Friday, February 20, 2009

Copaxone Drama

In my early thirties, I realized that my daily life was my own personal soap opera. When I had that epiphany, I vowed to keep drama onstage and remember that I cannot control everything. Since then, I have kept a majority of drama onstage, with a few exceptions.

Somewhere at the end of January, I received my monthly call from my specialty pharmacy to schedule delivery for my Copaxone. According to my understanding, after January 1, my copay would be $150 per month, with Shared Solutions paying $50 of that, leaving me with a balance of $100. Imagine my shock when the person on the other end of the phone line told me my total would be $500+!!! I calmly told her not to ship the Copaxone and hung up the phone. Needless to say, my blood pressure skyrocketed, and I was positive my head was about to explode. Mind you, I do not have any high blood pressure problems. I advised GH of the situation, lit a cigarette to calm my shaking hands to begin the marathon telephone session to multiple entities. (Dear readers, please do not comment about my smoking vice. I know it is unhealthy and I am making plans to quit for Lent.)

First call was to my health insurance company's pharmacy line. Everyone with whom I spoke was very polite and helpful. Problem number one: the specialty pharmacy is now considered out-of-network, therefore my Copaxone would cost $150 per month copay PLUS 20% of the actual cost of the medication. WTF? When I received notification of the new specialty drug changes in November, I called the insurance company and was assured that my current pharmacy had been purchased by a larger company that was in the network. There would not be a problem. Yeah, right. The gentlman gave me the number to the larger network pharmacy and wished me luck.

Call number two went to the health insurance company proper. I informed the very nice lady that I was misled and misinformed by their representative. She kept me on the phone for about 40 minutes, trying to resolve the issue. She apologized profusely, and stated that most of the problem was with the terms my employer had negotiated with the insurance company. She wished me the best of luck.

Third call was to Shared Solutions. As always, the people there were incredibly helpful and assured me that they would take care of transferring my prescription to the new pharmacy. However, said new pharmacy was not a participant in the Shared Solutions discount program, so I would have to pay the entire $150 copay each month. Fine, just get my drugs, already! Then she said she would forward my information to Chronic Disease Fund to see if I qualified for their Copaxone Assistance program. OK, sounds like a plan to me.

I finally calmed down. GH sat there in amazement, saying he couldn't believe I had handled all of that without yelling, screaming or cursing. He usually handles these types of situations, as he is a professional buyer for a school district and negotiates very well. However, in this instance, he stepped back and let me fight this battle. Although if I got overwhelmed, he was ready to jump into the fray with teeth bared.

The next day, I received a voicemail from Chronic Disease Fund. They e-mailed the requisite paperwork; I filled it out and faxed it back to them. A few days later, I was informed that I qualified for an emergency something-or-other and they would pay up to $2500 of the cost of my Copaxone for this shipment. Awesome!

Then the new specialty pharmacy called to set up delivery. By this time, I had approximately 7 days of Copaxone left. He set up the delivery and told me I did not need to pay anything! More awesomer! (Yes, I know that's grammatically incorrect, but I like making up new words, just like Stephen Colbert's "truthiness").

I received my Copaxone last week and did the happy dance. Then I received the multitude of forms from CDF to fill out for long-term Copaxone assistance. I sent them 18 faxed pages and crossed my fingers. However, I had a sneaking suspicion that our income level was too high to be helped on a long-term basis. I was correct in this assumption. I received a letter yesterday informing me that my application had been denied. Bummer!

Honestly, I wasn't terribly disappointed. There are so many people in the MS community who truly need this assistance. GH & I are blessed with employment, insurace and otherwise good health. We are not going to bitch too much about $150 per month. The results are priceless.




You did AWESOME!!! What clear headedness in the midst of shock and rage. And you managed to work this out in so few phone calls, I'm impressed.

Sorry about the $150 copay, but it does beat $500 by a longshot.

mcwflint said...

Ah the joys of insurance. Like you, I am grateful to have it. But, oh, the battles. I read that oftentimes a fourth appeal gets you approval because so few will ask that many times,

PS. Like the new blog name

Amy said...

hate hate hate insurance companies!!! ugh!!! glad you got it worked out!!!

Lanette said...

That is great! I myself just recently started copaxone and found out about their co-pay program. My specialty pharmacy does not participate yet, however, I only have to pay $50/month, so I suppose I cannot really complain.

I do find thought that most of the people you speak to at these companies are trying to help as best they can. I always tell my husband, don't shoot the messenger! Glad to hear you got it sorted out! :)

m said...

I am so glad that your situation worked out. I have not been so lucky. My company has changed our health insurance and my co pay for my perscriptions has gone from $300.00 to 3,000.00 for the year. I ordered my medicine and was under the impression that it would be the normal 100.00 per month fee and they sent the medicine along with the 3,000.00 bill. I have no way of paying this bill and will run into problems in the months to come as I will not be able to afford my medicine. I have no idea where to start, please any advise or suggestions?