Banging my head against a wall. Again.

Discussion in 'Failure to Thrive' started by soapbox, Mar 1, 2016.

  1. soapbox

    soapbox Member

    Oldest is an "adult" now. Sort of - you may know what I mean. We're into the next layer of ... no support anywhere. Please forgive me. I just need to RANT. There are no answers.

    Oldest is working, full time. Had half decent benefits, then the company gets bought out. New benefits plan... OUCH!

    He's on four medications, three of which are expensive.
    I don't care who covers or whether any plan covers the inexpensive one.
    Of the other three, ONE is partly paid for by a provincial plan.
    One is not covered by ANY plan that we have access to.
    And the last one, well, the old plan covered a fair bit of that one. But. There is an annual limit. Which we reach before we get to the end of the year. At about $500 per month... OUCH!

    The new plan has a severe restriction. All "non-controlled" medications used on a regular basis (i.e., this doesn't count for, say, antibiotics, or for controlled substances like Ritalin) must ONLY be purchased through one specific on-line pharmacy.

    Psychiatrist wants oldest to be on bubble-pack for the medications.
    Pharmacy can only do that if they dispense ALL of the medications.
    Extended insurance plan won't cover three of the medications unless it is NOT dispensed by retail pharmacy. (The plan will cover the controlled substance being dispensed by retail... and the on-line pharmacy cannot dispense that one, so can't do bubble pack either)
    Psychiatrist says there are no other medications that will work, due to liver damage (long story, not oldest's fault) and drug interactions. Some of the standard medications might have worked and are a LOT cheaper - but we can't go there. Provincial drug plan says: one of the medications is not covered for anybody, there is a short-acting form that is just as good (not - been there, too hard to be consistent); and that same plan says the other expensive medication is not covered for the diagnosed condition.

    Oh, and we're still adjusting medications. Psychiatrist expects us to make the switch on the day we get the script. Not one-to-two weeks later that is available through the on-line pharmacy. And adjusting one medication means adjusting at least one other medication.

    Social services will not cover any of it - he makes too much money.

    Do we really live in a world where insurance plans and pharmacies get to determine what medications people can or cannot take? Where the medications that are covered are going to kill you - and the medications that are not covered kill you anyway because you can't afford to eat? (yes, son eats - because we pay for both his food and his medications...)

    This is 2015, people. And this is the best we can do?

    (I'm in Canada - we don't even have the option of carrying oldest on husband's group benefits, because... he is older than 18 and not a student.)
     
  2. in a daze

    in a daze Well-Known Member

    Infuriating, isn't it, Soapbox?

    Difficult Child' s psychiatrist wrote a letter to one of his plans as his antidepressant was not on formulary and they ended up covering it. Sometimes it takes a letter of medical necessity from the doctor. Could you appeal?

    My parents died in 2005, and they were on some really expensive medications not covered by their plan...risperdal, requip, a couple others I can't recall. So I sent away for them from....guess where...Canada! Guess things have changed. (I know you can't use the mail order because they are still titrating.)

    Just curious, why the bubble pack?
     
  3. soapbox

    soapbox Member

    Bubble pack. Psychiatrist wants him to be as independent as possible. Already has it set up so all medications are once per day at breakfast (psychiatrist says it's the best way to be medications compliant - make it simple). Bubble pack makes it obvious if a day's medications have been taken or not. Also makes it obvious when he is needing to re-order.

    Things haven't changed, IAD - it's just that the newest medications are REALLY expensive, and really not covered period.
     
  4. Copabanana

    Copabanana Well-Known Member

    I made a good decision a year ago.

    When Obamacare went into effect son could stay on my insurance until he was 26. By that time he had gotten himself approved for SSI which included medical coverage. None the less I petitioned that he be maintained on my insurance based on his disability and they approved. The coverage will be reviewed every 5 years with the potential it last I think until I die.

    Even though he has double coverage it gives me peace. My son has Hepatitis B (not his fault either.) He is not taking the medication and has not for several years but when he did it was $1000 a month almost.

    While he was growing up he might have qualified for government benefits, I think. I refused to even think about it, because I wanted to assume he would be OK.

    This is the thing that haunts me somewhat. By my stance, did I help or hurt him? Nobody will ever know. Because the story is not yet written. We do not know how it will end.
    Sounds like a good doctor.

    COPA
     
  5. soapbox

    soapbox Member

    On one side of things, yes.

    On the side of getting help with insurance issues, or applying for the Canadian version of "disability"... no. He doesn't want paperwork (he IS busy, but still), and doesn't want oldest to end up getting hung up on this "being disabled" thought process. Because, he IS Aspie, whether they have given him that diagnosis or not - and when he gets something in his mind, it is very hard to get it back out again.
     
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