The Price of Being Healthy

It has been an emotional day. I feel emotionally run down and, to be honest, angry.

I decided that I wanted to give a true shot at trying to get the price of my Lamotrigine ER lowered. Sometimes, if a medication is medically necessary, the insurance company can work out an affordable price for the patient. I thought considering I have to take an anticonvulsant for the rest of my life and I originally tried the non-ER version of the medication that I had a solid case.

First, I called the medication manufacturer, Par Pharmaceuticals. Many pharmaceutical companies have assistance programs because they want people to be able to afford their medication. They have a vested interest in whether or not you are continuing to take their products. Unfortunately, there is no such program for Lamotrigine ER.

At the suggestion of a friend, I called the insurance company directly to inquire on coverage since it is medically necessary. The first customer service rep was understanding and transferred me to someone in the pre-cert program in order to negotiate. The lady she transferred me to from minute one was defensive and rude. She also flat out lied to me. She said the insurance company has no control over the amount covered for a prescription - that the prescription manufacturer tells the insurance company what they want them to pay.

Not true. Manufacturer sets retail price to make back their money on research, patent and distribution. Insurance company negotiates the amount they cover.

I was so angry I practically hung up on her.

There are many patient assistance programs out there but they all have income requirements. If you are above them, then you don't qualify for the help. I don't understand that concept at all. Just because someone makes a decent living doesn't mean they can afford a medication that is $1000/month. That's insane. Plus, if a medication is treating a chronic condition, that probably means that there a lot of other bills to pay, as well.

I called my neuro's office to ask if they knew if any assistance programs that don't have income requirements. Nurse Gary told me that their practice has an assistance program but he doesn't know if there is an income requirement. He seemed absolutely stunned by the fact that I paid $675 last month for a 30-day supply. I am going to call the office after work tomorrow and inquire about it.

Also, Dave's company has a third party handle their benefits. I emailed the account manager and she told me to call her tomorrow so we can try and figure something out. I have a feeling though that my options are pretty limited and it is going to come down to what Dr. L's office says. I really don't want to switch back my medication, but I also really don't want to pay this much for something that is keeping me safe. That's unfair. I'm not even looking for complete coverage, just enough to take the edge off. I was thinking in between $350 and $400. I don't think that's incredibly unreasonable. I just don't want to keep feeling this extreme sense of guilt over the medicine being so expensive. I know that Dave reassures me that we will be fine (and I'm sure we will be), it doesn't take the sting of the price away. I hate the fact that I put our family in this position. I will do anything to take some of the burden away. I will talk to EVERYONE I have to in order to help.

I will post tomorrow after talking to both my doctor's office and the account manager.