Saturday, August 2, 2014

I Can't Afford A New Epipen. I Could Die.

An Epipen lasts a year.  My Epipen expired at the end of March, 2014.

On July 28th, I attempted to get a new Epipen.  I ended up not getting it because it was too expensive.  A new Epipen would cost me $351.73.   That's about 30% of my paycheck.  The reality of my situation is that if I purchased it, I would not have had enough money for food.

I can't afford my life saving medicine.  I could die.


I didn't think it would be so expensive.  I have health insurance that I get through my job.  I pay $135 a month for my portion of the insurance plan.  I thought it would cover life-saving medicine like my Epipen.  I called Aetna, my health insurance provider.  I talked to Customer Service, and they transferred me to Prescription Customer Service.  The Aetna Prescription lady explained to me that my Epipen was considered part of my deductible.

'What?  How can life saving medicine be part of my deductible?'  I exclaimed loudly over the phone.  I really was hoping that this was a mistake, and they'd tell me they realized this was an error, and cover the Epipen.

I studied the plans carefully when I signed up last year.  I remember the $2500 deductible for health care services, such as hospital stays.  I remember looking over the prescription drug coverage, and I do not remember seeing anything that said that prescription medicine had any sort of deductible. I sadly accepted that I would just have to pay out of pocket each time when I saw my therapist & psychiatrist, because my plan said it applied to my deductible.  I can only afford to see my therapist once a year these days.  I probably need to see my therapist more than that because of what transpired next over the phone.

'I have prescription health care coverage!  There is an Rx Bin number on my card!  I've been paying $130 a month to Aetna for the past year and a half!  How is it that Aetna is refusing to cover my life saving medicine?'

The Aetna prescription customer service lady gave me zero compassion.  She told me that I needed to meet the deductible.  Then she told me that I was halfway to meeting my deductible for the year.  This wasn't a horrible mistake.  My worthless Aetna health insurance wasn't going to help pay for an Epipen.  And here I was, a severely allergic person walking around with expired medication that may not work.  I was up shit creek without a paddle.

I felt the full horror of my situation.  Having been diagnosed with Idiopathic Anaphylaxis in August of 2011, I don't even need to eat anything to bring it on, I could go into shock and die at any time for no reason.  My only hope for survival was the Epipen, and I was not going to be able to afford an Epipen.

Shock, disbelief, and total hopeless abject terror, are some of the emotions that I felt initially.  I felt like the lady had read me my death sentence.  Fear quickly became replaced with anger, and outrage at the injustice of the situation.  How dare Aetna take my money every month and then refuse to cover medication I needed to live.  And then I yelled at the lady over the phone in anger.  I do not remember what I said, I could have even said a swear word or two.  I went full on CAPSLOCK OF RAGE on this lady.  I think I remember telling her that I would tell the entire world about how Aetna was trying to kill me by refusing to cover the Epipen.  And then I hung up.

I feel bad for yelling at the lady, because it wasn't her fault personally that she worked for an evil for-profit corporation that had just essentially condemned me to death.  I am trying to avoid yelling at people in anger these days and handle my emotions with skill and equanimity.  But in that moment of fear and horror, I absolutely lost my shit.

When I calmed down, I tried to find options to help me pay for my medicine.  I called my doctor's office.  The helpful lady at my allergists told me that a lot of their other patients were having trouble affording life saving epinephrine medications, and she could send me a couple of coupons for a small discount.  She offered to ask the doctor to rewrite the prescription for a single Epipen.  I told her that was not a good idea.  My last anaphylactic reaction required 3 Epipen injections to stop my throat from closing up.  My allergic reactions seem to be getting faster and more violent each time.  What's the use of carrying a single dose, if it's not enough to save my life?  She agreed and said she'd send me the coupons on Wednesday.

I went online and filled out an online form for a 0$ Copay 'free' Epipen on the Epipen website:

http://www.epipen.com/en/copay-offer

Because I have my crappy Aetna health insurance, and it covers prescription medication I qualified only for a $100 discount.  But the fine print on that coupon said: This offer may not be combined with any other EpiPen coupon or savings offer.  I wasn't going to be able to use the coupons my doctor's office was sending me.   So my out of pocket cost for two new Epipens would only be reduced to $251.73.  Could I swing that?  Not really.  

The manufacturers of the Epipen, Mylan, have a patient assistance program that helps people afford their Epipens.  I called 1‑800‑395‑3376 and talked to a Mylan representative who asked me questions.  I didn't qualify for help through Mylan's program because my health insurance included prescription drug coverage.  What?  No it doesn't!  I mean, Aetna says I have prescription drug coverage, but it won't pay for my Epipens.  So that phone call and Mylan's patient assistance program is worthless.  You'd pretty much have to be homeless, and not have any sort of drug coverage to qualify.     

Out of desperation I called the number on Healthcare.gov  1-800-318-2596

The lady was nice.  She said that since I qualified for three dismal cheap plans through my employer, I did not qualify for any plans through ACA.  Great.  I told her my situation and she told me to call the State Office of Insurance for Washington at 1-800-562-6900.

They are open Monday through Friday and are closed today.  I called and left a voice mail. I will blog again when I have an update.  Thanks for reading.  Please subscribe to my blog.

17 comments:

  1. I'm hoping that somehow you get a new epipen and that all is well.

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    1. Fenu Greek, you are a compassionate and beautiful human being.

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  2. Just left the pharmacy without an epi-pen for the same reasons. Got home and googled aetna epi and found your blog. Did you ever work out anything cheaper? Interestingly, they only wanted $20 more for 3 epis. Blows my mind. I don't need 3, but it sounds like you might. If I wasn't filling the Jr dosage I'd send you my extras

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    1. Thank you for reading my blog, and thank you for the comment. Yesterday, I made phone calls for 2 hours, and basically came up empty handed. The government (FDA, Healthcare Insurance Exchange Regulatory Agencies, Etc) currently does not regulate what Pharmaceutical Corporations charge for medications with a patent, such as the Epipen. I'm in the process of writing a blog update with all that I learned. In the meantime, I'm planning to drive to Vancover, Canada on Saturday to buy a cheap Epipen set for $99.99 Canadian, over the counter! Hallelujah Canada! They don't let evil drug companies get away with overcharging people! Thank you so much for your kind offer of sending me extra Epipens. You are a generous and gracious person. We need to get the law changed in the USA to prevent drug companies and insurance companies from doing this to people. Thanks again for your support.

      In Compassionate Solidarity,
      Denise

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  3. I know how you feel. My daughter needs quite a few pens to leave at school and grandparents and her fathers and mine. Went to cvs and I couldnt believe the cost of $718 for 2 packs of 2. I paid $275 in august to have ready for school and went back for more because they old ones all expired in september. What is the point of working and having health insurance. I bet if I quit my job I would than qualify to have all that given to me FREE.... our system is messed up

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  4. Wondering why epi-pens are so expensive, a google search lead me to here. I loved your description of yourself and was curious enough to peruse the rest of your blog.

    You are obviously pro active and educated so what I am about to suggest might already have been explored and discarded but just in case, I thought I'd mention it.

    Have you ever looked into Mast Cell issues, like Mast Cell Activation Syndrome (MCAS)? It isn't well known, so a doctor may have slapped Idiopathic Anaphylaxis as an exclusion diagnosis without knowing there were other plausible options to explore. It would make a lot of sense in light of your depressive symptoms, as it comes with a plethora of organic brain syndrome symptoms.

    The bad news is that it takes time to identify the triggers and they can range from perfumes in the likes of hair spray or fabric softener (so the whole world can trigger you!) but the good news is that once that's done, you are fully in control and can get back to your old self.

    If this is not something you have discarded and you have questions, I'd be happy to answer them to the best of my knowledge. I have MCAS and found the medical community to be of no help whatsoever so I've been educating myself on granules, neurotransmitters and inflammation response and I am now pretty much symptoms free :) It feels awesome to be getting myself back!

    In any case, good luck to you, I'd wish you some courage but you already seem like you have your fair share :)

    Isabeau

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  5. I am going through the same thing with my insurance deductible! When I signed up for Wyoming bcbs they fail to mention that there is a $4000 deductible for prescription s ANNUALLY! Ive called and called and just get transferred to prescription services. I contacted the makers of epipen and had I NOT had insurance they would send me one free. I also contacted the Wyoming prescription donation office and AGAIN had I not had insurance they would send me one. I am 35 and was just hospitalized for the first time a few months ago. I am now allergic to shellfish. This is something I have eaten my entire life and now I have to be so careful if I eat out I have to make sure that shellfish is no where near the food I eat. Quite honestly I don't even think the cooks really know. I need this life saving medicine too. I am just a waitress and I pay WY BCBS $160 a month for basically nothing! If you find any answers please let me know and I will pass any info I can get to you!!! Best of luck!!!

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  6. Yesterday I went to fill my epipen rx and was so shocked when the pharmacist asked me if i was sure i wanted to because the price was over $600! I almost started crying. I cant afford that. I started searching the web for an answers and found your blog. Countless hours you saved me. There is no hope for me in getting my life-saving pen. I will continue to carry the expired one. If nothing else, it will show the person that finds me collasped on the ground whats up. But I wanted to write to say a big Thank You. God help us all survive Obama Care.

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    1. I have an EpiPen that expired in April, and the same thing happened to me. I had my coupon from the EpiPen company (Mylan is their name, by the way), but it only takes off up to $100 despite the coupon saying $0 copay, which is stupid. I haven't met my health insurance deductible, so they won't pay for this medication. I'm currently looking at online Canadian pharmacies. I just found one that seems legitimate, and it's called CanadaDrugs.com. They have the EpiPen listed from about $113 to $160 depending on who is manufacturing it (makes more sense when you look at the page). They require a prescription for it (which is good - the fake online pharmacies DON'T require prescriptions). I'm likely going to try it out, and if it works, I'll let you know.

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    2. I'm really sorry to hear you are struggling getting an Epipen, Bj. I really, really know how you feel.
      Obamacare is not causing this problem.
      The problem is the unregulated greed of corporations like Mylan, who manufactures the Epipen.
      The United States of America does not regulate prices on precious, necessary life-saving medication. The Evil Corporation Mylan charges whatever they like and there is NO REGULATION OR LAW TO STOP THEM.
      I actually think that people are dying because of this.
      Our country needs regulation on prices the pharmaceutical industry is allowed to charge. There is no way that a couple of Epipens actually cost over $600.
      You know what is disgusting? The profits that Mylan Pharmaceuticals reported for 2015. This corporation made $2.70 billion in 2015!! Guess where the money to run our country comes from? Tax dollars from people like you and me. Mylan stashes their profits in hedge funds and offshore accounts and does not pay their fair share.

      http://www.post-gazette.com/business/healthcare-business/2015/10/30/Mylan-reports-third-quarter-profits-pittsburgh/stories/201511300008

      You know why corporations are allowed to get away with this?
      Because corporations have bought out the government. In the Supreme Court Citizen's United ruling, corporations can buy elections and bribe politicians not to pass laws to protect citizens like you and me because corporations are considered 'people' and money is considered 'free speech.'
      The USA desperately needs a new Constitutional Amendment overturning the disastrous "Citizen's United" decision. I am part of that movement. It is time to reign in the greed of evil corporations like Mylan. It is time for citizens like you and me to take a stand.

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  7. Yesterday I went to fill my epipen rx and was so shocked when the pharmacist asked me if i was sure i wanted to because the price was over $600! I almost started crying. I cant afford that. I started searching the web for an answers and found your blog. Countless hours you saved me. There is no hope for me in getting my life-saving pen. I will continue to carry the expired one. If nothing else, it will show the person that finds me collasped on the ground whats up. But I wanted to write to say a big Thank You. God help us all survive Obama Care.

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  8. My epipen cost is $684. Thankfully I have at the moment, Medicaid, but because my daughter and I couldn't live on $535/no with $180 in food stamps, I got a job. It pays me $10/hr. I lost my food stamps because of that. And I'm sure my medical will be the next thing to go. So, when it does, I will have no insurance and will use up one whole paycheck on buying an epipen. My rent is $650 ( I rent rooms from an elderly lady) so my presc will be more than my rent?!

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  9. I saw this, and I am in a similar situation. Epipens are now 650-750 - per year. However, it isn't really the fault of the insurance company like you say above(I realize eventually you post a comment about Mylan). This is the fault of a company called Mylan, blocking generics from hitting the market. They have no competition. The price of epipens when I first started needing them was $80. Then in 2010 they wouldn't let you buy single pens anymore, only two packs. Raising the price up to $200s. Slowly over the course of the last 5 years, it had become $375 last year. Today I went in and they're now between 650-750 depending on if you costco or not. This is the same price the company charges hospitals, cruise ships, disney land. Again - this is not a problem with the insurance system. It is a problem with pharmaceutical monopolies. Companies are buying up the rights to produce drugs, and jacking up the prices.

    ReplyDelete
  10. I saw this, and I am in a similar situation. Epipens are now 650-750 - per year. However, it isn't really the fault of the insurance company like you say above(I realize eventually you post a comment about Mylan). This is the fault of a company called Mylan, blocking generics from hitting the market. They have no competition. The price of epipens when I first started needing them was $80. Then in 2010 they wouldn't let you buy single pens anymore, only two packs. Raising the price up to $200s. Slowly over the course of the last 5 years, it had become $375 last year. Today I went in and they're now between 650-750 depending on if you costco or not. This is the same price the company charges hospitals, cruise ships, disney land. Again - this is not a problem with the insurance system. It is a problem with pharmaceutical monopolies. Companies are buying up the rights to produce drugs, and jacking up the prices.

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    Replies
    1. This is the truth^^^. Im not even trying to get one anymore.

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  11. Please sign and share so that patients with allergies can get their epipens more easily. Many lives could be saved with this petition.

    http://www.thepetitionsite.com/113/048/471/lower-prices-on-life-saving-epipens/

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  12. Absolutely fantastic posting! Lots of useful information and inspiration, both of which we all need!Relay appreciate your work. certified organic skincare

    ReplyDelete