the joys of expensive prescriptions

15Jul15

If you’re on MS medications, you know that they’re expensive as all get-out. Most of us are lucky enough to have some sort of coverage, or patient financial assistance program… much needed, because without either of these, many medications would run upwards of $3000-4000 every month. (And I know that MS isn’t the only disease with expensive treatment… but I’m talking about what I know.)

I learned all about this first-hand recently…

Apparently, when I switched everything over from my own insurance to my work plan in late 2013 (and thus canceled my own plan), and I was told all of my meds would be shifted over, my MS drug (Rebif at the time) was not moved to this new coverage. Much to my surprise, at the end of last year (when they were doing year-end audits), I got a letter from Old Insurance telling me I owed them for roughly 1 1/2 months of Rebif–or, almost $7000.

OK. Right. So, with new insurance, there’s a crapload of paperwork to fill out, though they think coverage won’t be a problem (as they said earlier this year). I filled it out, with a little extra effort and phone calls because this is a medication delivered from a specialty pharmacy in Portland–I can only get it through the mail. In other words, I couldn’t just go down to my local Walgreen’s and get a copy of the receipt.

Paperwork sent in, all is hunky-dorey, right?

(And… yes, this all came up during 10th week of spring quarter, when I was ready to be DONE with everything.)

Surprise, collections notice from Old Insurance. So… what? New Insurance never paid up? I sent them the form back in March, I never heard anything else… silly me for thinking that meant everything was going to work out. No news is bad news, in this case.

I called New Insurance, irate. (I had 30 days to deal with this, per Old Insurance and Collections.) I told my story to I-don’t-know-how-many people. The customer service folks seemed sympathetic, but their hands were tied–it was a Claims issue. Their Claims department had had my paperwork for nearly 3 months and had done NOTHING with it.

You will likely not be surprised to hear that I was emailing or calling New Insurance almost every day to harass the Claims department–and yes, they flagged it as a Collections case. But weeks went by.

Finally, after 3 weeks (of the four before my Collections case escalated), New Insurance issued me checks. But–they wouldn’t arrive for two weeks.

(Luckily, I was able to talk to the Collections folks–telling my story to yet again someone else–and get that all worked out, so I won’t have this on my record.)

And the case is now resolved….

But it really makes me not want to deal with expensive medications… y’know?

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4 Responses to “the joys of expensive prescriptions”

  1. Oh, my gosh! I’m so glad you were able to get it all worked out! My anti-seizure meds are outrageously expensive, too. I keep saying to Steven, “What do people do without insurance???” Couple thousand dollars a month? And not to mention all the doctors’ appointments and the hospital stay/surgery. Our insurance at work switched administrators on July 1st. I had an MRI on July 1st. Apparently, they had a “glitch” in the system and they weren’t authorizing anything – lots of people affected, obviously. We had to pay out-of-pocket (credit card) and we’re being reimbursed when they get the paperwork…I think it’s $1500 just for that one procedure. I can’t imagine…Oy! Hope all goes well with your situation! 🙂

    • I know, right? I’ve heard of some MS patients who just forego drugs because of the cost.

      I actually go out of my way a little to another facility (hospital) when I need my brain/c-spine MRIs to check up on my MS, since it’s cheaper (Providence in Everett, for those in the Seattle area!). I do have pretty good coverage, but I still pay a small percentage… and I have 4 total scans (two regions, one with contrast dye and one without). I had it initially done at the same place where my first MS specialist practiced–a Seattle hospital–and their staff was great, but it was about twice the price. I think even *my* part was over $1000! Meaning, the full price was nearly $20,000!!!

      (Granted, I need higher detail to catch any new potential damage, so I have high-res MRIs–that’s why the higher price)

      During these “glitches”–assuming the reimbursement works–I pay with my credit card that gives me double miles… so at least I can use it all for travel! 😀

  2. Its all so different in the uk, i was on rebuff for 6 months but couldn’t shake the side effects so stopped. I still have the unit. since being diagnosed with ms it has opened my eyes to the business side of being ill. good luck with all your meds in the future. #msfamily

    • It is eye-opening, isn’t it? It’s horrific how much they charge for these medications. Where does it all go? (Now you’re making me wonder where I put that crazy autoinjector that I no longer use… must be in a closet somewhere…)


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