and ask about COBRA. It will be pricey but maybe not insurmountable for a month.

I have heard good things about the assistance programs at the drug makers, that's a good route as well.
posted by radioamy at 3:40 PM on April 15, 2014

Also, good for you for helping your girlfriend. It can be really hard to manage these situations and get appropriate yourself when you have anxiety/depression/etc. and it is so helpful to have someone pushing back at the system with you!
posted by radioamy at 3:41 PM on April 15, 2014 [1 favorite]

Best answer: You would be amazed at the lengths to which pharma companies are willing to go in order to solidify a future paying relationship with a consumer in temporary financial trouble - as others have suggested, look into assistance programs offered directly by those companies - for them, offering some meds to bridge your partner is good PR, good karma, and a good investment.
posted by analog at 6:49 PM on April 15, 2014

Sure there's recourse at the doctor's office. Does she have supply on hand? How much? Is she married to her current drugs? Because if she has a week or more on hand and she's willing to switch drugs within the same class, her doctor can prescribe something cheaper and give advice on cutting over.
posted by crazycanuck at 9:06 PM on April 15, 2014

I had a similar situation a year and a bit ago. I googled something along the lines of "Washington prescription assistance" and found a state assistance program which enabled me to get my pills for a really quite reasonable price. I think Washington is probably an especially good place for that sort of thing, but there may be something in your state as well.
posted by Because at 1:08 AM on April 16, 2014

Best answer: since cymbalta is generic now pretty much no one will have samples anymore. you should likely be able to get samples of abilify from your pdoc or your gp (if she has one, she should call and ask, explain the situation, tell them the pdoc will send a script or call them or whatever...). they are still pushing abilify pretty damn hard because it is newish and expensive.

there's something here about a 30 day abilify trial. maybe that can help.
posted by misanthropicsarah at 7:20 AM on April 16, 2014

Response by poster: Thanks, everybody. It turns out that she's already used the 30 day Abilify trial once, and so won't be able to again, but I've marked those suggestions as best answers anyway since they will likely be relevant to anyone who reads this question later. She says that it's not a huge deal, since the Abilify is more of a second-line mood stabilizer and she didn't have much trouble when she went off of it previously. As for the Cymbalta, unfortunately the withdrawal kicks in quickly and extremely enough that the amount of time required to get Lilly to send a free batch will take too long, especially since it requires action on the part of her absentee psychiatrist. Instead we're going to use that GoodRX coupon* and eat the full cost of the generic duloxetine, which while not ideal is something we can manage. We're looking into seeing if the plan can help retroactively with these costs when it starts up, and I'll report here on whether that works out.

* It's worth noting that this would be written in past tense except for the fact that when we went to Walgreens this morning, the pharmacist dismissed the coupon out of hand, so I had to call GoodRX and they told me basically that they will call the pharmacy to remind them that they're contractually obligated to accept the coupon from me. Hopefully it works.
posted by Two Stranger at 11:43 AM on April 16, 2014

Call her previous insurance company with her and complain about being dropped without notice. That's illegal...and they are responsible for any say the following words:
Bad faith, damage that is irreparable, bad us before we have to get serious.

Good luck.
posted by OhSusannah at 10:31 PM on April 17, 2014

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