This is effed up

The past 24 hours have been filled with lots of tears.

I won't lie; my parents pay the bulk of my health insurance every month.  I don't have a big girl job therefore I count on them to foot the bill for what is a ridiculous amount every month.  Health insurance ain't cheap, especially when you need to have the best plan available.

So it came as a surprise to me yesterday when my pharmacy called to make sure I knew that my first Humira dose was going to cost 4000 dollars.  After I fronted the 4 g's, I'd be reimbursed by my health insurance company for half that amount.  2000 dollars?  For the rest of the year, I'd have to shell out 1500 monthly, being reimbursed half the amount again.  No big deal right?  Basically, the two weeks I waited for approval was so they could tell me, "Have fun figuring this one out."

When you are an individual who decides to purchase health insurance, even when you have the highest, most expensive package, you do not receive the same benefits as someone who has insurance through their employer.  Employers are able to negotiate the terms of insurance, etc.  Therefore they can apparently get things for their employees that even an individual just trying to keep themselves healthy cannot purchase.  I'm just learning this because I've only been on my own policy for about a year and never really had to get expensive prescriptions.

The shocking aspect to me was that Remicade, which I was previously on, is the same price as Humira.  However, it is administered through outpatient at the hospital.  Why then, can I not receive the SAME type of drug that I received for free in the hospital, at home?  What benefit do they receive from me being in the hospital when I get treated?  I understand it, but at the same time, I don't.  If I were to continue down this path without effective treatment, I could end up in the hospital possibly having surgery.  I guess in the long term, surgeries and hospital stays once or twice a year are cheaper than giving someone a good quality of life.

Luckily the nurse at my doctor's office has been extremely helpful in terms of working this out with me.  It's a bitch.  I have to apply for a couple of patient assistance programs, one of them offered through Humira, specifically for people with health insurance who aren't totally covered.  It consists of lots of paperwork, which is going to delay this process even longer.  Because Humira is a newer drug, they want people to be on it.  This specific program offers the most substantial aid in covering my co-pay and it's good for one year.  After that year is up, who knows?  Maybe this year is the year they discover the cure.   

1 comment:

Ashley said...

hi, my name is ashley, I too have chrones. For me it was the opposite, i wanted to go on remicade and i was on humira. Humira only costed me 50 bucks a month whereas remicade was going to cost 1700 a month. Its stupid because they are the exact same drug, shouldn't they cost the same?
I hope all works out for you, and you get to switch to humira