So regarding Medicare, I'm wondering who else here is in the same boat that I am in - meaning, you don't pay a premium for Medicare and you don't have to deal with the Donut Hole issue. In other words, just last month I suddenly was no longer paying for many of my prescriptions. particularly my triplicates - the Percocet and MS Contin are now free and the others: Soma, Ultram ER etc are still $3.15 or so. My question is, has anyone experienced any kind of limit put on their medication in the last month. I just went to get my MS Contin refill last week and I was going to run out by today but didn't think there would be a problem. But suddenly after having taken MS Contin since March of this year, it was suddenly a problem for Medicare to pay for it. They are now limiting me to 120 pills instead of 180 (I don't need 180 but my doctor wants me to have as big of a stockpile of meds as I can, so the extra amount is always a good help for that). AND on top of that, they suddenly had a problem with it having to be brand. Well, sorry, but generics for my pills that count - the heavy pain killers, don't do jack for me so I can only take brand. And why is there suddenly an issue. Of course, my doctor's office was supposed to take care of this for me and when I called on Monday they still hadn't, even though I said I was going to run out on Tuesday. I ended up calling AARP who I have my prescription plan through and fixing the problem myself, so I just picked up 120 pills with teh brand name. But the woman said they had just put a limit on the medication, but couldnt' tell me exactly why. It would be great if they could put out some kind of notice, telling you that now these drugs on this list now have certain limitations, etc.
Another problem that we just discovered, is that when I finally had my disability for a year and got my Medicare, in august of 06, no one told me that if I had other insurance, I needed to call them and switch that insurance over to a supplemental insurance. No one told me I had a 3 month limit and in that amount of time, that was what needed to be done. Well shit! My mom called Blue Cross yesterday because every two months - when my dad pays my bill - the price keeps going up and up, for no particular reason at all. I dont' want to lose Blue Cross as my alternative back up insurance because one day I plan to not need Medicare anymore and if I go away from Blue Cross, I'll never be able to get it again and it might be nearly impossible for me to get any type of insurance on my own, because of my pre-existing conditions. So my mom calls to see what the deal is and the guy is so rude, talking so fast and eating his lunch while he's talking, making these gross chewing noises. Gees! What is wrong with people?? So she finally finds out that this needed to happen a year ago and that I'm basically shit out of luck - meaning that if I switch Blue Cross to be my supplemental insurance, that I won't have prescription coverage for 3 months, until january. Now, yes Medicare pays most of my prescriptions, except one - my Klonopin - this is not a med that I can change, as others like it have not worked the same way. The problem is that I can't get it refilled until the 19th of Sept and I only get #30 a month, so I'm hoping that if I explain the situation to my doctor, he can tweak my prescription and write it for at least double the amount. I use it to sleep and also when I'm having panic attacks and really bad days. So I don't take it too often but I can't not have it around as it is a great lifesaver when I do need it.
I just don't get the system at all. But I think what we're going to do is just wait until I can get my Klonopin refill on the 19th, then when my parents are back from Tahoe on the 24th, my mom will call and get Blue CRoss switched to supplemental so the bill for over $400 which is due Oct 10th, doesn't have to be paid. I hate that I can't pay it myself but my parents swore that their kids would always have insurance, because it's one thing that is pretty hard to get once you've lost it.
I still can't afford to get Actiq, the drug that would normally keep me out of the ER when I flare up pretty severely, I have one left! Blue CRoss no longer covers it - I used to be able to get it from them at $10 a pop. But Medicare says they won't pay for it for me because it's prescribed mainly to people with cancer. What a bunch of bullshit!?! My pain is certainly at the cancer pain level, if not higher at times. (I'm not trying to compare myself to someone else) - but....come on! What the fuck?? I'm so pissed and ticked off that me as a pain patient is being denied certain medications that could save me from much sufferign, because the makers of Actiq won't add chronic pain to their list of uses for the drug. Actiq is Fentanyl, but I can't use it in the patch form, unfortunately - makes me severely nauseous even at the lowest dose. But the lozenge pops are wonderful! If I had to pay out of pocket, which I did once when I got my workman's comp money - I bought 30 pops for over $2000. It was insane! I think I would have to pay $40 a piece for them or something ridiculous like that. And the company used to have a advocate system that would help you appeal to your insurance if they weren't willing to pay for it for a chronic pain condition but the 800# no longer works or is out of service and you can't get anywhere online. We definetly need more advocates to help us - especially since I can't tolerate the stress involved in dealing with insurance companies and certain doctors, etc. I mean, we have advocates to help you when applying for SSI and SSDI but not for getting medications and dealing with insurance?? How does that make sense?
Anyway, that's my rant for the day.
