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Medication needed will take over half monthly income

Posted by januaryjane @januaryjane, Jul 7 2:21am

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.

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januaryjane | @januaryjane | Jul 19 11:56am
In reply to @marjou "Check with pharmaceutical company to see if you qualify under their Patient Assistance Program" + (show)
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Check with pharmaceutical company to see if you qualify under their Patient Assistance Program

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Thanks, will keep this in mind

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januaryjane | @januaryjane | Jul 19 11:58am
In reply to @marjou "Check with pharmaceutical company to see if you qualify under their Patient Assistance Program" + (show)
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Check with pharmaceutical company to see if you qualify under their Patient Assistance Program

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Learned Brexafemme is not being sold right now after insurance would finally cover it.

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januaryjane | @januaryjane | Jul 19 12:00pm
In reply to @tsch "Can your doctor request an exception?" + (show)
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Can your doctor request an exception?

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Dr sent to insurance all that I've tried and they finally approved. But the medication is not being sold at the moment due to recall.

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januaryjane | @januaryjane | Jul 19 12:02pm
In reply to @maidenmn "Sometimes the drug company offers financial assitance. Did you reach out to them? I take an..." + (show)
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Sometimes 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.

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Thanks and that's good for you! My insurance finally covered the medication then I couldn't order it anywhere. Turns out there's been trouble with a recall and studies being pushed back.

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januaryjane | @januaryjane | Jul 19 12:13pm
In reply to @roch "@januaryjane It is always frustrating when the solution to problem is not available due to insurance..." + (show)
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@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?

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My insurance finally approved Brexafemme just to learn that it's not available due to a recall and clinical trial problems. There isn't many options so I just got done with 14 days of Diflucan. This is the 5th time I've been treated this year and I feel like I still have it, am going back to gyno next week.
Im taking probiotics and boric acid suppositories. Just ordered probiotic suppositories. I even bought Benefiber which has probiotics and restricting diet. Yeast got cultured and it's the common species. Swabbed for mycoplasma and ureaplasma, which was negative. Blood sugar and A1C normal. Switched oral birth control to patch.
Don't feel good.

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