Bad News, Good News

I have a couple of chronic diseases and have to inject myself with a medicine called Enbrel once a week. I tell you this not for pity or anything, but because that is what this post is about, the bad news and good news of using Enbrel.

Enbrel is a very, very expensive medicine. However, my medical insurance covers is and my co-pay is only $110/month. Added to the rest of the medicines I have to take my total co-pays each month is over $200. Monday I saw the dr. and he changed one of my medicines and added another and they run in the $30-50 co-pay range.

Well, I get to the pharmacy and the pharmacist tells me, "We did an audit of our medicines and inventory and reconciled it to our records. We discovered that we have been undercharging you for your Enbrel. We have been charging you for only one dose instead of 4 each month. So really we should have charged you $3,200 more. But since it was our mistake, we won't back charge you. However, from now on we will be charging you the correct price, $436.59/month."

Are you kidding me?! There is no way on earth I will ever be able to afford this. So I spent the rest of Monday in a real bad/sad mood. I cried and cried not knowing what I was going to do. It was even suggested to me that I was faking my symptoms. Then it was suggested to me that I was just lazy and why don't I quit crying like a big baby, get off my rear and get a real job so that I could purchase the medicine. Thanks for the support. This was a real dillema for me. Without the medicine, I literally cannot move and eventually my spinal colum and my ribs will fuse together, not to mention the effects of the other disease. So what to do, what to do. Change jobs, stop the medicine, quit living?

What I ended up doing was praying really hard that I could find a solution to this problem.

Forward to Tuesday afternoon. I called the insurance to see if it was really true that my co-pay was $430+. The helpful customer assistant tech that I talked to told me that yes, indeed, my co-pay for my prescription is $436.59. Then he said, "But wait, that is a specialty medicine and I wonder if it would be cheaper if you go through the specialty pharmacy. Let me look that up for you. Can you hold?"

I am thinking that if he could get it for even half I would be happy. He came back on line and said, "Ok, if you continue going to your neighborhood pharmacy a 1 month supply of Enbrel in your dosage is $436.59. But if you were to use the specialty pharmacy you can get a 3 month's supply for $25."

Are you kidding me?! I can continue paying over $400 for 4 injections or I can pay $25 for 12? I may not be a great mathematician, but this appears to be a no brainer to me. All I have to do is have my rheumatologist write me a prescription for a 90 day supply and fax it to the insurance. Then the insurance company will get the paperwork to the specialty pharmacy and my medicine will be delivered to my door.

Next thing I did? A prayer of gratitude for this wonderful solution to my dillema.