So, I was originally planning to have this post be about natural healing, but I feel that this is a slightly more important topic. As I’ve mentioned probably a million times before, I am taking Plaquenil and Celebrex to control my RA. I take Plaquenil twice a day to keep my immune system under control. The Celebrex is taken twice a day as needed, and I usually only take it on days when my inflammation levels are high and there’s a lot of pain. My doc told me it was okay to take it daily, but at $60 for a 30 day supply, I figured I’d save myself some money.
Well, I recently needed to get a refill on my prescriptions. Imagine my surprise when the pharmacy told me that it would be $160 dollars for the Celebrex! I was aware that my insurance company had bumped up my copay a bit, but really?! My Plaquenil only went from $10 to $15. Sometimes I feel like insurance and pharmaceutical companies think everybody is rich. The truth is though, that if my prescription is going to be $160 a bottle, then I need to make sure the bottle I just got lasts for the next 6 months. I’m still in school, so I only work part time. Quite frankly, this expense is worth half of my paycheck. I still have school loans and other bills to pay, and I need to somehow find a way to feed myself. I know Mom will always be willing to help, but I’m too stubborn to have other people paying for my expenses. And I’m sure as hell NOT going to charge it to my credit card, because 60 little pills aren’t worth the ridiculous amounts of interest that I’d be stuck paying.
I spoke to a friend of mine, who happens to be a pharmacist. She explained the 3-tier system that insurance companies use for determining the amount that we pay for a certain drug. She sat down with my and we checked out my insurance company’s website to see what they had Celebrex listed as. Turns out that it is a third-tier prescription (meaning the most expensive) and is also listed as “Supply Limited” for my insurance company. At that moment, it dawned on me: this week makes it exactly one year since I got my official diagnosis. When I told her this, she said that companies usually only cover a certain amount of a prescription’s cost for one year. Any longer than that, and a patient needs to pay a higher price.
However, there might be a happy ending. She said that since this is a medication I might be on for the rest of my life, my doctor may be able to contact the insurance company and get the price brought back down to what I was paying before.
This got me thinking though…I consider myself to be very fortunate. As much as the pay may suck sometimes, I have a job that gets me by. I have medical insurance (thanks to Mom, of course) that keeps me from paying full price for doctor visits and prescriptions. But what about the people who aren’t as lucky as I am? How are they supposed to buy the medication they need? Or are they just supposed to suck it up and deal with the pain in other ways? What if it’s a child with JRA who’s in pain? Tylenol and Aleve help slightly, but they aren’t strong enough to combat a full blown flare. And then of course, my thoughts turned to my boyfriend, who has HIV. If he didn’t have insurance, how could he afford to pay thousands of dollars a month for the medication that’s keeping him alive? What if his insurance company started charging him a higher copay for it?
Here’s my logic. Plants and herbs are relatively cheap, correct? And though I’m not a pharmacist and don’t have a degree in medicine or chemistry or anything, aren’t most medications made with plants? So, doesn’t that mean that in theory, it shouldn’t cost an arm and a leg for a single pill? I mean, generic brand prescriptions and OTCs are generally on the cheap(er) side. Does that mean that the only reason I’ll need to sell my future firstborn child to pay for this stuff is because it’s a “designer label”?
My doctor and I have had the same discussion a million times about why he won’t change my prescription. I’ll explain that in a future post. So, I’m going to ask: What would you do if your copay went up? Would you continue to buy the prescription as usual? Would you stop taking it? Have your doctor change it? Feel free to leave some comments, but be nice!