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Thu Oct 10, 2013, 02:16 PM

Insurance Company: Mini-Rant

Suddenly my insurance company is refusing to pay for a drug that I have been taking and that has been doing a splendid job for four years. To refill it will cost $2,598.88, or $28.77 per pill.

I am relatively young (50) and I'm fortunate to have a secure, well-paying job with insurance. I can't pay $2,600 a month for a drug, but I am grateful nonetheless that I have insurance and good health care.

But I have never hated an entity as much as I loathe this insurance company right now.

My doctor was on the phone with them for 25 minutes, justifying my need for this drug. They said it would take five days to make a determination. I don't have five days' worth of the drug left.* And their decision could be "no." If it is, my doctor is going to have to transition me to a new medicine.

I cannot imagine the lives of the uninsured who need medicine. I am very grateful, and I also feel very guilty that I have insurance when so many don't. Can the ACA honestly do enough?

* I can't be without the drug, so I will have to find a way to buy 10 pills to get me through to the day they make their decision. I can't afford $287.70 right now. (My wife is a federal employee. . . . )

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Response to Bertha Venation (Original post)

Thu Oct 10, 2013, 02:21 PM

1. Go to the manufacturer's website. Frequently they will offer very generous coupons.

Or try googling "drug name) discount" or "drug name) coupon".

And check the prices at a Canadian pharmacy. I have used onlinecanadianpharmacy.com and have been very satisfied. Their prices for some medicines are hugely discounted compared to here. (It's a long process for your first order, however, so this is more for the long term than your immediate needs).

On edit: ask your dr if he has any samples he can give you to keep you going for now.

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Response to Nye Bevan (Reply #1)

Thu Oct 10, 2013, 10:39 PM

4. Hi, Nye

I checked Janssen's website (drug's mfr); they do not offer discounts, coupons, or special programs.

Invega is one of the few drugs my doc - a great one - doesn't keep samples of.

Haven't checked Canadian pharmacies yet.

Thanks for your suggestions.

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Response to Bertha Venation (Reply #4)

Thu Oct 10, 2013, 11:03 PM

9. Online Canadian Pharmacy has that drug for much less than $28 per pill:



http://www.onlinecanadianpharmacy.com/drugdetail.aspx?DrugName=Invega

Having said that, I obviously don't know if one of these sizes is the same as your prescription. This is a legitimate pharmacy, a member of CIPA (Canadian International Pharmacy Association). I used them for a prescription medicine and they insisted not only on me sending them the prescription but they also called the doctor to verify the dosage. The whole procedure took a couple of weeks but this shows they are not just concerned about making money.

The manufacturer does offer a free 15-day trial which you should be able to take advantage of one time:

https://www.invega.com/free-trial-invega-voucher

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Response to Bertha Venation (Reply #4)

Thu Oct 10, 2013, 11:18 PM

10. Also notice that you can buy the generic version (Paliperidone) from Online Canadian Pharmacy

at a price of $195 for 84 tablets (3 mg) which is enormously cheaper than $28 per pill.

My understanding is that the generic has not yet been made available in the US but of course this does not prevent you buying it from Canada.

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Response to Bertha Venation (Original post)

Thu Oct 10, 2013, 02:23 PM

2. After this, you want to consider

changing to your wife's FEHBP? Open Season when?
Good luck.

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Response to elleng (Reply #2)

Thu Oct 10, 2013, 10:42 PM

5. We can't afford to put me on her insurance

The premium would be four times my current premium with my employer's insurance. I must say here, though, that this is the first insurance problem I've had. May it be the last.

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Response to Bertha Venation (Reply #5)

Thu Oct 10, 2013, 10:49 PM

7. Fingers crossed.

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Response to Bertha Venation (Original post)

Thu Oct 10, 2013, 02:30 PM

3. Good luck. Surely they are offering some alternative.


When I changed employment, the new insurer would not cover a med I took. There was an older generic which was much the same, but was not time released. It was a lot cheaper. I complained, etc. Doc assured me the older med was just as good, I only had to take it more often. It was a lot cheaper, so I gave it a try. And, in my case, it worked.

I don't know what drug you are taking, so there may not be as simple a way out.

In any event, I hope the insurer does something to keep you from having to deal with this, with a dead-line approaching.

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Response to Hoyt (Reply #3)

Thu Oct 10, 2013, 10:43 PM

6. Thanks, Hoyt.

I'm very glad you found a solution that worked!

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Response to Bertha Venation (Original post)

Thu Oct 10, 2013, 10:50 PM

8. I find it odd that some people think that "the government" "getting between" them and their doctors

would be any worse than the way insurance companies get between them and their doctors.

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