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John D
Member in Phase 3
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Posted: Wed Mar 2nd, 2005 02:03 |
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For all who must pay out of pocket for meds, (no insurance or high deductibles) please use this topic for comparing pricing at various sources so you can find the best pricing. If you know about a source that is more competitive, please post a message here. I previously started a similar thread on sarcinfo.com. and you will find some suggestions for negotiating better pricing from your local pharmacist there. Here is the link to the SarcInfo 'medication purchasing strategies' thread.
For phase 2 and 3 abx, see the similar topic in phase 3 if you are a phase 2,3 registered participant: http://www.marshallprotocol.com/forum35/1871.html
I reported my suggestion for Walmart pharmacy for the best price for Benicar has increased from $1.31 each to $1.40. The pharmacist told me she sold me my previous order for less than her cost and the new price covers the price increase. If that is true, $1.40 would seem to be as low as we might expect.
If anyone has a source with a better Benicar price in the last couple of weeks, please post here. Thanks, John Dresser
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Sarc- Lungs dx (biopsy)1985, pred 3yrs to 88. Begin MP:Feb/04 1,25D=58.1, 25D=18.1 Phase 2: June/04. Phase 3: Sept/04. Clean-up phase Oct/06. April/05: D1,25=13 25-D=6. June06: D1,25=31 25-D=11. Sept07: 25-OH D=18
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John D
Member in Phase 3
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Posted: Tue Apr 12th, 2005 20:41 |
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My most recent Benicar price at Walmart pharmacy is $1.37 each. (actually less than the insurance approved price when I purchased some using my insurance benefit)
For those who pay for your labs out of pocket, you will be thrilled to see the premium you pay in "patient cash price" vs insurance company allowed price for the D blood testing. I just spent about two hours bouncing around to different phone numbers trying to nail down what I actually will pay for the D tests, and I am still not sure what the bill is going to be!
Don't you all wish our medical system was correct in assuming all of us who pay out of pocket have all this extra money available to subsidize the medical costs for those that have insurance companies to negotiate a much lower price?
Prices are for both D lab tests, not incl office visit to draw blood:
Mayo lab patient price $318
Dynacare patient price $434
Dynacare insurance price $ 250 (last year $203)
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Sarc- Lungs dx (biopsy)1985, pred 3yrs to 88. Begin MP:Feb/04 1,25D=58.1, 25D=18.1 Phase 2: June/04. Phase 3: Sept/04. Clean-up phase Oct/06. April/05: D1,25=13 25-D=6. June06: D1,25=31 25-D=11. Sept07: 25-OH D=18
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Ames
Board Staff
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Posted: Sat Oct 15th, 2005 21:35 |
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I am starting to worry about how I will be able to pay for my MP meds in four months.
At the current moment, I have an insurance plan extended from my college years which will expire in February and cannot be renewed.
I have been researching insurance providers and all the plans are extremely extremely expensive. Also, I have no idea if they would even be willing to cover Benicar and all of my antibiotics because they are not considered a "conventional" treatment. Also, since I take these meds already, I'm not sure if they would refuse to cover them since they might claim they are part of a pre-existing condition.
I was thinking that it might be in my best interest to just pay out of pocket for my medications. Then today I inquired about the price of Benicar and the abx at my pharmacy. I was floored to see how expensive Benicar is! There is absoluetely no way that I will be able to pay for Benicar after my current insurance expires. I am almost worried I would have to stop the protocol.
I will continue investigating every insurance option I can find to see if there is any plan that might be reasonable. Right now, I don't even know where to begin. I was hoping that anyone out there may be able to offer me some guidance. What do other people without insurance do to get Benicar? Does anybody know any insurance provider that would cover MP drugs for a reasonable cost? All I need is prescription drug coverage, not a plan that includes doctors visits...
Finally, I have considered applying for Medicaid. I have no job, and my parents cannot help me out when it comes to medicines so I feel I would qualify. Do you think that Medicaid would cover MP medications?
I would really appreciate any feedback or help in this area.
Thanks!
Amy
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CFS/FMS/osteopenia/severe insomnia Non -MP meds: Gabitril (16 mg),Trazodone (150 mg),Tramadol (20 mg) for pain. Light: Noirs (outside and bright lights), thick layers, sunscreen
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BARNEY
Moderator
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Posted: Sat Oct 15th, 2005 21:42 |
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Ames,
You can apply to Sankyo before your insurance runs out and they will supply your Benicar at the rate your doctor prescribes. He should be able to write the scrip for 4 per day. (40mg)
Also there is a program for the mino, and all the Phase 2/3 meds. We can PM before you need them and I will get the addresses for you. It takes mino 9 months to get to you. They are really slow.
HANG IN THERE, WE WILL MAKE IT!!! BARNEY
____________________
64jointsarc77skinsarc80lungsarc81asthma/migranes
95rkidneyremoved(cyst)diabetic/gallbremoved,96
totalhyst(cysts,endom)01fibro,Benicar40/20mg&xtra
as needed,stage5,
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Aussie Barb
Research Team
| Joined: | Thu Jul 22nd, 2004 |
| Location: | Australia |
| Posts: | 19547 |
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Posted: Sat Oct 15th, 2005 22:35 |
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Amy
Dr Marshall suggests that the German prices may be more affordable?
see Benicar for Aussies Page: 3 has latest prices
and How to order Benicar from Germany has details..
all best, Barb ...
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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Ames
Board Staff
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Posted: Sat Oct 15th, 2005 23:02 |
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Thank you both SO much for these helpful ideas.
I will start looking into them very soon!
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CFS/FMS/osteopenia/severe insomnia Non -MP meds: Gabitril (16 mg),Trazodone (150 mg),Tramadol (20 mg) for pain. Light: Noirs (outside and bright lights), thick layers, sunscreen
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John D
Member in Phase 3
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Posted: Sun Oct 16th, 2005 19:37 |
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Amy,
You can take a look at the following topics to see some history of our discussion of different strategies for procuring our abx:
http://tinyurl.com/d94y6
http://tinyurl.com/bum4u
http://tinyurl.com/95g4v
Consider finding a major medical insurance policy to keep your premium down. You would have a high annual deductible and thus pay out of pocket for most of your med costs until you hit the deductible ($2500 to $5000). You could then qualify for the free meds programs since your insurance essentially is not covering your scripts. If you have something major happen (beyond the expected MP costs), you then will have coverage. Check with your doc's office to see if they have a program to take care of the applications for the free drugs. They will still make you jump through hoops to get them, but you can save enough on Benicar alone to justify your effort. If Sankyo stonewalls your applications, try calling directly to straighten out the problems. Also, you need to start this process soon, as it takes a month or more to get things going.
Recent increases in insurance costs and med costs certainly give us incentives to try to find employment that offers coverage, but those jobs are harder to find now, and employers are passing more and more of those premium costs on to employees.
I have been self employed, but have been pretty much unable to work (at least full time) since starting the MP. After about 19 months on the MP, I suppose I could probably function well enough to work at something full time, depending on the task.
John Dresser
Last edited on Mon Oct 24th, 2005 04:03 by
____________________
Sarc- Lungs dx (biopsy)1985, pred 3yrs to 88. Begin MP:Feb/04 1,25D=58.1, 25D=18.1 Phase 2: June/04. Phase 3: Sept/04. Clean-up phase Oct/06. April/05: D1,25=13 25-D=6. June06: D1,25=31 25-D=11. Sept07: 25-OH D=18
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hrts4me
Member in Phase 2/3
| Joined: | Sun Oct 17th, 2004 |
| Location: | Texas USA |
| Posts: | 590 |
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Posted: Sun Oct 16th, 2005 19:54 |
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Ames,
If you have no prescription insurance coverage there are free manufacturer's drug programs that are available, and we use regularly for our antibiotics, and other meds. The applications are very easy to obtain and download online, the patient fills out their portion, includes their financial information, takes the application to their caregiver, who then fills out their portion, including dosage and amount needed monthly. They then send it to the drug manufacturer. The manufacturer sends your prescription drug to the office of the caregiver, for you to pick up. One can use multiple manufacturers to obtain their various prescriptions. As far a the Benicar, we have a cabinet full that was obtained from our caregiver (samples).
http://www.rxassist.org
http://www.needymeds.com
http://www.helpingpatients.org
Some of these may charge a $5.00 fee for each med. Don't do that. Go straight to the manufacturers page, and get their application and download it. There is no charge that way. These links will tell you the manufacturer usually, and the programs that they have available. Some are just databases, and charge nothing.
You can also find the manufacturer for the rx you are looking for and go directly to their patient drug programs on their website by googling the drug name. There are more urls available for data clearinghouses on drug programs if you will google a search using the keywords, "free drug program manufacturer" or "free rx" or other various combinations.
As a side note our mino arrived in just a month's time. The applications for the manufacturer's drug programs vary, but most are renewed every 6 months to a year.
Medicaid would be another remedy for you, in that it would not only cover your prescriptions, but your other health care needs as well. I am the only person in the family that has government assistance at this time, I receive Medicare Disability. I have NOT however signed up for the Medicare Drug Program, as they would never allow the ongoing, more expensive antibiotics. Instead it is wiser for me to use the manufacturer's drug programs.
In order for you to qualify for Medicaid, you will have to file for disability. Medicaid is only given to qualifying children and the disabled. This will take much longer than the 4 months of which you speak before your meds run out.
There are two ways in which the government helps the disabled. First there is SSDI or Social Security Disability Insurance in which you then are put on Medicare, if your claim is accepted, and also recieve a monthly monetary benefit. Medicare is NOT based on one's income and resources. It is based on your being found disabled, unemployable, and your work earnings history of Social Security taxes paid in. Medicaid is based again on your financial state. Medicare has copays on medical services rendered.
The second is SSI, which IS based on your income, assets, and resources. It is a supplemental payment to you monthly in addition to your Medicare Benefit if you qualify. You can go to the Social Security Administration website, and find all the qualifications for both programs. When you file for disability you immediately file for both programs, will receive claims forms, and then must wait for determination as to whether your claim has been accepted after they receive all the documentation and examinations they request.
I would be happy to give you the name and contact info on one of the best Social Security Disability lawyers in the country. He works cases throughout the U.S., and is tops. I believe he has been mentioned on this site, and can be found on many CFS and FM sites as well. He works on a contingency basis, in other words, one files disability from the date they became disabled and unable to work. They normally receive a lump sum settlement in back benefits, and Social Security lawyers, take a small percentage of this settlement. Very worthwhile, with the help that one gets from their assistance, and a favorable claim in which you then are assisted with your medical costs, plus a monthly benefit for as long as you are disabled. The lawyer intercedes when the SSA wants you to see THEIR docs, and make sure you are seen, examined, and reports issued from your OWN doctor--very important, as your doc knows of your disability and is trying to prove it, while the SSA docs are trying to disprove it.
Your age may hinder you in your pursuit of Disability, however, as it is based upon your Social Security Earnings. In otherwords the amount of years and the amount you have paid INTO Social Security.
Therefore it may be best for you currently to go with the manufacturer's drug programs to meet the immediate need for your prescriptions. You can ask for your Social Security Statement online at the SSA website, and this would be instrumental for you in ascertaining whether or not you qualify for Disability. This may be something that would benefit you, so that your appointments, hospitalization, etc. would be covered...either by Medicare, or by Medicaid depending on your financial status, in the future if you are unable to work. This does take more time, though, and quite a bit of effort. Fortunately I was awarded my claim first time out, and did not have to go through appeals and hearings.
If you would like any further information, pm me, and I will be happy to help.
Best wishes,
hrts
Last edited on Mon Oct 24th, 2005 04:06 by
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LYME COPD Arterioscl Seiz FM CFS Hypertens NASH HiChol/ 4.2cmKidneyMass&Stones HyperCaPhUria Angina Arryth SOB RadNeurop BiPolarI| 1/05 25D-14 1,25D-13 2/07 25-D14| Nitro Verapamil Hydrocodone Baclofen Dicyclomine promethazine clonazepam
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Ames
Board Staff
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Posted: Sun Oct 16th, 2005 20:22 |
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I cannot thank all of you enough for taking the time to give me such detailed information about how to use the drug assistance programs to obtain the medicines I need. Your help will truly make a monumental difference in helping me to successfully complete the MP.
I am actually moving from Chicago back to Washington DC tomorrow, so I am packing today and then when I arrive I will not have internet for a few days. However as soon as I get it working again I will start downloading all the forms and working on starting to fill out the forms I need immediately.
I will write more about how this goes as soon as I am settled back in DC. Thank you again for taking the time to help me out!
____________________
CFS/FMS/osteopenia/severe insomnia Non -MP meds: Gabitril (16 mg),Trazodone (150 mg),Tramadol (20 mg) for pain. Light: Noirs (outside and bright lights), thick layers, sunscreen
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BARNEY
Moderator
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Posted: Sun Oct 16th, 2005 21:04 |
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Ames,
As I told you on the PM, as long as your insurance is in effect, it would be a waste of time to fill out the forms because they will only deny you. You do not want to start out like that.
I should have posted everything I PM'd you so that anyone else on MP who needed help could get the help needed.
You can obtain all the meds needed for MP, if your income is low enough, some of the amts are quite high. As I told you in the PM, I find http://www.needymeds.com to be the best one to use. It is user friendly. Hrts4me gave some good advice.
You might also consider taking in children to tutor around your home area, so that they come to you and you do not have to go out.
Hope this helps you and many others.
HANG IN THERE, WE WILL MAKE IT!!! BARNEY
____________________
64jointsarc77skinsarc80lungsarc81asthma/migranes
95rkidneyremoved(cyst)diabetic/gallbremoved,96
totalhyst(cysts,endom)01fibro,Benicar40/20mg&xtra
as needed,stage5,
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ShrnHml
Member in Phase 2/3
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Posted: Sun Oct 16th, 2005 22:19 |
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Two things occur to me:
1) I have read on this site that going through Sankyo "needy meds" program will only get you one pill per day. If this has changed, please let me know.
2) You have to be on Social Security Disability for two years before you qualify for Medicare
I have recently qualified for MediCAID, and my first order for Benicar is coming up soon. I hope they don't pull the one-pill-a-day thing on me.
Sharon
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Neuroborreliosis, MP 3/05, 1,25D 62; 3/06 25D<4, ModPh2 12/05, Premarin, Effexor, stopped Benicar 1/07....no longer in study
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Ames
Board Staff
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Posted: Mon Oct 17th, 2005 01:35 |
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Barney,
The info in your PM's was very helpful. When I say that I am going to start to fill out the forms, I mean that I plan to get them ready so that the day my current insurance expires I will be able to send them in. I am very thankful that you informed me that I could not submit them at the current time -that is an important point.
I do plan to do some tutoring if I can. There are several colleges and high schools near where I live in Washington D.C. I think that it will be good for me because I can control the lighting and do the tutoring on my own time. Thanks for the suggestion!
I am moving back to DC tomorrow and will not have the internet for a few days at least. But after that I will look into disability and medicaid etc in more detail. I will also continue to write again in my progress report. I realize I have been missing in action over the last few weeks and will continue to update my progress.
Best to all,
Amy
____________________
CFS/FMS/osteopenia/severe insomnia Non -MP meds: Gabitril (16 mg),Trazodone (150 mg),Tramadol (20 mg) for pain. Light: Noirs (outside and bright lights), thick layers, sunscreen
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John D
Member in Phase 3
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Posted: Tue Oct 18th, 2005 01:04 |
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Sharon,
Sankyo's program will give you 4 Benicar tablets per day with your doctor's prescription for that amount. It was quite an ordeal for me to finally get this for my first 3 month supply, and you likely will need to be persistent. Call directly and ask for Karen (supervisor) if they do not send the prescribed amount at first.
Dr. Marshall wrote that the drug companies are obligated (agreements with the government ??) to provide this service to needy patients.
I just received my second three months supply, and was only issued 3 per day, but am awaiting a follow up call-back from the supervisor, to hopefully straighten this out.
John Dresser
____________________
Sarc- Lungs dx (biopsy)1985, pred 3yrs to 88. Begin MP:Feb/04 1,25D=58.1, 25D=18.1 Phase 2: June/04. Phase 3: Sept/04. Clean-up phase Oct/06. April/05: D1,25=13 25-D=6. June06: D1,25=31 25-D=11. Sept07: 25-OH D=18
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John D
Member in Phase 3
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Posted: Wed Oct 19th, 2005 21:42 |
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Re:my previous post on benicar/Sankyo
I don't know who is playing games with me, my doc's office or the Sankyo Open Care program, but Karen called back to inform me my doc sent a script for only 3 Benicar/day, and they would send more to me if Doc sends a revised prescription.
I left a message with Doc's assistant, and she said I they would give me their free samples to make up the difference. I have no idea why Doc would have changed the daily amount. They don't seem to be very organized there......according to Sankyo, they submitted the original request (for the second 3 months supply) without including the required prescription, and it took two more tries before they got it right to satisfy Sankyo. I finally received the Benicar about two weeks late.
If anyone else has problems getting the right amount, I suggest you call the Open Care hotline at 866-268-7327, and if the first person can't get it straightened out.........then, ask for Karen (the supervisor). Perhaps from my experience, it might be best to fill out and submit the forms yourself, with the prescription from your doctor, then you know exactly what has been submitted to Sankyo.
John Dresser
____________________
Sarc- Lungs dx (biopsy)1985, pred 3yrs to 88. Begin MP:Feb/04 1,25D=58.1, 25D=18.1 Phase 2: June/04. Phase 3: Sept/04. Clean-up phase Oct/06. April/05: D1,25=13 25-D=6. June06: D1,25=31 25-D=11. Sept07: 25-OH D=18
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hrts4me
Member in Phase 2/3
| Joined: | Sun Oct 17th, 2004 |
| Location: | Texas USA |
| Posts: | 590 |
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Posted: Thu Oct 20th, 2005 19:32 |
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ShrnHml wrote: 2) You have to be on Social Security Disability for two years before you qualify for Medicare
My Social Security Disability benefits and Medicare Coverage began at the same time. In other words my premium (cost) for my Medicare Coverage was taken out of my first Disability Benefit check. Thus medical coverage began immediately. My Disability claim was awarded in 2004. I don't know of a policy change.
Hrts
____________________
LYME COPD Arterioscl Seiz FM CFS Hypertens NASH HiChol/ 4.2cmKidneyMass&Stones HyperCaPhUria Angina Arryth SOB RadNeurop BiPolarI| 1/05 25D-14 1,25D-13 2/07 25-D14| Nitro Verapamil Hydrocodone Baclofen Dicyclomine promethazine clonazepam
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BARNEY
Moderator
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Posted: Thu Oct 20th, 2005 19:57 |
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It depends on how long your case took to be approved. If it took 2 or more years to be approved, that can be the reason.
It took me 5 years and the loss of a kidney to win my disability hearing, so my Medicare started right away also.
You do not have to be approved for Social Security disability to get Medicaid disability, you just have to go thru a hearing and have your doctor proclaim you are disabled and why.
HANG IN THERE, WE WILL MAKE IT!!! BARNEY
____________________
64jointsarc77skinsarc80lungsarc81asthma/migranes
95rkidneyremoved(cyst)diabetic/gallbremoved,96
totalhyst(cysts,endom)01fibro,Benicar40/20mg&xtra
as needed,stage5,
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jcwat101
Research Professional
| Joined: | Tue Jul 20th, 2004 |
| Location: | Pasadena, USA |
| Posts: | 1453 |
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Posted: Sat Oct 22nd, 2005 15:59 |
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On the issue of obtaining Benicar under the needy meds program -- I just looked at the form and it says you aren't eligible if you have any prescription drug coverage from Medicare or Medicaid.
Has anyone gotten the meds through Sankyo for free who has been on Medicaid?
I'm doubtful that my Medicaid HMO doctor would prescribe it all and certainly not at 3 or 4 per day. And if my outside doctor prescribed it, I doubt Medicaid would pay for it. Any thoughts?
Joyce Waterhouse, Ph.D.
Last edited on Sat Oct 22nd, 2005 16:00 by jcwat101
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20 yrs with CFS/FM/Lyme/IBS, food sensitivities; 1,25D/25D 8/04:64/11 http://SynergyHN.com
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BARNEY
Moderator
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Posted: Sat Oct 22nd, 2005 17:58 |
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Joyce,
You have nothing to lose by filling out the form and having your doc send it in. All they can do is say NO if they do not want to help. Then turn around and appeal their decision, explaining your situation. Appeals sometimes work miracles.
Nothing ventured, nothing gained as my grandmother used to say.
Hope this helps!
HANG IN THERE, WE WILL MAKE IT!!! BARNEY
____________________
64jointsarc77skinsarc80lungsarc81asthma/migranes
95rkidneyremoved(cyst)diabetic/gallbremoved,96
totalhyst(cysts,endom)01fibro,Benicar40/20mg&xtra
as needed,stage5,
|
hrts4me
Member in Phase 2/3
| Joined: | Sun Oct 17th, 2004 |
| Location: | Texas USA |
| Posts: | 590 |
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Posted: Fri Nov 4th, 2005 05:08 |
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Joyce,
I was dx'ed with Lyme, right after receiving my Medicare disability for FMS and CFS, along with some other conditions. The practioner who dxed me with Lyme told me NOT to apply for the Medicare Prescription Programs. They would never agree with the long term use of abx nor the expense of some of them, and that I would be better off with the manufacturer's drug programs. Thus I have Medicare part A & B so my office visits, labs, procedures, and hospitalization, etc. are covered, but have no prescription insurance---so I can receive the free meds from the drug programs.
BW
hrts
____________________
LYME COPD Arterioscl Seiz FM CFS Hypertens NASH HiChol/ 4.2cmKidneyMass&Stones HyperCaPhUria Angina Arryth SOB RadNeurop BiPolarI| 1/05 25D-14 1,25D-13 2/07 25-D14| Nitro Verapamil Hydrocodone Baclofen Dicyclomine promethazine clonazepam
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jcwat101
Research Professional
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Posted: Sun Nov 13th, 2005 22:15 |
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I was wondering, if a doctor is asked by an insurer why the patient needs Benicar, is there some other indication other than high blood pressure that the doctor might refer to?
Or should they just try not to answer--saying only that "it is my judgement the patient benefits from it?" I have somewhat low blood pressure to begin with before the Benicar.
I know from Meg's previous post on this that the doctor should not mention the MP and just say that they are the one's practicing medicine and it is up to them. But I think it may be tougher with my insurer (see belos) -- does anyone have any suggestions? Or might the doctor say, the patient benefits from its anti inflammatory effects, or something like that? Or simply that it gives the patient some relief from symptoms of pain or fatigue?
I’m going to be trying with an Medicaid HMO, probably the toughest sell of any out there for coverage. I’m not even sure if my doctor will agree to request it at all (I have an outside doctor who has been prescribing it for me so far).
I want to give it my best shot, but I’m wondering if I do get a denial, then perhaps I can take a letter of denial to Sankyo and get them to provide some. Sankyo’s program says on their form that one is not eligible if one has drug coverage from Medicaid. I want to see whether, if I can show them that my insurance won’t give it to me, if Sankyo will. Anyone have thoughts on the Sankyo aspect of it? Whether if you can show your drug coverage won’t cover it, whether Sankyo will provide it.
With Medicaid you automatically get the drug coverage --one can't decline it like with Medicare, as was mentioned above.
Joyce Waterhouse, Ph.D.
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20 yrs with CFS/FM/Lyme/IBS, food sensitivities; 1,25D/25D 8/04:64/11 http://SynergyHN.com
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