Just wondering what you can do when a medication is not on the formulary and you can't get your insurance company to pay for it. Do you call different pharmacies to ask what they charge? IS there somewhere you can find out what various drug stores charge?
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I do not know if various drugstores is published anywhere. I do know, at least my drugstore, will tell you over the phone what the price is of a certain medication, and that is before they know who you are. I do agree, the price of prescriptions is crazy! I am glad I am not on a DMD, because I am primary progressive, because they are so expensive. I wish you the best of luck in this endeavor. Keep us updatedhunterd/HuntOP/Dave
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MS World
hunterd@msworld.org
PPMS DX 2001
"ADAPT AND OVERCOME" - MY COUSIN
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There are a couple of things you can do. Yes, you can call pharmacies to find out what they charge for a particular medication. It's worth noting that all brand-name drugs are expensive.
Also, if the medication is brand name, you can contact the manufacturer to see if they have an accessibility program that will provide the drug at a reduced or no cost.
As you know, there are often several different medications that treat the same condition, so if you can't get exactly the one you want, it might be possible to get into an accessibility program for a similar drug that might also not be on your formulary, or find a more affordable version of the one you want.
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I know many people encounter this with provigil/modafinil. I have had this issue thru several insurance carriers, since it is FDA approved, but not specifically for MS Fatigue.
Since it was a pill that could be split, my neuro would order double the dosage and 90 day supply, so it would last me 180 days. So I would pay 2/x a year. I got lucky a few times and the first fill was covered, but second not. Must have been glitch in insurance system, but glad for it.
Does your carrier have alternative meds that are on formulary? One carrier made me try anantadine, and when did nothing, they approved provigil with neuros letter of need, not just the Rx. Then my employer changed carriers, and could not get approved again.
If you can't get manufacturer assistance and there are no approved alternatives, you could research ordering thru a Canadian pharmacy. Depending on the RX, it may actually ship from same overseas plant that manufactures it for the pharmaceutical. But there are also stories where the formulation of the pill not the same. So you need to research.
Good luck.Kathy
DX 01/06, currently on Tysabri
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