Wednesday, August 20, 2008

Insurance blues

My seizures continue to come, even with the medication adjustment. I am waiting for a call from my neurologist as I write this. It seemed at first that the increased dose had controlled them. The increase has definitely made them more mild.

I found out the hard way, that my medication is now available in a generic form. Lamictal has always only had the brand name available. My insurance company has a program through Walgreens mail order service. If you send in a 3 month supply/prescription then your medication is cheaper. I am currently on a high deductible plan. But pharmacy covereage is not the best on this plan. My medication, prior to the increased dose, had a co-pay of around $850.

I sent in my new prescription via mail. About a week or so later I received a generic form of my drug. No one called to tell me a generic was available or ask me if I wanted generic or brand name, as they sometimes will as you if you walk into a pharmacy. My co-pay this time was $517, even with the increased dose.

I am sure that most people assume that generic medication is exactly the same as brand name or non-generic. That is not the case in most situations. And I have always been told to not substitute a generic for an epilepsy medication regardless.

A kind of panic ran through me as I stared at this new bottle of a drug I was afraid to take. Even if I had been having no issues with active seizures, I do not think that I would have been tempted to take the risk of any difference between generic and name brand.

I walked into a walgreens to get a small amount of my pills so that I could continue with my name brand for now until I could sort things out with the mail order issue. They tried to give me generic there as well, but I was able to change it while I was there. Twenty-five pills was $112.

I called Walgreens mail order to try and return the generic drug. They will not take it or refund the amount. They are filling the prescription according to what my insurance company has in place for my coverage apparently. The coverage is stated such that if a generic is available, a generic must be prescribed.

I called the insurance company since this was the first time a generic was available for Lamictal. They said they would not refund it and if I tried to get brand name that they would pay nothing on brand name. They said I could try to appeal their decision. I filed my appeal throught the proper channels and then hung up the phone.

The next day the appeal department returned my call. I tried to explain to her that generic and brand name is not always the same. She said that as long as the active ingredient is the same, that they will only cover generic. Of course the active ingredient is the same, but it does not mean that the pills have the same amount of the active ingredient. Guidelines are different for generic manufactures compared to brand name drugs.

The insurance rep told me that she had seen a claim come in from a Walgreens for a new prescription for me for name brand. I had my doctor call in more pills for me to get by until this was all sorted out. She said they denied the claim and the full price would be mine when I picked them up from the pharmacy. This time, fifty-five pills was $293.

She asked me if I wanted to continue with the appeal. I asked her if I should even bother since now they will not pay anything on my brand name drug. She said it would get denied. So we closed the conversation.

As a third option, and out of defiance, I called the credit card company where the charge had been billed. Because I wanted to return the generic and had not used it I wanted a refund, which was being denied by Walgreens mail order service. My credit card company put the charge in suspense until they could research the claim. You can dispute a charge for certain circumstances. I felt that this may be one of them.

I have not heard back yet from my credit card company, but I will let you know how that turns out! Read more!