Connect
Medication needed will take over half monthly income
I've been dealing with yeast infections since the beginning of the year. Take all advice, do the diet, species is common, and swabbed negative for ureaplasma mycoplasma. Now Im wanting to try a different medication. I've been taking Diflucan in multiples when infection reappears or doesn't go away completely. Now im in a loop of this every month. Dr prescribed Brexafemme but it's over 500 dollars.
My insurance denied it even though I've tried everything else. And when I thought I had a good coupon I read the fine print and Medicaid recipients are excluded from this coupon.
Hmm, well if I would buy it, it be over half my monthly fixed income.
How the hell does that all work out?
I need to have it. I've been sick for 7 months. Im at a loss and barely hanging onto sanity.
No idea what to do but go broke.
Like
Helpful
HugInterested in more discussions like this? Go to the Women's Health Support Group.
Connect
Can you ask the pharmacist if there’s a generic brand of the same medication?
-
Like -
Helpful -
Hug
1 Reaction@januaryjane
It is always frustrating when the solution to problem is not available due to insurance issues. I have also ran into this situation. I am on Medicare, but some of same rules apply to Medicare as Medicaid. The newest drugs are usually more expensive due to no generic version being available. In my case, I was able to use a GoodRx coupon. I checked for Brexafemme and even with coupon it is over $500. Also, I did a little research on why pharmaceutical companies will not let Medicaid and Medicare patients use their coupons, it is due to the Anti-Kickback Statute from the Social Security Amendments (1972).
I can offer few suggestions:
- Discuss price with provider, sounds like you tried other medications, but let him know Brexafemme is not an option due to cost.
- Appeal the denial. Here is some general information about appealing a health care decision:
-- https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/indexappealinghealthplandecisions
-- https://www.healthcare.gov/appeal-insurance-company-decision/
- Medicaid is administered at state level, so you will have to check with your states Medicaid information about appeal process. It may require your provider to provide documentation on what alterative / cheaper medications you have tried and the fact they did not work and why Brexafemme is needed.
Are you going to continue with current medication instead of Brexafemme?
-
Like -
Helpful -
Hug
5 ReactionsSometimes the drug company offers financial assitance. Did you reach out to them? I take an $85,000 biologic for my rheumatoid arthritis, but I only pay $35/month because the drug company pays for most of it, with my insurance picking up most of the rest.
-
Like -
Helpful -
Hug
2 ReactionsCan your doctor request an exception?
-
Like -
Helpful -
Hug
1 ReactionWhat kind of doctor is treating you? Have you been screened for diseases that increase risk of yeast infections, such as diabetes or a weakened immune system ? Has you discussed with your doctor treating a sexual partner? In unusual cases, yeast infections can be passed back and forth sexually. Have you had a vaginal micro biome test? Has a fungal culture been done? If the yeast is resistant to fluconazole, perhaps there is a cheaper alternative that it is sensitive to? I’m just thinking out loud about ways to treat you effectively without breaking the bank.
-
Like -
Helpful -
Hug
1 ReactionCheck with pharmaceutical company to see if you qualify under their Patient Assistance Program
-
Like -
Helpful -
Hug
1 ReactionAre you sure that what you have is a yeast infection? I had symptoms that were like a yeast infection or UTI (which I tested negative for both), but it turned out to be interstitial cystitis, causing the same sort of irritation. I went to a urologist, and they recommended estradiol cream, which worked like a charm. Plus, it's very inexpensive. The secret was not to follow the instructions on the package because that was too much and it burned, but my doctor said to use a small dime size dollop every other day and low, and behold all my symptoms disappeared. Now I only use it as needed.
-
Like -
Helpful -
Hug
2 ReactionsNo generic
Yes, Im seeing a gyno and I've been tested every time. They occasionally check my urine too. Not sexually active, tested for stds, cultured(common species), and my blood sugar and a1c tests always normal. Recently did another swab for mycoplasma and ureaplasma which was negative. Limiting sugar, taking probiotics orally and now the suppositories.
Yes seeing a gyno. No diabetes or sexual partner. Cultured and was common species. Tested negative for mycoplasma and ureaplasma. Found out my insurance finally approved Brexafemme and learned they aren't even making it right now due to recall.