My medication costs $1000/week! [long]

So, my medication sample arrived. My doctor knew my insurance (TriCare) would dink around and take forever and a day to approve, so he requested that a sample of the progesterone injections be sent to me. So, I was grateful for the one week of samples and eagerly awaited the arrival today---only to find FIVE WEEKS dosage in the box!!! Amazing! That gets me to viability!   Big happy dance.

Wholesale this vial I hold in my hand costs $4500. My copay when I start to receive it will be $621/month. Which blows my mind. So, not long after signing for my "sample" I get a call from the pharmaceutical company (Makena) to discuss setting up my first paid shipment. My doctor had already warned me that it was expensive (although I was expecting $100-200/month, not $621!!! I could have swallowed the $100/mo and choked a little at $200, but $600 just is NOT possible). My doc also told me that IF I couldn't afford the co pay or if my insurance didn't cover it, Makena would make arrangements with me to pay what I could and they'd write off the rest for taxes or some such and that'd be that.

Because my insurance is government funded like Medicaid and Medicare, etc which are government assistance programs (Thanks F*ing government! My husband WORKS for his "government" funded insurance---I can show you where the cost comes out of his check!) Makena is not able to assist by cutting me a deal and writing off the rest!!!

So, I'm going through scenarios in my head...seeing if there's a cheaper medication Dr S can prescribe or if I can get my bank to give us a loan (thank God for excellent credit) or what because $621/month is just not going to happen out of pocket. So, I offhandedly mention "well, at least I have the sample you sent out to get me through until I can get this straightened out" and she cuts me off and said "Please hold on a minute" and comes back very quickly and says "We're going to keep you on our sample list and cover your medication FREE OF CHARGE"---

So I burst into sobbing mess of tears of gratefulness *hormones* (which was awkward for the poor customer service woman who was helping me, although she teared up too, haha). This HUGE burden that had just been dumped on my head was suddenly GONE and the small worries I'd had about paying for it (when I thought it'd be $100-200/mo) were gone too and I'm just magically going to have it show up at my door once a month and be able to do everything to keep her in her place until its safe for her to come. I don't have to go get refills or pay copays or do anything but sign for it at the door.

God and I may not always agree on things and I may often not understand the many tragedies he has sent my way, but even I must admit: The Man Upstairs does give me wonderful blessings. I hope He stays in a giving mood when it comes to me and babies for a good long while! Thanks, Big Guy!

Still can't go around spouting that "God is Good" stuff because I know all too well that God can also be one cruel bastard, but I must say that when he does a good deed, he sure does it right! I will forever be grateful that I have been given this little gift, even if this pregnancy ends poorly. I will always remember today as a good day!

aweeee that's awesome. So, they'll just send it continuously?

That is a mighty big blessing there!! lol Awesome!

What tricare are you on? I was prime when I was pregnant and on progesterone, and I didn't pay anything out of pocket..I'm glad they covered it otherwise though!

Wow good for you. That is amazing. So happy for you.

Quoting melindapple:" aweeee that's awesome. So, they'll just send it continuously? "

I'll get a call the first of every month and they'll ship it right on out overnight just like they did this one...sharps contaner, syringes, and all. Even sent alcohol prep pads.

I'm still crying off and on. That sudden panic of "She may die if I don't find a way to afford this" sent me right off the cliff of Zero Hope that I've teetered on this whole pregnancy---but then I got yanked back up forcibly 2 minutes later, so I'm an emotional wreck today...mostly relieved and good, but still trembling from the hard bite of fear that went through me too.

Man--- this pregnancy is going to give me a damn heart attack!

That's great!

That is SO awesome!!!

Quoting Red Rover:" That is a mighty big blessing there!! lol Awesome!"

I am still blown away!

That is AWESOME!

Quoting P Pickle Pants:" So, my medication sample arrived. My doctor knew my insurance (TriCare) would dink around and take forever ... [snip!] ... that I have been given this little gift, even if this pregnancy ends poorly. I will always remember today as a good day!"

I'm on tricare prime as well and that makes me worry my p17 shots will cost a arm and a leg too =/ i went through a company in NC that charged $90 per 10 week batch back in 2010... can't believe it's gone up so darn much.... im gonna try to find my papers from the last shots i got and see if theyre still selling at the same price.

Quoting Turt McGurt™:" What tricare are you on? I was prime when I was pregnant and on progesterone, and I didn't pay anything out of pocket..I'm glad they covered it otherwise though!"

I'm on Standard because my FABULOUS *sarcasm* military doctor said I'm not high risk and don't need to be seen off-base at all (my last son was born at 23 weeks in the same hospital and they dont even have a NICU at all and refused to airlift me to the hospital with a NICU.) He also told me to stop the progesterone and baby-aspirin that my specialist had put me on for TTC/early preg when i saw a specialist last year while DH was deployed (I was on the east coast living with family and saw a specialist for my pregnancy/miscarriage/testing then).

So I switched to an out-in-town specialist with a FABULOUS *no sarcasm* reputation and lots of experience and a practice of other docs with even more experience and know-how dealing with ONLY high risk patients (my doc is the multiple-early-loss/pre-term specialist). So, I am seen and everyone treats me great and paperwork goes fast and smooth and its amazing the differences between them and the base doctors offices.

And TriCare North (east coast) covers it, but apparently TriCare West only covers a portion---how/why I do not know but everyone I've talked to in the N or S regions has had it free (if filled in a base pharmacy, ours doesn't even carry it), or had a copay of under $100/mo for it off-base with Standard. So, when she said "$621" I shat myself a little. I even called TriCare to confirm.

Because progesterone is a FERTILITY medication (8 pregnancies later, you'd think they'd have a clue that I'm smurfing fertile and you can't get more pregnant than I am now! Its just about the baby getting bigger, not me getting more pregnant!). Idiots!

Regardless, though, I'm covered and I can breathe. I just hope for next pregnancy they'll send me HOME to the N region and I can deal with the group that makes some semblance of sense.

Although, I haven't had ANY copays for my doc visits, ultrasounds, tests, etc, so I guess it doesn't suck too bad, haha.

So glad they are generously covering you. But holy cow! What is the difference between that progesterone and regular progesterone in oil? Mine costs $45 out of pocket for a two week vial.  

What an amazing miracle! So glad they are helping you out! Makes the stress go away, so that is one less thing you have to worry about!

<blockquote><b>Quoting P Pickle Pants:</b>" I'm on Standard because my FABULOUS *sarcasm* military doctor said I'm not high risk and don't need ... [snip!] ... Although, I haven't had ANY copays for my doc visits, ultrasounds, tests, etc, so I guess it doesn't suck too bad, haha."</blockquote>




Yea definitely come back to the east coast!   it's odd they cover it for one region and not the other   I didn't even realize it was a fertility medication! Glad you were able to get to a better dr!