Declining Medication Benefits?!

Declining Medication Benefits?

I have BC/BS - I take Effexor for hot flashes... I'm now being forced to prove it is *medically necessary* to continue treatment. When I signed on, hot flashes were ok... now after talking with them it sounds ifffyyy.... The XR work better than the generic, but if necessary I'll go back to generic.

Anyone have suggestions? I've changed insurance companies before just based on medications (I take 8, 3 generic)... now the new one is catching up...

How do people pay for $600/mo worth of meds?

Half vent/other half plea for help.

I know how to get reduced meds from the drug companies & other areas (I don't qualify).

TIA....

4 weeks ago
Thank you... No $600 is what I have to pay until my deductable is met (think jan/feb) - my out of pocket after 2K is about $100. The Effexor ER is about $150/month. I do not qualify for most plans because I actally have health insurance that DOES include prescription health coverage. If I didn't have that, I could apply to the drug companies directly (I've assisted one of my co-workers, she gets 1K+ a month free)... I own too many assests & make a fair amount of money....

It is the middle class crunch. I can deal with the $40 co-pay right now... I don't think I can do the extra $100.

Catch 22

Tia, my heart goes out to you and many others who find it difficult to pay
for the rising cost of medication.
If you feel that the Effexor (brand name) works better for you than generic,
speak to your physician about it and see if he/she will document that you
require the brand name. That should help you to continue receiving brand
name Effexor; at least it is worth a try. I know of others for whom this worked,
as long as their doctor was in agreement that the brand name was necessary, and there are some doctors who do believe that is sometimes
true.
I am assuming at this point that the $600 you are talking about is the co-pays
for the drugs you require each month, as you state you have BC/BS. Do they
cover the prescriptions at all?
There are programs like the Together program that help people with lower
incomes to help pay for prescriptions. I know there is another but I am
sorry, I cannot recall the name right now.
If you are a senior, perhaps your local senior center could provide you with
some helpful suggestions. Or your local library may be able to provide
some suggestions for local help.
I do wish you all the best; from experience, I know it is not easy.
God bless you,
Doris
WithWingsofAngels@comcast.net