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so stressed- between insurances

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Ulcerative Colitis
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Posted 10/20/2015 7:03 PM (GMT 0)
i just cant stop crying. my insurance stopped when i turned 26 last month and my medicaid doesn't start until november 1. i haven't had my simponi in october because i dont have insurance. i am technically enrolled but it wont kick in yet. i am starting to feel the cramps again and i am just a wreck-mainly emotional wreck. it took me so long to get in remission and it's just not fair that i dont have access to my medication.

not really looking for advice. i just needed to vent to people who understand. i've called my nurse and walgreens pharmacy 50x this past month and i think they are sick of hearing from me.

my sister's baby shower is nov 8 and i really want to be healthy and okay enough to go. i have a feeling i will end up in the hospital before then and dont want to ruin things for her. i never have a slow decline. it's always fast and then i'm screwed.
Posted 10/20/2015 7:15 PM (GMT 0)
I am so sorry to hear this! Can u call the simp company?
Posted 10/20/2015 7:17 PM (GMT 0)
dmc, i did call them when i was technically uninsured, but now that i am in medicaid enrollment, they have to handle it. i'm just scared. i dont wanna feel that pain again. the kind where i cant concentrate or talk because i'd rather kill myself.
Posted 10/20/2015 7:37 PM (GMT 0)
Got any prednisone in your medication cabinet to hold you over for a few weeks? That sucks...
Posted 10/20/2015 7:38 PM (GMT 0)
Does your doc have samples you can use? I hate the way our insurance system works. So sorry you are dealing with this, banana.
Posted 10/20/2015 8:38 PM (GMT 0)
I have some prednisone iPoop but I'm not gonna use it. I plan on smoking a few cigarettes if it comes down to it.

Momt2b, he doesn't have any sadly. I guess they don't keep simponi in the office. They said I could buy it without insurance right now but it's $5,000. I don't even have that much money!
Posted 10/20/2015 8:43 PM (GMT 0)
Yes i agree to take pred if you have to in this case. ;-(
Posted 10/20/2015 10:42 PM (GMT 0)
i'm so sorry to hear it! the more stressed out you are the more symptoms you may have, it's only ten days until November so i keep my fingers crossed that you pass them smoothly without any flare. I know it's no consolation but imagine that biologics are not refunded in Poland and people who are really seriously ill sometimes even don't know what remicade is. I really don't know how they can cope with it but they say that if you know that something is unattainable, you set your mind to a different survival mode. Don't panic because everything will be OK :)
Posted 10/20/2015 10:50 PM (GMT 0)

bananagirl said...
i just cant stop crying. my insurance stopped when i turned 26 last month and my medicaid doesn't start until november 1. i haven't had my simponi in october because i dont have insurance. i am technically enrolled but it wont kick in yet. i am starting to feel the cramps again and i am just a wreck-mainly emotional wreck. it took me so long to get in remission and it's just not fair that i dont have access to my medication.

not really looking for advice. i just needed to vent to people who understand. i've called my nurse and walgreens pharmacy 50x this past month and i think they are sick of hearing from me.

my sister's baby shower is nov 8 and i really want to be healthy and okay enough to go. i have a feeling i will end up in the hospital before then and dont want to ruin things for her. i never have a slow decline. it's always fast and then i'm screwed.

Can you get a sample pen from your GI? Mine gave me 2 for loading. When it didn't work for me, I gave one of mine back to them to give to someone for a sample.
Posted 10/21/2015 4:15 AM (GMT 0)
You're right, ewa. The more I stress about it, the worse it is. I'm going to try to get my mind off of it since I can't do anything about it anyway. No sense in getting myself worked up! I am lucky I live here and have tried all the biologics. I know my colon would be long gone already if they weren't available.
Posted 10/21/2015 5:16 AM (GMT 0)
Can you get some Ativan until you get the simponi? Is the pharmacist willing to give it and when the Medicade comes through they will get the money?
If not maybe the doctor can order it for you as stock and than bill you for it when insurance comes through

Hope u feel better ASAP
Posted 10/21/2015 2:58 PM (GMT 0)
Can your doctor and pharmacy work together and post date the medication for insurance purposes for Nov 1? Its 10 days! They should be able to do that.

It would be like the doctor writes the script for 11/1 and your pharmacy doesn't process it thru your insurance until then? The pharmacy will get reimbursed...
Posted 10/21/2015 3:01 PM (GMT 0)
I'm not sure what Ativan is for but I haven't been able to fill any medication this month. None of it would be covered and there is no "pay when you can" type of the thing at the pharmacy. You have to pay that day in order to take the medicine home. Imagine how many people they would never see again if they gave medicine out like that!!!
Posted 10/21/2015 3:11 PM (GMT 0)

notsosicklygirl said...


Can you get a sample pen from your GI? Mine gave me 2 for loading. When it didn't work for me, I gave one of mine back to them to give to someone for a sample.

I had the same thing with Humira, my GI gave me 4 pens while I waited for my insurance to approve Humira. I returned the remaining pens back to their office so someone else could use them.

I'd ask your GI if they have any sample Simponi that they can give you.

You only have 10 days to wait until Nov 1. Most-likely you won't flare in that time, all these biologicals build up in the body so you'll have some Simponi reserves in your body.
Posted 10/21/2015 3:31 PM (GMT 0)
Totes, I'm not sure what you mean. My GI office is doing everything they can but its the stupid Medicaid that isn't budging. I already hate it with a passion!

KS and Nssg, momto2boys asked me the same thing above and i said the office doesn't keep simponi there. I guess it's not something just lying around. I figure it might be because patients find it painless enough to do it at home. I've seen people that need to go in for humira though! I am banking on the fact that simponi somehow stays in your system for longer than four weeks!!! I am just scared of building antibodies and am not sure how fast that happens.
Posted 10/21/2015 3:32 PM (GMT 0)
I was able to go to my local pharmacy, riteaid, and describe my plight. They gave me a weeks worth of lialda while my insurance was switched from one to the other, before that order was approved by insurance. Once approved, I returned to get the rest of my month's prescription (less the pills I already got). It all worked out.

I know lialda was $1,000 for a month's supply, simponi is like $5,000 and might be a little different to get. I'd try asking. Everyone agrees patients should stay regular on their medications, and most get that insurance switchover can be a nightmare, and often commonsense prevails. You just gotta make it happen.
Posted 10/21/2015 3:42 PM (GMT 0)

bananagirl said...
I am just scared of building antibodies and am not sure how fast that happens.

Steroids and Antihistamines can help to prevent antibodies from building up. I use to take Benadryl a day before my Remicade infusions and a few days after the infusion.
Posted 10/21/2015 3:44 PM (GMT 0)
IPoop, walgreens is being the biggest turd of them all! I think I've been on the phone with them a few times a day this entire month. Every time I call, they say my order is on hold in the insurance department and they can't do anything until it leaves that department. I think I cried on the phone yesterday and told the lady how important it is to take on time. She was like "I seriously don't think you will take it in October unless you want to buy it yourself." I wanted to punch her! Luckily I have all of my other medications and don't need to make an appointment with anyone this month. Insurance blows!
Posted 10/21/2015 4:11 PM (GMT 0)
That's when I'd say: I need to talk to your manager asap.

Insurance does suck, they're in charge at the top in charge with what a patient needs being only secondary...
Posted 10/21/2015 4:45 PM (GMT 0)
Try cvs. I find they are much more helpful than Walgreens the problem is that you usually use Walgreens so the pharmacist at cvs might not be willing to do it for a new customer.
My pharmacist knows my first name already 😁
Not a good sign.
Posted 10/21/2015 4:50 PM (GMT 0)
Bananagirl -

I believe Medicaid reimburses medical bills incurred up to 180 days before the enrollment date. They also give you a temporary medical assistance card during this time, no? If you can get access to Simponi right now, medicaid will pay for it when you are enrolled. I would give them a call and see what they can do.
Posted 10/21/2015 6:38 PM (GMT 0)
dikid, i dont know if cvs has a specialty pharmacy, do they? walgreens is a specialty pharmacy and i dont even speak to a pharmacist. its done all through the phone. i talk to someone different every time since it's a call center.

guardian, yes, they did mention the past three months if i have medical bills, i can send them in. i know it's technically covered. the problem is that its still going through insurance. like you know when you start a brand new biologic and it takes a month or two for them to approve it?? i think that's what is happening here. even though its not a new drug for me, it is a new insurance for me. i just hoped it wouldnt take this long since my doctor knows how this drug is taken.
Posted 10/21/2015 6:43 PM (GMT 0)
Yes, their specialty pharmacy is called "cvs caremark".

800-552-8159

www.caremark.com

I use them for remicade (per my insurance's best price/recommendation). My health insurance is geha (government employees health association).
Posted 10/25/2015 3:49 PM (GMT 0)
well luckily my gut is doing great without the simponi. i'm guessing my cramps were from the salad greens and broccoli i ate last week. weirdly though, i've had a solid poop every morning and then i'm good all day. i usually have soft mush 2-3x a day so this is a nice change. i know simponi alters the gut bacteria so maybe my new "normal" gut bacteria is more balanced now from all the probiotics and resistant starch i take. i have also upped my curcumin dosage (5,000 mg per day) just so i have some back up anti inflammatory medication.

i did calls walgreens again friday and the guy on the phone said they have a log of all my calls and that i dont need to keep calling. he said they would call me if it was approved and to just wait til that happens. so yeah, i dont have any idea when i will actually be taking my shot.
Posted 10/25/2015 7:41 PM (GMT 0)
I think the smoking plan is a good one...not ideal of course, but it might just tide you over for a short while, It is something I would try.
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