I realize there are people a lot sicker and a lot poorer than I am. My rant here probably is not justified, but I need to tell somebody about the frustration I'm encountering. One of my illnesses has to do with my blood forming clots for no apparent reason. After being hospitalized a time or two with life threatening pulmonary embolisms, my doctor decided it would be a good idea to put me on blood thinners for the rest of my life. The go-to drug is Coumadin. Right from the first prescription my insurance company objected, as if they know better than my doctor. Warfarin was cheaper and they had no other justification for not paying for the Coumadin. My doctor conceded, and went with what the insurance people decided.
Warfarin is a tricky drug that can interact in strange ways with other drugs. It works on the vitamin K level in your blood so that you have to be careful what you eat too. I was pretty stable using Warfarin for about ten years. Then, blood clots started to form again. That's a whole different story I don't want to get into in this thread, but I will say my trust of the doctors in Missouri has been diminished. Anyway, after some ultrasounds to confirm what was happening the blood thinner drug was changed from Warfarin to Xaralto. While the Xaralto seems to be doing its job, my co-payment rose from $12 for the Warfarin to $145 for the Xaralto. That's a pretty hefty price to pay for a pill 1/4th the size of the one I was taking. It's an outrageous co-pay, but it's doable.
When I received my monthly statement from the insurance company, they claimed to be paying out over $1000 for the Xaralto. That explains the rise in my co-payment. Being allied with Medicare, there is a limit to how much I can spend on drugs every year, or rather, how much the insurance company will pay. Once they pay out $3700 (more or less) they stop paying for any medications at all. At that point I will have to pay the retail price for Xarelto, which is nearly $1200. It's the old donut-hole trick that Gary has explained to us more than once. I won't go bankrupt paying $1200 for pills I can hardly see with the naked eye, but it will have an impact on the budget. With luck I'd only have to pay this once a year, depending on how many other expensive drugs I have to consume in the meantime. It all gets reset back to zero in January, when the new insurance cycle starts again.
None of the above is too bothersome for me. I know what to expect so that there have been no surprises. But then I found out some people can get Xarelto free, as in at no cost whatsoever. My son-in-law also has to take blood thinners and was put on Xarelto right off. The medical staff did all the paperwork for him, and he now gets free Xarelto. He lives in Florida and runs a large division of a major medical supply company. In other words he is making mega bucks working. So, I asked my daughter how he is able to get free Xarelto, and she sent me the information. My hematologist gave me the same information when I told him about my concerns. My primary care physician also gave me the identical information. All I had to do was go to their website, apply for a discount card, and get authorized. I did that and was told I don't qualify for the freebie because I'm covered by Medicare Part D.
There is a reason I must use Medicare. I'm old and I'm not working and my income is not half a million dollars a year. Thus I need all the help I can get to pay for expensive necessities. I can't afford to drop Medicare so that I can apply for free drugs. There are too many other things Medicare provides for very well. But here, my highly successful and quite wealthy son-in-law qualifies for drug assistance, and I do not. It's not his fault. I understand that. There is simply something wrong with the system that allows such situations to arise in the first place.
