Insurance Question on Prescriptions

**forHISglory** · 09-30-2011, 11:15 AM

Hi,
My elderly parents were just informed that their insurance company would no longer cover one of Dad's prescriptions. He needs it to stay alive!!! They have a very limited income (about $12000 a year from SS) and absolutely no money to pay for this. And the cost is too much for my sibs and I to absorb month after month, although we are willing to help.

Do any of you know of any organization that gives relief to seniors in this kind of condition? Thanks!

**Greebo** · 09-30-2011, 11:22 AM

Medicare and Medicaid come to mind.

However, I'd start w/ a call to your state insurance commissioner's office.

**Greebo** · 09-30-2011, 11:22 AM

Also, are you sure the ins. co isn't simply requiring your parents to get generic versions?

**Sara Noel** · 09-30-2011, 11:27 AM

BenefitsCheckUp - NCOA's Online Screening Service (specifically the first two links on that page)
Locate a foundation for the aging in his area:
Eldercare Locator

Can call manufacturer's directly. Ask his doctor for samples, too.
Contact United Way, Salvation Army and Goodwill, too. This is an emergency situation if he can't afford medication he requires to live.

What state is he in? There are some drug assistance programs available.

**Uniwolf** · 09-30-2011, 11:31 AM

You can also try your local Chatholic Church, some have funds that they use to help parishiners and community members to pay for scripts.

**heartofmine** · 09-30-2011, 11:49 AM

He needs to see his doctor and see if there is another prescription that can replace this one that insurance will cover. I also believe the doctor can write a letter to the insurance saying that he absolutely has to have the med to live to get them to cover it.

**forHISglory** · 09-30-2011, 12:20 PM

Thanks for the suggestions. I am passing them on to my folks and my sibs. He is already on Medicare, and there is not a generic for this drug. The insurance company specifically stated that they would not cover it, so it wasn't about switching to a generic. He went to the VA today (he's a vet), and they agreed to help with the meds. I'm not sure how much, so I really appreciate your suggestions. Thanks!!!

And about the generic..... I am on a generic for lowering cholesterol (simvastatin), and my insurance company just informed me that they would no longer cover it. My hubby also was informed by the same company that they would no longer cover his blood pressure meds. I also have some friends who got similar info in the couple months. What is going on???

**McD** · 09-30-2011, 12:21 PM

I know the city that I live in has a discount prescription program through the city. I'm not sure what it entails or what the benefits really are, but perhaps it is something to check on.

Best of luck.

**Ramona** · 09-30-2011, 12:40 PM

Originally Posted by Sara Noel

BenefitsCheckUp - NCOA's Online Screening Service (specifically the first two links on that page)
Locate a foundation for the aging in his area:
Eldercare Locator

Can call manufacturer's directly. Ask his doctor for samples, too.
Contact United Way, Salvation Army and Goodwill, too. This is an emergency situation if he can't afford medication he requires to live.

What state is he in? There are some drug assistance programs available.

Excellent advice. I see t.v. advertisements for meds that say if you have trouble paying for your prescription, contact the manufacturer.

**frugalfranny** · 09-30-2011, 12:54 PM

Originally Posted by forHISglory

Do any of you know of any organization that gives relief to seniors in this kind of condition? Thanks!

Talk to the Dr.............there is a program for low income to get the meds. free.........the Dr. has to fill out the form and send it in......but like the others said......contact the Manuf. as they can help too.

THERE IS HELP for low income...........it is just a matter of tracking it down.............but don't give up!!

A friend of mine was getting her Arth. drugs ($1500 a month!!) sent to her free...(overnighted and packed in a cooler)......she qualified and was low income.

Good luck..........

**ktsmama** · 09-30-2011, 12:57 PM

Originally Posted by forHISglory

Thanks for the suggestions. I am passing them on to my folks and my sibs. He is already on Medicare, and there is not a generic for this drug. The insurance company specifically stated that they would not cover it, so it wasn't about switching to a generic. He went to the VA today (he's a vet), and they agreed to help with the meds. I'm not sure how much, so I really appreciate your suggestions. Thanks!!!

And about the generic..... I am on a generic for lowering cholesterol (simvastatin), and my insurance company just informed me that they would no longer cover it. My hubby also was informed by the same company that they would no longer cover his blood pressure meds. I also have some friends who got similar info in the couple months. What is going on???

Glad to hear he might be getting some help with his medication!

**MaryCarney** · 09-30-2011, 01:26 PM

If your Dad is a veteran - the VA will take care of him at no cost. My dad gets all of his meds from the VA.

Just because there is no generic for a drug, does not mean that there is no other drug of a similar classification that will work just as well. Docs tend to prescribe the 'latest and the greatest' - when there are other drugs that work just as well.

You local senior services more than likely has a drug education program. You can ALWAYS go to Walgreens and talk to a pharmacist about this.

**frugalfranny** · 09-30-2011, 01:33 PM

Originally Posted by MaryCarney

Docs tend to prescribe the 'latest and the greatest' - when there are other drugs that work just as well.

Yeah, that. PLUS......check on $ about the NUMBER that is prescribed.

It is cheaper for me to pay for 90 of my pills myself than to do my co-pay for three months time, as that is all that is "ALLOWED" to get at one time. (30 pills at one time----X 3 months = 3 co-pays) (hope that makes sense)

AND.........my Dr. was going to give me just 20 pills that HAD to be picked up at my ins. pharmacy.......and I told him if he couldn't write it for 30 to forget it as 20 pills cost exactly the same as 30 pills...........due to the co-pay!!

The things you have to watch for!! wears me out....

**shoiji** · 09-30-2011, 02:21 PM

Check to see if your state has a prescription plan for seniors. Have your parents call the doctor and stating that their insurance no longer covers the medication. Tell the doctors office which prescription plan they have. Many times the doctors office will know what medication is covered under a prescription plan. Hopefully they will be able to change the prescription.

This type of situation has been going on for a while. You really do not find out about it unless your medication all of a sudden becomes one of the ones not covered. Many of the places I go to before the doctor prescribes a drug they ask what insurance I have. Every year your insurance company probably sends you a list of the medications that are or are not covered under your plan. Try to get yourself and your parents in the habit of asking the doctor if it is covered under your insurance before you walk out the doctors office. You can probably understand more why people were going to Canada to get medications cheaper.

Personally I try to do as much as I can to avoid having to take medications. Sure there are some you can't avoid, but I try to be as holistic in my approach to stay as healthy as possible. Also, all the side effects from medication that is supposed to help you makes me want to stay as healthy as possible. I know if I am a certain weight my cholesterol will be ok. If I gain weight my cholesterol goes up. Things like that.