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I need medicine. What do I do?

asked 2016-03-23 23:00:40 -0800

GaiaofSpiders gravatar image

updated 2016-04-04 22:53:10 -0800

Susan gravatar image

I am disabled & housebound. I have a degenerative spine disease & other conditions. I've been on SSDI, paying monthly premiums & Medicare D [AARP Preferred RX--bunch of CRAP]. They have increased premiums every year -- first year I am recieving a lot less....But BIG Problem is that Medicare D has removed 3 of my medications from it's formulary. I CANNOT be without a maintenance medication...but Optum RX has denied my doctors request twice. I am having severe painful random muscle spasms from butt down to toes, 24/7-any time. The Rx Medicare D has records of my always being on a muscle relaxant, since I have bilaterally compromised nerve roots at L5 and C6. Their doctors have refused my PCP's 2nd request, and OptumRX is putting me in medical jeopardy. I'm too scared to get handicap taxi to doctor, and what good will it do? Do I need to get medical legal aid? I am stressed, and without the medication, I am in acute pain when spasms occur-and must deal with chronic pain from degenerative Spine Disease. All my regular doctors & rheumatologists have retired. I desperately need cortisone injection, and what do I do (I'm on extra help -- they pay for all the very cheap meds -- yet the huge increase in Medicare D shows that the plan barely pays anything for .90% of my medications. Holy Cross ignored me about my medications, and secretly lowered the dose of my seizure medication (they only gave me 1 of 2). The exact day I was to be discharged, I had 1 or 2 (do not remember, but roomate does!) Gran Mal Seizues--Right in front of H.C,'s Dr. Lemna. They ignored my medical routine. Now, I desperately need Metaxalone or some generic, but Rx coverage is refusing ... I'm afraid to go to bed -- I'll be waken up by severe muscle spasms in toes, calves, hamstrings, buttucks ... but Optum RX has denied REQUIRED Maintenance Medication. I'm in pain. What do I do?

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answered 2016-04-08 12:32:36 -0800

Susan gravatar image

So sorry for your difficlties! Sometimes drug companies will help you directly if you or your doctor asks. You might try contacting your doctor to ask for his or support in this effort or go directly to the drug company and include your notification that your medication is no longer covered along with an indication of your income level. They may very well be able to help you directly.

It is also my understanding that drug companies set up Patient Assistance Programs  in order to provide free or low cost drugs to those who cannot afford them. The programs typically include most brand name drugs. These are not government funded but are private programs. Usually they provide only to those without insurance or prescription coverage but you should be able to apply since your medication is no longer covered by your insurance. It would also help if you have a letter or a  copy of your notification that your medication is not covered. You can find a list of specific diseases and the co-pay assistance organizations that offer help with them here.

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