Can't afford meds for ADHD, any advice?



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scubasteve
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14 Feb 2011, 11:45 am

For the past sixth months, I've been locked in a battle with my employer-provided insurance over a stimulant I take for ADHD. I've tried at least 10 different meds and this is the only one that worked, but I can't afford it out of pocket and the insurance company won't budge. So, 2-part question:

1) Does anyone here know of an organization that helps pay for psychiatric medications, or helps fight these insurance companies on our behalf?

2) Has anyone here personally bought medications internationally from a website? (I've seen much better prices online, but not sure who to trust.)

Thanks so much



SyphonFilter
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14 Feb 2011, 12:06 pm

What medication do you take? Some drug manufacturers will help patients cover the cost of buying the meds; for example, I've heard of people getting coverage for Vyvanse (developed by Shire Pharmaceuticals). After filling out some kind of paperwork, Shire covered the cost of the patients' Vyvanse.

However, these patients may have been low-income.



pgd
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14 Feb 2011, 12:18 pm

scubasteve wrote:
For the past sixth months, I've been locked in a battle with my employer-provided insurance over a stimulant I take for ADHD. I've tried at least 10 different meds and this is the only one that worked, but I can't afford it out of pocket and the insurance company won't budge. So, 2-part question:

1) Does anyone here know of an organization that helps pay for psychiatric medications, or helps fight these insurance companies on our behalf?

2) Has anyone here personally bought medications internationally from a website? (I've seen much better prices online, but not sure who to trust.)

Thanks so much


----

Are you saying that Obama health care reform (2011) isn't working exactly as advertised from the Obama White House? Sounds like it's the medical business as usual like it was under the Bush, Jr. White House aka profits before people. What you describe is going on all over the USA (2011) including in the area of the many epilepsies where persons find that a brand name works but a generic doesn't (and standard health plans refuse to pay for the difference and will only provide generics which don't work/don't work as well). It's a big problem (my view). A possible solution might take years/decades to happen but it would mean that brand name meds for ADHD are sold over the counter at pharmacies at much lower prices than today. However, that's unlikely to happen since many of the ADHD meds fall into the category of controlled drugs which tends to mean that the ADHD drugs will always be quite expensive. Old slogan: Follow the money. The system is unlikely to change anytime soon. Expect the politicans to continue to swear on the Bible that the USA has the best doctors and best medical system in the world but also expect to continue to be treated like you have been.

How part of the system of business in the USA works:

Area: the Military/the Industrial Complex

Military–industrial complex - Wikipedia, the free encyclopedia
Hartung, William D. "Eisenhower's Warning: The Military-Industrial ... No.1 1958 · Dwight David Eisenhower, Farewell Address On the military-industrial ...
History - Origin of the term - Current applications - See also
en.wikipedia.org/wiki/Military–industrial_complex - Cached (Google)

Area: Pharmaceutical Drugs/the Industrial Complex

The Medical-pharmaceutical industrial complex (Eisenhower's principle still applies)



scubasteve
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14 Feb 2011, 12:23 pm

The medication is called Provigil, and is manufactured by Cephalon. Unfortunately, they're saying they can't help me because I do have insurance (albeit a really lousy one.) They only offer assistance to people who have no perscription drug coverage at all. I am taking Vyvanse in the meantime and it is fully covered, but it doesn't work nearly as well for me as Provigil did.



wavefreak58
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14 Feb 2011, 12:53 pm

pgd wrote:

Are you saying that Obama health care reform (2011) isn't working exactly as advertised from the Obama White House? Sounds like it's the medical business as usual like it was under the Bush, Jr. White House aka profits before people. What you describe is going on all over the USA (2011) including in the area of the many epilepsies where persons find that a brand name works but a generic doesn't (and standard health plans refuse to pay for the difference and will only provide generics which don't work/don't work as well). It's a big problem (my view). A possible solution might take years/decades to happen but it would mean that brand name meds for ADHD are sold over the counter at pharmacies at much lower prices than today. However, that's unlikely to happen since many of the ADHD meds fall into the category of controlled drugs which tends to mean that the ADHD drugs will always be quite expensive. Old slogan: Follow the money. The system is unlikely to change anytime soon. Expect the politicans to continue to swear on the Bible that the USA has the best doctors and best medical system in the world but also expect to continue to be treated like you have been.

How part of the system of business in the USA works:

Area: the Military/the Industrial Complex

Military–industrial complex - Wikipedia, the free encyclopedia
Hartung, William D. "Eisenhower's Warning: The Military-Industrial ... No.1 1958 · Dwight David Eisenhower, Farewell Address On the military-industrial ...
History - Origin of the term - Current applications - See also
en.wikipedia.org/wiki/Military–industrial_complex - Cached (Google)

Area: Pharmaceutical Drugs/the Industrial Complex

The Medical-pharmaceutical industrial complex (Eisenhower's principle still applies)


And how does you posting propaganda help scubasteve?


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SyphonFilter
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14 Feb 2011, 2:13 pm

Part of the problem may be that Provigil is not FDA-approved to treat ADHD. Many insurance companies will only cover drugs categorized as 'on-label', meaning that the drug has gone through clinical trials and shown efficacy treating a particular condition. In your case, Vyvanse is most likely covered since it's FDA-approved in the treatment of Childhood & Adult ADHD; however, Provigil's only 'on-label' use is for narcolepsy, its 'off-label' use is for ADHD.



Last edited by SyphonFilter on 14 Feb 2011, 2:15 pm, edited 1 time in total.

scubasteve
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14 Feb 2011, 2:14 pm

It's an interesting post, and I do appreciate all the replies so far. But yes, what I'm really looking for is possible solutions. If anyone has a website they personally use and trust to deliver medications from other countries with good drug oversight (I live in the U.S. where medications are most expensive), or knows of an advocacy group or foundation that helps people with these issues, it would really help me out. Thanks again.



Nerdykid
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14 Feb 2011, 2:18 pm

Yeah in my state it is pretty much impossible to get health care and they are cutting it further. My problem is you cannot get state assistance unless you are no income and female. Since I work and my employer does not give health care, I cannot get it. I really need anti anxiety meds and cannot get them. The other day I smashed my hand on the floor during a meltdown and now owe like 2500 dollars. What a great country we live in.



scubasteve
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14 Feb 2011, 2:23 pm

Yes SyphonFilter, that is the reason my insurance company has given. I've tried all the usual ADHD medications though, and didn't get very good results until over a decade of medication-hopping led me to this one. I described all of this in a very passionate yet polite letter to the company, which I can only assume was glanced over and recycled... Anyway yes, off-label prescription, and I've pretty much given up fighting the insurance company at this point. Looking for another way.



wavefreak58
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14 Feb 2011, 2:38 pm

My wife went through hell getting a prescription for migraine medicine. Basically, they would only give her 4 doses per month. But she gets 8 to 12 headaches a month. We had to have her doctor document in writing that she needed it and document that none of the other migraine medicines would work. The doctor has to do this, it must be in writing and it must completely document the history. If after doing all this they still reject it, I don't know what your options are.


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Verdandi
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14 Feb 2011, 2:46 pm

wavefreak58 wrote:
And how does you posting propaganda help scubasteve?


Most especially how does it help to suggest that this situation was caused by something that has not even gone into effect yet? The problem scubasteve's having now has been endemic to commercial health insurance for decades.



scubasteve
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14 Feb 2011, 3:00 pm

NerdyKid, wavefreak, sorry to hear that, and all the best to you both. I think sometimes the best way to deal with a broken system is just to work around it, which is why I'm looking through reviews of Canadian online pharmacies at the moment. I just wish there was an easier way to figure out who to trust. That's the peril of working around a system - The other parties can be a bit shady.

And yes, Verdandi, parts of the new law are not yet in effect. NerdyKid, that may be something you'd want to look into though. I think there was something in there compelling employers to provide insurance.



schleppenheimer
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14 Feb 2011, 3:17 pm

Another option may be to have your doctor "say" you have narcolepsy, and that way your insurance company would provide the Provigil. Isn't it awful that you have to dance around to be able to get the meds you need?



wavefreak58
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14 Feb 2011, 3:18 pm

scuba ...

If your doctor hasn't pushed hard you will never win against the insurance company.

If your doctor HAS pushed hard, then maybe you could get Todesking to invoke some violence :wink:


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SyphonFilter
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14 Feb 2011, 5:05 pm

schleppenheimer wrote:
Another option may be to have your doctor "say" you have narcolepsy, and that way your insurance company would provide the Provigil. Isn't it awful that you have to dance around to be able to get the meds you need?


scubasteve's insurance company, like most other insurers, will ask that generic drugs such as methylphenidate or amphetamine/dextroamphetamine (both of which are 'on-label' for narcolepsy) be tried before they'll pay for brand-name Provigil. Add to the fact that once diagnoses are given, they stay on your medical record. Permanantly.

Finding the most cost-effective online pharmacy would indeed be ideal. Sorry I can't speak much about online pharmacies, though. I've never had to consider that option when receiving my prescriptions.



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