prescription max?

A

anonymous

New member
Help! I am so upset and frustrated right now. I just found out that we met our prescription maximum for Allie's meds and now nothing is covered until 1/01/06. She had one treatment of TOBI and this put us over the maximum. Wow. I'm not sure what to do.

Does anyone else have this problem and what do you do about it? I'm not sure how we will pay for her Prevacid and enzymes until January and lord help us if she has tp gp pn TOBI again. What do people do when they are on TOBI regularly???

Any help or advice right now would help me out a lot! I want to crawl under a rock and hide from all these problems. Money should not be an issue when you have a sick child.

Thanks,
Amy
mom to Allie 4w/CF and Betsy 16months w/out
 
J

JazzysMom

New member
what do they mean by max? Are they referring to ??? amount or allowed amount of the med itself. I know people who have limited amount on meds themselves including enzymes.
 
A

anonymous

New member
Once the insurance company has paid $2000 on our meds they stop. This is the max amount they will pay per year. This is not a lot if you consider how much TOBI is. We would've been fine had she not had to ahve TOBI last month.
 
A

anonymous

New member
wow, they only pay $2000?! I would use that up in one month for my daughter. I have never experienced this, but maybe check state programs for children or even the manufacturer themselves. Sorry I couldn't be more helpful.
 
A

anonymous

New member
We have Blue Cross Blue Shield but it's the Blue Advantage program. Which means we have to buy it ourself b/c I'm a stay at home mom and my husband is self employed. Allie hadn't been diagnosed when we got the coverage so we weren't anticipating all of these expensive medical costs. Now we're stuck b/c if we try to get a new policy they'll re- underwrite us and Allie's CF will make it much more per month....they may even be able to deny us b/c it's a consumer plan. I'm so upset right now I can't even think straight. And you're right....$2000 is not a lot at all considering how much we pay per month to have the stupid thing.

Amy
 
N

nycgirl

Guest
you should look into state programs for her, or talk with her doctor or her social worker at her local clinic.
i have never heard of meeting a max for RX. what about the cf pharmacy in maryland? do they have an assistance program?
good luck to you!
jessica NYC 28 w/cf
 
A

anonymous

New member
Wow-- my son has used $18,500 in med costs so far this year. I have never heard of a med maximum! Good luck with everything! I know it is hard enough to fight with this disease and then also to have to worry about their med's and health care and all the expenses that go along with it.

Angie
 
J

JazzysMom

New member
You might try talking to the social worker at the CF office because many of the manufacturers of CF meds have programs available to obtain the meds if unable to afford them. If your social worker is not very imformative (tho they should be) you can research yourself on the CF Foundation website links.
 
A

anonymous

New member
Try looking into Tobi patient assistant program. <a target=new class=ftalternatingbarlinklarge href="http://www.needymeds.com/papforms/tobifo0359.pdf">http://www.needymeds.com/papforms/tobifo0359.pdf</a> There are usually programs for every drug you take to help people who can't afford them. They give you the prescription for free if you qualify under the income requirement. I have had Ultrase (emzyme ) send me money back under there R/X cost reduction program, because my co-pay was so high. Every little bit help. Here is a site that can link you to patient assistants program. https://www.pparx.org/Intro.php It just makes it easier to locate the assistant program for each drug company. You put in your drugs you are taking then it will direct you to the manufacturer site assistants program. Good Luck
 
You must log in or register to reply here.
Top