I am sure we have all struggled with medical and/or prescription coverage at one time or another. Most likely, like me, you have gone without a particular medication because of cost and/or insurance denial. It is not even uncommon to be dependent on a medication and have coverage revoked or changed midstream..
I have been on a medicine that went generic several years ago but still pay the non generic price for “generic medication”. Thankfully I only take 1/4 pill twice a week or this would cost substantially more per month. I am not counting on Restasis coming down in price for decades. I manage to spread that out by being on two days and off one. Generic plaquenil, perhaps the oldest drug for lupus, thankfully works well for me so far.
Right now, I have no one to tell me they will not cover what I take because we have the joy of being on a Health Savings Account. That means, the insurance pays almost nothing until we meet a huge deductible, of their approved expenses. I am thankful that I have not incurred any extremely large expenses since this started a couple of years ago.
Health insurance coverage is becoming a complicated thing for most people and promises to get more complex and challenging as the years progress. Adam can attest to this. Adam our Tough Mudder participant (post 20) finds himself in a tough situation again. Here is what he had to say.
I need to enlist your help to spread the word about how horrible a company BCBS of Illinois is to its patients. They are making me go through an appeals process again this year for a drug that has been life saving for the past six years that they approved last year. This time around they are denying it every step of the way and yet my doctor is the one who wants me to have the treatment. They are going based on their own accord. Please help and spread the word on how terribly they treat Lupus patients.
This week I received this news.
I have reached out to BCBSIL through social media (Facebook and Twitter). I will keep you posted on what happens. I have also contacted my HR benefits department about this issue, so I have a little assistance from them, as well as the Lupus Foundation, Chicago Chapter. In addition I am starting the ball rolling with my attorney.
I know that this medication has given Adam his life back or he would have never been able to compete in the Tough Mudder. As a man with lupus, he faces some unique challenges while supporting his family, and raising a young child, at the same time. Adam is not alone in this fight for coverage. The Lupus Adventurer went through the same thing with Rituxan in 2011. Though she was not successful with her fight she trusted God for another solution to help control her lupus. That help did come, in the form of Benlysta. You can follow her journey with this new cutting edge lupus drug, on her blog.
The good news is, there are people and resources to help. For years there were no new medications on the horizon for people with lupus. Many people have worked tirelessly for years to change that, and they did. But as controversy swirls around some of these medications we see there is still much to be done on behalf of those of us dealing with lupus, and other autoimmune diseases. Even so, we can not lose heart.
Pray along with me that Adam finds resolution for his situation. You can leave any comments you like here for Adam and I will forward them to him.
UPDATE: I know I just posted this post, but Adam has received news that his appeal was won for 2013. That was a quick turn around. I think his aggressive, no nonsense approach was quite effective and a lesson for others.
I am reminded of this comforting portion of the bible that says:
Hear my cry, O God, listen to my prayer;
from the end of the earth I call to you
when my heart is faint.
Lead me to the rock
that is higher than I,
for you have been my refuge,
a strong tower against the enemy. Psalm 61:1-3
Be encouraged, we are not alone. There are people all around us helping, supporting, praying, and loving us. There are people we do not even know, working to better the future for all those with lupus etc. There is a God who cares for us. He longs to help us carry the load, if we would look to Him.
Until next time….Leslie Rose K