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Stupid insurance...

Do you have it and does it cover your needs?

by Spm24 » Sat Sep 23, 2017 10:38 am

I got a letter from my insurance company stating this was a one time approval for my med. Yet this is the not the first time I have gotten it. Whatever. This is the med I was going to ask to be taken off of anyways. But seriously why did they decide at this point to say they will no longer pay for it. Granted this is a hell of an expensive drug...just annoying. Why wait till my third refill to do this. Yeah whatever..I'm over the stupidity...
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by Duckysmom » Sat Sep 23, 2017 11:22 am

Which med is it? I know you are transitioning to another pdoc, but can your GP write a letter on your behalf. My insurance would not cover my Rexulti and it was $1100! My pdoc fought the insurance and the drug company offered me assistance as well. If you need the assistance asap, the drug company might help with discounts, etc. My insurance gave in and approved me for one year, so this November my pdoc has to go at them again.
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by Mocha » Sat Sep 23, 2017 11:55 am

I'm with Ducky.....which med is it, and why did you want to dc it?

Also if you don't mind me asking, what kind of ins. do you have?

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by Spm24 » Sat Sep 23, 2017 11:58 am

It is my Latuda... $5000 a pop... A bit much to me..they gave me a list of alternatives....I have ninety day supply so I do have sometime....I don't think there is fight from my pdoc.. not sure if my GP would know anything about it to fight for it...

I want to DC it because it has messed with my appetite...

I have Aetna..through Tracy.....
Snowflakes gently floating from the sky just dusting the ground. Then it picks up bigger fatter flakes cascading from space at a faster rate. From a dusting to a trace. Then the deluge comes. Oh what joy. Watching everything slow to a crawl, then a stop. Step outside and even with things moving it is quiet. It is a giant muffler the earth is wearing. Causing everything to be muted.To be calm.
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by Mocha » Sat Sep 23, 2017 12:22 pm


You still have the same pdoc, right? And ninety days would give you time to find a new one? But of course you would want to get started on that asap. Any leads yet?

I know you're taking Lamictal, so maybe there's another mood stabilizer that would work for you besides an AP like Latuda. Why did pdoc start you on Latuda to begin with? To treat what symptoms?

About the pricey Latuda.....I'm thinking Tracy's ins just decided it just cost too much to cover so they took it out of their formulary, and obviously it's still under patent. Won't go generic in the US until sometime in 2018, not exactly sure when. It is generic in several countries overseas.

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by Spm24 » Sat Sep 23, 2017 12:36 pm

Still have the same pdoc. Ninety days should give e me time to find a new one. That's my chore for this upcoming week. To check reviews and then make some calls on availability. I take Lamictal, Latuda and Lithium.

I believe the Latuda was added for psychosis..hearing and seeing things..that of course were not there. I believe there are other meds out there that can treat that.

Yeah I am sure that's why they took it out of their drug regiment that they pay for...
Snowflakes gently floating from the sky just dusting the ground. Then it picks up bigger fatter flakes cascading from space at a faster rate. From a dusting to a trace. Then the deluge comes. Oh what joy. Watching everything slow to a crawl, then a stop. Step outside and even with things moving it is quiet. It is a giant muffler the earth is wearing. Causing everything to be muted.To be calm.
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by AvantGarde » Sat Sep 23, 2017 9:33 pm

I honestly can't get over how expensive meds are over there... It blows my mind. My Invega is 28€ and my Valproic Acid is 60cents.
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by Mocha » Sun Sep 24, 2017 12:26 am

AvantGarde wrote:I honestly can't get over how expensive meds are over there... It blows my mind. My Invega is 28€ and my Valproic Acid is 60cents.


Supposedly it's because it's because (so Big Pharma says...:roll:) it's to cover the cost of research, develop and bring a drug to market, and make a profit so they can continue to research new meds. There are no regulations so they can do and charge whatever they want. Then there are the patents which could go on for years, before the meds could ever go generic.

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by AvantGarde » Sun Sep 24, 2017 12:44 am

It's really "what they say" situation. We have the same here, even national pharmaceutical companies and the EU research thingy, and the price ranges are the same. Newer, not yet generic, meds like Invega for example, cost a bit more but as you can see just 25/30 euros more.

Usually pdocs that are under pharma's payroll prescribe them the most, my pharmacist told me Invega it's the top sold antipsychotic near the mental hospital because of the marketing campaign they did and the docs that prescribe them having the larger number of psychotic patients, despite it not even being the best antipsychotic for all cases.

In my situation, they put me on the shot without even checking if I could tolerate the med, not even Risperdal.

Edit: I live in a semi socialist country so the State pays for about 90% of the cost, making Invega here about 280€ really, a fraction of what the med costs over there.
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by Spm24 » Sun Sep 24, 2017 5:47 am

Capitalism is nice when it works. But when it is manipulated like it is by big pharm it is deadly for many. But insurance can be just as manipulative taking in payments for years and when you need it they can deny you just because they want to.

I love my country but hate it at the same time....
Snowflakes gently floating from the sky just dusting the ground. Then it picks up bigger fatter flakes cascading from space at a faster rate. From a dusting to a trace. Then the deluge comes. Oh what joy. Watching everything slow to a crawl, then a stop. Step outside and even with things moving it is quiet. It is a giant muffler the earth is wearing. Causing everything to be muted.To be calm.
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by AvantGarde » Sun Sep 24, 2017 6:13 am

Guys like Hayek ruined capitalism for the rest of us commoners. :)

I get that, sometimes it's enfuriating to see how much you guys suffer with insurance companies, healthcare in general (when it's bad of course) and lack of resources in remote areas.

My country is really corrupt (they don't even deny that there are "secret" societies running the place, it's on the news even) and severely lacks in employment and money to the peoples, but at least we have medium to good healthcare and inexpensive. The biggest problems are on big cities and lack of infrastructures to accomodate people especially in oncology and mental health, it would be resolved by decentralization but they don't want to change that, too much of a hassle I suppose. But going private is not expensive either. Most people use both, like me.

And in no way insurance companies have that much power here. Most people have health insurance just in case something awful happens and we really need some private especialist. I've been using it more lately because I found a cheap and great private clinic here.
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by Spm24 » Sun Sep 24, 2017 6:34 am

Yeah luckily I'm not remote so I have some access to mental health care. Not nearly as much as is needed. But its better than none. Just hard to find good and accessible care.

Yeah our government is corrupt. Both sides are. People are just in denial. Everyone seems to be in bed with someone else. Everyone denies it. We would have to revamp our whole system to correct it..

General health care as long as you have decent insurance is affordable. Oh yeah you need to be semi healthy.

Lack of employment and wages is never a good thing.. makes it hard to afford things and live comfortably.
Snowflakes gently floating from the sky just dusting the ground. Then it picks up bigger fatter flakes cascading from space at a faster rate. From a dusting to a trace. Then the deluge comes. Oh what joy. Watching everything slow to a crawl, then a stop. Step outside and even with things moving it is quiet. It is a giant muffler the earth is wearing. Causing everything to be muted.To be calm.
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by AvantGarde » Sun Sep 24, 2017 6:41 am

Yeah, but if you live outside of Lisbon life is pretty comfortable and cheap, usually better wages too.

I'm thinking of moving to another city/town when I can, somewhere close. It's basically what everyone else my age is doing, or moving to another country which I don't want to do.

A friend of mine just rented a 3 bedroom house for 500€/month on a nearby town, with a garden, porch and sunroom, my apartment is less than a third of the space, 2 bedrooms, 600€ and comparing to the prices they're asking now (e.g. 1000€ for 1 bedroom) it's very cheap.
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by Spm24 » Sun Sep 24, 2017 6:52 am

Sometimes a move is for the best when prices for things are so much higher in a big city. It is the same around here. Big city everything is expensive compared to smaller towns. That varies from state to state. Some places the cost of living is significantly lower or higher then others.

A house is a lot more spacious then an apartment. And that is a heck of a difference in price. Yes very cheap...

Only drawback for moving might be losing the convenience of having so much amenities close by. Within walking distance..
Snowflakes gently floating from the sky just dusting the ground. Then it picks up bigger fatter flakes cascading from space at a faster rate. From a dusting to a trace. Then the deluge comes. Oh what joy. Watching everything slow to a crawl, then a stop. Step outside and even with things moving it is quiet. It is a giant muffler the earth is wearing. Causing everything to be muted.To be calm.
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by AvantGarde » Sun Sep 24, 2017 7:04 am

Depends if I find something cheap in this neighbourhood or not.

I talked to my mom a few weeks back about the future (again) and things in the media seem better but they're really not, it will take a while for things to get close to what they were before, a decade maybe a bit more. Working hours are still crazy and with my mental health, the way things have been until now, I really can't afford to go nuts again.
We talked about keeping it smooth for me, we've got a good thing going with the Airbnb apartment, which is a lot of work and she's not sure she will be able to handle it in the future, with her health and whatnot. So, for now, and as long as I'll be going back to college and finish it and stuff, things stay the way they are. In the future we'll see.
Also depends on the quality of her health. If her health deteriorates a lot, I can't in good conscience just leave you know?
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by Spm24 » Sun Sep 24, 2017 7:15 am

Yeah it takes awhile to come back in a comfortable time when you have a major economic setback.

I don't think any of us can afford to go nuts. Wait... We're already nuts :roll: :lol:

Keeping your good thing going right now is a very good thing. Gives you stability in your life.

Yeah I could not leave in good conscience if my parents were sick.. hell if my in-laws got sick and the other was dead I am sure we would take care of them as long as we could. So yeah I know
Snowflakes gently floating from the sky just dusting the ground. Then it picks up bigger fatter flakes cascading from space at a faster rate. From a dusting to a trace. Then the deluge comes. Oh what joy. Watching everything slow to a crawl, then a stop. Step outside and even with things moving it is quiet. It is a giant muffler the earth is wearing. Causing everything to be muted.To be calm.
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