But It'll Cost Ya

[saavedra77]

On learning of my recent bouts of the twitches, my doctor graciously consented to put me back on brand-name anti-seizure meds. Another several days' worth of miscues followed before I was able to actually get the pills from the pharmacy. But, as of the middle of this past week, I'm finally back on the meds that actually work--or, at least, the ones that have best done so in the past.

The catch? The formulary has changed. So from now on, the drugs that actually work are going to cost me three times as much.

The thing is, I'll happily pay it to avoid having another seizure. Hell, I'd practically do anything to to have that.

Comments

[feyandstrange.livejournal.com]

Did you try having your doctor write a note to the insurance company saying that the generic doesn't work?

[saavedra77.livejournal.com]

Until now, my whole focus was just on getting the damned drugs--and that has been unbelievably difficult. My neurologist's first instinct was just to increase the dose. By the time that we were having this discussion, I was already trying to do that, and not filling a whole lot better. I pushed returning to the brand-name because of what I heard from the on-call doctor that night and from you. And because I'd had months of experience of the stuff working for me, compared to the rapid-fire seizures I'd been having during the few weeks I'd been on the generics.

Point is, my doctor was not a strong advocate. Maybe he could be made one, but I was not sensing enthusiasm.

Interestingly, after we'd had all this out and agreed that I needed to go back on the brand-name, his staff somehow still managed to convey to the pharmacy that I just needed an increase in dose. The first time I showed up at the pharmacy to pick up the prescription, that's what I found: just a bigger bottle of the generics. I said no way and told them to straighten it out.

When they called me back, they gave me the bad news about the price. It's not like I could stand to hold off until we straightened out the cost.

In short: Getting my doctor to write the insurance company a note will require a whole new campaign, for which I haven't had time, yet.

Meanwhile, they've kind of got me cornered.

[feyandstrange.livejournal.com]

Oh, what suckness! Well, I'm glad to hear you've got the right pills back, at least. Most of the cases I know if, it's been more of a problem with the insurance folks than the doctors - but most of my sick peers have *had* to find a sympathetic doctor already.

It is remotely possible that you could just deal with your insurance folks directly on this one, but I expect they will want a doctor's note. You could try talking to them, though, and see if they have something they can just fax to your doctor for a signature, which might be less hassle.

[verbicide.livejournal.com]

That's terrible about the cost, but I'm glad there's something out there that works for you. Good luck with this.

Don't count them out entirely...

[ketina.livejournal.com]

Certainly give up on that generic, but don't give up on the concept of generics yet.
I used to take brand name allergy pills, however my insurance company always insists on only covering generics if there is one available that matches the original drug. Thankfully, if you can prove that the generic does not match the original then they'll still cover the original. They initially put me on a generic allergy medicine, but it made me sleepy and didn't do anything to help with being itchy. After much argument regarding the match, they allowed me to go back on the original. Then, about 2 years later, someone came up with a generic that really does match the allergy medicine, and I've now happily been on that for several years.
So I know it's a huge pain, especially in your case as seizures are definitely a lot worse than just being sleepy and ichy, but eventually they might get a generic right. :)

Re: Don't count them out entirely...

[saavedra77.livejournal.com]

Understood--I've never been one for sweeping judgments. On the other hand, (as you say) an ineffective anti-epileptic can be pretty catastrophic. So I'll always be cautious about changing. What I'll want to hear is not just that the drug's supposedly active molecule is the same, but that it's been clinically demonstrated to be equally efficacious for treating seizures in multiple trials. (This is a theme that seems to be emerging in the literature: the current generic anti-seizure meds are proving less efficacious than the brand-names, and some of the latter's supposedly extraneous chemical components may actually be part of what makes them effective.)