Wednesday, September 28, 2011

2011_06_21 Roller Coaster

What a crazy few days it's been. Thursday, I got a call, THE call which I'd been waiting for, the call about the $$ copays. I sat with notepad and pen as this nice young man, Brian, gave me numbers that sent waves of adrenaline through my body.

My copay for the newest drug, Incivek, would be $4678.36 per month. He then explained that Vertex, the company that makes Incivek, had a patient assistance program in which they offer up to $10,000. Well, that pays for a little over 2 months, and it's a 3 month round of pills. That would leave us owing about $3800 for month 3.

The interferon, Pegasys, has a $449.27 copay per month. Although a much smaller amount, still out of our reach. I am already paying out over $500 per month in medical bills. Heck, I've not quite finished paying for the kidney stone Greg had last August! But this drug also has patient assistance programs.

Needless to say, the call left me very upset. Thinking about that 3rd month on Incivek made it all impossible. I had plans for the day, and kept them so as not to sit home and worry all day. The distraction was good, but in moments of quiet, my mind wandered and the adrenaline would flow. I'd taken 2 Klonipin and they weren't touching it. But I reached a point that day of simply letting go. I said quite clearly to God that He'd have to make this happen. There was no way I could do it. We couldn't come up with that much money. If it was meant to be, God would have to make the way. If He didn't, I would take it to mean this was not meant to happen now. I decided not to share my worry with Greg. That's not something I am usually able to do, but he fell asleep that night knowing nothing about it.

Friday was my "scoot down, scoot down" appointment to be fitted for a diaphragm. That was nice and uneventful. I'd purposely made an appointment with a woman, and that was easier (I'm just not okay with a male GYN anymore). She was very sweet (and very pregnant) and said all looked good. I have a prescription now for my diaphragm.

Late Friday afternoon, I got another call from Brian. He asked if I had made my calls yet, but I had not. He said he was calling with better news. Bring it. We are about $1200 from meeting our deductible($6000). But we have an annual out-of-pocket cap of $10,000. Which means after one month of these meds we'd reach that cap and I'd have no more copays. It took a long time for that to make sense to me, but I see it now. It's not that "I" have to pay out $10,000, it's that the insurance pays 80%. How that other 20% is met is between me and the service provider. So having the drug company absorb that 20% counts toward my out-of-pocket total. So I will only need assistance for the first month.

Monday I made my phone calls. That's bit of a phobia for me. I am not comfortable on the phone. I am an email person. And the idea of calling and asking for financial help just made me ill. But I did it. The Incivek people were great. It took all of 10 minutes for me to have several numbers for the pharmacy to use to process payment. It's a done deal! The Pegasys people were equally nice, but their process is a little more detailed, as they help find non-profits who help pay the copays. I should get a call from them tomorrow. But even if they don't help, I feel certain we can come up with that one copay for the first month. Of course, I'd prefer not to, but we can rob Peter to pay Paul one month if we have to.

Anyway, the ball is no longer in my court. And I finally told Greg the whole story. We are getting closer and closer. :)


Stephanie said...

WOW! I don't know what else to say...That's a lot of $$$$ for a drug! I totally understand the phone aversion, I get anxiety too, I hate it. I'm so glad things are falling into place!

GregJrsMom said...

It is disgusting, isn't it? Who could possibly pay bills like that? If my 20% is $4600, that means the drug costs $23000 per month. Taking 2 pills three times a day, that comes to $127.77 per pill. Is my health worth that? Of course it is, but that doesn't make it okay. I realize these companies have to make money and getting drugs approved is very costly, but if the cost keeps people from being able to take it, what's the point of having it?

jaci said...

My mind is boggled. I don't think it gets better under the new health care bill, either.

Still praying for you, Penny!