Lost in the medical-insurance maze

February 1, 2015

Be warned, gentle readers. I’m back on my soapbox. If you don’t want to hear about my medical-insurance problems, you may want to stop reading right now!

I have heard medical-insurance horror stories from my friends for the past couple of decades, and in recent years, the stories have gotten worse. Some are paying now much higher premiums for medical insurance this year than in previous years, while others search for alternatives to higher-cost plans. Still others have lost their medical insurance and have little choice but to sign up for plans with higher deductibles and reduced benefits. I have now joined this party.

My problem concerns my access to and the price of a medication that I have taken for a number of years. As you may know, I was diagnosed with multiple sclerosis more than 15 years ago. For the past few years, I have taken this expensive medication because it helps me walk better. It is a relatively new drug, so it’s not available in generic form. It’s the only FDA-approved drug that helps people with MS walk better. My choices are quite limited.

Last year, after I exceeded the annual amount that my private medical insurance plan pays for prescriptions, I enrolled in an additional plan — a Medicare Part D plan that came with an additional monthly premium. Yet, the monthly cost for this prescription has climbed from $40 to about $630 a month. And that’s after my insurance pays!

Let me repeat this, because it clearly defies logic: I have more insurance this year than I did last year. I am paying a higher monthly premium than last year. And yet, I am being asked to pay almost $600 more each month to buy the same drug I bought last year.

Needless to say, I cannot afford to buy the drug at this price. After I did a little research into this problem, I found out that the price of the drug changed because my insurance changed. Specifically, the price changed because this new Medicare prescription insurance is now my primary insurance. My private insurance, which had been primary, is now secondary to Medicare. So now, I am no longer eligible for the drug company’s “co-pay assistance program,” which had allowed me to buy the drug for $40 a month.

Going forward, I continue to work with the company that makes the drug so see if there is some other way to reduce the price of the drug. On Tuesday, my case manager suggested I apply for the company’s “prescription assistance program,” which may further reduce the cost of the medication, should I qualify. She told me that the company would send me an application form for the program. Five days later, I am still waiting on that form.

But that’s not all. I ran out of the drug about three weeks ago, and with each day that passes, my ability to walk declines. As a result, I have tried to minimize my walking by curtailing my activities. I already walked with a cane, but now I am even more unsteady on my feet. I stumble often, and if I fall, I could break a bone.

Based on my recent experience with this company, I estimate that I will probably have to go without the drug for a few more weeks. It may be time to bring in the walker from the garage and dust it off.

This isn’t rocket science. This drug company, and probably many others like it, is obviously struggling to serve its customers in a timely manner during this upheaval in the medical-insurance business.

Here’s an idea. Maybe the company could hire an additional staff member or two on a temporary basis to provide more timely service to customers. Just sayin’.

Gentle readers, take note. I will be back in touch as soon as I have more to report.  Wish me luck!




5 Responses to “Lost in the medical-insurance maze”

  1. Jan Jenner Says:

    Hi Jane,
    This is horrid news. I so hope that the manufacturer will help you get the medicine more cheaply — and that they’ll do it quickly.

    Stay strong,




  2. Sherry Whisenhunt Says:

    So sorry! I never applied for that one because I was afraid the insurance would reject it since I already have one that is $5000 per month and a few others. I didn’t try when I was driving because of the risk of seizures, but now, I just figured they refuse it. Sorry you’re having to deal with this.

    Sent from my iPad



  3. Judy Says:

    I know many people, myself included, who are trying to stay healthy and dealing with trying to get the medications they need at an affordable price. I’m thinking of you and wish you the best. Hang in there.


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