Medicare Question

[Guest guest]

To whomever has any info that can help me:

I started to recieve Medicare in September of this year for my

prescription plan. I dont' know the exact type of plan that I'm on,

but it's the one where I dont' have a yearly fee, no co-pay and my

meds are $2 generic and $5 brand. I don't even know if the donut

hole applies to me. But I will be getting some help with finding out

about all of that. If anyone has a great counselor or knows of

someone who can go over all of this with me, please let me know the

info.

Most importantly, Medicare has recently denied paying for one of my

most needed narcotic medications. I'm going to go pick it up

tommorrow from my pharmacy for over $600! That leaves with me $200

after my disability pay. But I just can't go off of this medication

and without it, I have to make numerous trips to the hospital or I

just want to die. There has to be justice out there to help with

this. I know pharmacy companies make so much money every month from

how expensive our meds are but $600?? I was told the drug is $45 per

pill! Yipes! What I need is to find a company or organization who

can help me appeal their decision and someone who can help me find a

source of extra money to help pay for this. Without this drug, I

will get worse and worse and with it, I can't pay the rest of my

bills with the little I have left over after paying for it.

I live in Alameda, California, which is in Alameda County. It

doesn't have to be smething in my county or my state but maybe in

the USA somewhere. So please, if anyone knows anything, even if I

have to get help from a lawyer, please let me know. Any information

is helpful or your story of what you did to fix a similiar problem.

Thank you!

Whitney

[Guest guest]

Whitney,

There are many varieties of prescription plans for the Medicare, it seems that

you have run into a problem with the particular plan you are on not covering

that certain medication. There are a few things you could try:

1. Talk to your prescription plan provider about similiar medications to the one

you are currently taking which they do cover the cost for and then talk to your

doctor about changing to one of the covered meds.

2. Find out about switching to a different prescription plan that does cover

that medication. This is allowed once without penalty. Be sure to evaluate

thoroughly the prescription plans offered for your area including such things as

a) what pharmacies they work with, meds that are and are not covered, any

changes in plan costs to you,and if the the " doughnut hole " would apply if you

switched?

3. Find out what company manufactures the drug and contact the company to enroll

in patient prescription assistance for that particular medication.

These are just a few ideas, there may be more that I don't even know about. The

trick with these prescription plans is that even with the extra assistance there

are certain medications on each plan which that prescription plan company will

not cover. These are not the same for every plan either so the plan needs to be

investigated concerning what meds you are on according to what the particular

plan covers. Two similiar plans may not cover the same meds. Even if you can't

find one that covers all of your meds, finding a plan that covers the meds with

the greater cost to you and then you would be responsible for the lower costing

meds would be of much greater benefit than either suffering financially or

physically due to one medication.

Hope this helps somewhat.

M. Okan

[Guest guest]

Hi Whitney,

I'm just going to through out a lot of suggestions here in hopes that

some will help

I don't know much about Medicare myself, but have to learn by

March ;( I have seen that your pharmacist can help explain your

drug plan and make suggestions.

Instead of getting the entire $600 supply, you can get a partial

supply ... in hopes of finding a solution soon and saving you a

little money. Catholic Charities offers prescription assistance, you

can call them. The company that makes drugs often has a program to

assist those who can not afford them ... another avenue you might

try. You can also ask your doctor if there is an alternative that

might be covered by Medicare. You can call Medicare and ask them the

same question ... what alternative would be covered. I don't know if

Medicare works like private insurance, but they often require an

authorization ... meaning my doctor has to write a letter to the

insurance company saying I need that particular drug, then they do

cover it. During this time is when I often purchase a weeks supply

myself or get samples from my doctor if available.

I hope some of this helps and I hope it all works out for you soon

Ramona

>

> To whomever has any info that can help me:

>

> I started to recieve Medicare in September of this year for my

> prescription plan. I dont' know the exact type of plan that I'm on,

> but it's the one where I dont' have a yearly fee, no co-pay and my

> meds are $2 generic and $5 brand.

[Guest guest]

If you have a Senior Services Center in your town... they can also help you with

all your medicare questions.. and help you get signed up for a prescription plan

if you don't have one. .. Prescription plans are totally seperate from

medicare... and usually have deductables... but medicare will usually pays those

for you.

Hope this helps a little.

Vickie

[Guest guest]

Thanks but unfortunately I did end up spending over $600. It's for Actiq.

The reason I'm being denied is because the drug is originally prescribed for

cancer patients. I explained to Medicare how much pain I'm in and that this

drug is also prescribed for my migraines as well. They say it doesn't

matter. So now I'm looking into pain patient support people who can help me

fight this battle. This is just ridiculous! I can't take the patch, as it

makes me too nauseous, so the lollipop version works better. It's either

that or make numerous trips per month to the ER for morphine! I'd much

rather stay at home in my own bed. So this is very frustrating and I'm

coming up on almost being out. I don't know what I'm going to do. The Actiq

assistance program only helps my doctor write a letter pleading with

Medicare to pay for the drug and they are denying it because 'i don't have

cancer'. I say, well, gees! This is what pisses me off abotu our healthcare

system. None of the drugs I'm on are prescribed for the condiitons that i

have!!! Can't they see that Actiq should be prescribed for people in severe

chronic pain and if you get your triplicate prescription, it should be

allowed. And I've been too sick or too much pain and fatigue rather to

actively hunt for someone to help me with this. I really need to find an

advocate. Does anyone know of where I can look for an advocate to work with

me here in California? I can't do this myself. It's way too exhausting.

Whitney

>

> Hi Whitney,

>

> I'm just going to through out a lot of suggestions here in hopes that

> some will help

> I don't know much about Medicare myself, but have to learn by

> March ;( I have seen that your pharmacist can help explain your

> drug plan and make suggestions.

[Guest guest]

Whitney,

I feel your pain. Been there is still is in the same predicament.

My doctor is Godsend. What he did was send my prescriptions to the

pharmaceutical company. I now got a year supply of all my meds.

Talk to doctor about this. If not you can always apply with them personally.

Good Luck!

Eileen

Whitney wrote:

Thanks but unfortunately I did end up spending over $600. It's for

Actiq.

The reason I'm being denied is because the drug is originally prescribed for

cancer patients. I explained to Medicare how much pain I'm in and that this

drug is also prescribed for my migraines as well. They say it doesn't

matter. So now I'm looking into pain patient support people who can help me

fight this battle.

[Guest guest]

my husband is a pharmacy tech and he says that there is a generic for

this now.

Kathy

Whitney wrote:

> Thanks but unfortunately I did end up spending over $600. It's for Actiq.

> The reason I'm being denied is because the drug is originally prescribed for

> cancer patients. I explained to Medicare how much pain I'm in and that this

> drug is also prescribed for my migraines as well.

[Guest guest]

OK.....there are a few things that Medicare Drug plan, no matter what plan you

have, will not cover......one is some narcotics the high end ones I think and

the other is barbituates like klonopin, xanax etc.

What you need to do in those cases is go to www.needymeds.com and go to the drug

name and do what it says to get it from the manufacturer at no cost. It will be

a form to have your doc fill out and they will send the med to your doc for you

to pick up there.

You can appeal all you want, bottom line, they exclude two classes of drugs at

the federal level.

[Guest guest]

Thank you ! Those are the kinds of things I want to know

about.

>

> OK.....there are a few things that Medicare Drug plan, no matter

what plan you have, will not cover......one is some narcotics the

high end ones I think and the other is barbituates like klonopin,

xanax etc.

>

> What you need to do in those cases is go to www.needymeds.com and

go to the drug name and do what it says to get it from the

manufacturer at no cost. It will be a form to have your doc fill

out and they will send the med to your doc for you to pick up there.

>

> You can appeal all you want, bottom line, they exclude two classes

of drugs at the federal level.

>

>

>

[Guest guest]

Yes! Thanks for all of the info. I'll try needymeds and see where I can get.

anbd I'll ask my doctor this week for ideas as well. The only problem with

the generic version is that I was told it is sugar free and I cannot take

chemical sugars, so I have to find out if they have a sugar and sugar free

version of the generic and/or what exactly is in it. Plus many of the drugs

I've taken in a generic form do not work as well, and I end up wasting my

own time putting more drugs into my system than is necessary, while I don't

have to do this with brand names. It sucks that it is that way. I don't

really get it but my doc said people can be ssensitive to the preservatives

they put in the generics and these can cause the drug not to work as well.

So that sucks! I'll let you know what happens!

Whitney

>

> Thank you ! Those are the kinds of things I want to know

> about.

>

>

> >

> > OK.....there are a few things that Medicare Drug plan, no matter

> what plan you have, will not cover......one is some narcotics the

> high end ones I think and the other is barbituates like klonopin,

> xanax etc.

> >

[Guest guest]

modestneeds.org is an organization that is good about helping people out with

bills... meds... etc. you have to fill out an application... but it is not very

long.

these are two number given to me by a drug company... i have not tried them...

but hey.. what's a phone call. hope this helps.... these numbers are suppose to

be to places that help get meds paid for.

1-

1-

Huggles!

Vickie

[Guest guest]

hello - i appreciate these shares on medicare and problems using generics.

several of my drugs do not have generics (ie: migraine meds) and for others, my

doctor does not want me to use them or i have not found them as effective. as a

result, if i use part d, my donut hole period will mean paying 600 a month. I

truly hope i can use some of the drug programs even with medicare. any other

suggestions besides needymeds would be great. but also knowing other people are

going thru the same thing helps. thanks for listening, karen