I am going to be losing my Tenncare (Tennessee's state Medicaid) September
29th. I am on Medicare also, so the Tenncare only paid what Medicare
didn't, and I have the Medicare part D. I will be getting put on my
husband's insurance at work, and they are going to be the secondary like
Tenncare was. The only problems are that when I was on my Part D, my
scripts only cost me anywhere from $4-$1. Now I am going lose that because
of my husband's insurance has prescription coverage, and even if I only use
that when I get into that donut hole where they won't pay for anything, I
cannot keep both and WILL lose the Part D and have to use the other. I am
on a lot of meds. Most of which are for severe chronic pain and cannot just
be "stopped". I would end up either in the hospital or dead if I tried.

The cost for scripts with them is anywhere from $10 for their preferred list
generics, to $50 or more for their preferred list brand names. If it's not
on their "list", it's not covered. I have found at least 2 meds I am on now
that aren't on the list at all, and one that is only brand name. I was
wondering if anyone knows anything about this insurance game and could
perhaps give me some advice on some things. Like what if I have been on a
medicine for years, and it's one of those that I cannot just "stop taking",
will they cover it? Is there any extra help available for people that have
private script coverage that the co-pay is so high they cannot afford it? I
can't afford to pay well over $250-$300 per month for my scripts.

Yes, I do realize that's pretty good compared to most other folks, I
understand alot of people don't even have insurance. But losing the
Tenncare pretty much wiped us out. Not only will this mean more money out
of hubby's check to pay for me on his insurance, my co-pays are going to go
way up. We have NO extra money to start with, so this is an issue of either
going without something for the month to pay for my meds, or getting off all
the meds and finding another way to deal with the pain. I have filed an
appeal to losing Tenncare and have lost it. Tenncare is very strict in who
they cover...you have to be either pregnant or a child. And then they don't
cover much.

So if anyone has any ideas on how I could get some help paying the co-pays,
or a way to discuss this with my PM (pain management) doc, I would really
appreciate it.

(PS..I have no idea what the issue is with the formatting on this post, sorry)

Thanks,
Robin

I do not know the fine print for your d/h's coverage, but I can share our general experience.
Some insurance carriers have a list of covered meds, which are their 'preferred' scripts. For example, someone could be on a stomach med, which we'll call "A" for years. The insurance company wants you to take "B" instead, because it is cheaper. Some will require evidence that you have tried "B" before they will cover "A".
I have found if our doctor writes a note, specifically stating that 'patient is not a candidate for medication "A", and must remain on medication "B", which has been proven successful in this patient', they will cover it.
I would call your doctor's office and ask about their experience with this provider. Good luck.

Yea the "step-down" thing. Tenncare has it too. I belieive it was an issue with an antibiotic once that had me dealing with that. I will definitely ask my PM doc about it, and about their experience dealing with this insurance. I am hoping that if they do end up covering the meds, they aren't in the "$50 co-pay" category, but they probably will be. I am looking at all my meds and trying to decide if they are really needed and perhaps I could get off some of them, for now anyway until we get better situated finacially and can afford to pay so much a month.

Not to mention, this is bringing up major guilt for me. I am feeling that I am costing us money we cannot afford right now. If you've read my "Bankruptcy" thread, you know we are going through the same thing that pretty much the whole country is going through. So this couldn't have happened at a worse time for us. Just feels like everything is crashing down and I can't keep juggling all this stuff much longer.

Have you checked Walmart and Target's lists of $4.00 drugs to see if any of the ones you take are on either list?

Also - I believe most pharmaceutical companies have prescription assistance programs. It will take some leg work on your part to identify the drug manufacturer and locate the programs, but might be worth the effort. I don't have any personal experience with these programs, so don't know what the requirements are. Certainly worth checking out.

(I just googled Astra Zeneca assistance and the first site is their Patient Assistance Program...try that with the companies that manufacture your drugs)

In the interim - can any of your physicians provide you with drug samples to carry you over until you get all of this worked out?

Best of luck to you.
Sandy in DE

On the Walmart thing, yes I have checked their formulary (online at least) and all but my blood pressure med are not on the list. I knew about that from hubby. He gets his blood thinners from there. I haven't looked at Target as I had no idea they also offered this. I will check there.

I thought that the assistance things from drug makers were for folks that don't have any drug coverage at all? I tried that for my Kadian and they sent me a $50 coupon. But it's for if you pay the entire price of the drug, over $300!

I'm sure that my doctor will work with me as much as he can. They usually give me sample of the pain patches I use. They are a topical analgesic type patch that delivers novacain type med to the area. They can't give samples of narcotics, though. It's against the law. And those are the ones I am having problems getting right now, of course.

Thanks for the tips. I will check the manufacterer's websites and see what they have to offer. I plan on calling my doc later today and asking his advice, also. The insurance company I am going to won't tell me much as "I am not an enrollee yet" Geez.

Go talk to your pharmacist and have your list of drugs handy. Ask him/her if there are any drugs that are similar to the ones that you are on that your insurance would cover. Pharmaceutical companies can take a drug and add one tiny thing to it and boom, it's a new drug, making the old one not as in demand, and they charge a hefty price. The older drug is now not as new or cutting edge so sometimes the price will drop. Maybe your pharmacist can find something that would work and you can ask your doctor about it.

Also if you have a medication that is not covered on your insurance, call around to several and get prices. You'd be amazed at how much more some pharmacies charge and how few people shop around for drugs.

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I've had a Foreman Grill for about six years. I've done about 85% of my cooking on it, but I've never burnt myself. Probably because I don't use it as a pillow.

Thanks for the great advice. Never thought of doing that. Especially since my pain doctor has us sign a "contract" stating we won't go to other pharmacies than the one we list. I guess that keeps people from "pharmacy shopping" and getting their scripts filled more than once or something like that. I am sure, however, that he would let me do this if I call around first and give him a list of the ones I want to use and we choose one from that list. I just can't use like one pharmacy for one script and another for this one and one for that one, etc. Have to stick with just one.

I am thinking the step-down thing is going to be my best bet. Most of these meds I am on have been over several years of trial and error to find just the right mix of what works best for me and my pain. I really would hate to mess with that and if he can send them something saying this, I believe they would cover it. Just would probably cost me more, that's all. I guess you can't have your cake and eat it. I will just have to find the money somewhere. I am definately willing to lose my internet (only $25/month..special "package" deal with Comcast) and my cable TV (also only $25/month) My total bill for all 3 cable, phone, and internet is $75.94/month.

Check Costco's prices...you don't have to be a member to use their pharmacy.

Wow..I didn't even know they had a pharmacy. Thanks, I will look into it.

Same with Sam's Club.

And is it even legal for the doctor to require you to use a certain pharmacy? Does he get kickbacks from them or something?

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I've had a Foreman Grill for about six years. I've done about 85% of my cooking on it, but I've never burnt myself. Probably because I don't use it as a pillow.

No they aren't saying we can only use a pharmacy they specify. They are saying we can choose, but we can only go to that pharmacy for the scripts they write to be filled. In other words, we can't go to one pharm one month and another the next, etc.

Okay, I see what you are saying now. You can change your pharmacy if you want to, but not constantly. I guess it is valid so the pharmacist will know all of the drugs a person is on to monitor for drug reactions and makes it easier to watch for prescription drug abuse.

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I've had a Foreman Grill for about six years. I've done about 85% of my cooking on it, but I've never burnt myself. Probably because I don't use it as a pillow.