By the end of June, I had successfully obtained all the medications I had calculated I would need for the month of July. The only change I made was to change the original order to take 2 capsules 3 times a day to taking 3 capsules 2 times a day. It’s just too hard to try to schedule and remember to take that 3rd dose. Especially since I eat only two meals a day.
It was a challenge to take my twice-daily cocktail of vitamins, minerals, herbal supplements, medical cannabis, and prescription meds from my hand, instead of being able to spread them out on my desk on a paper towel and sort them into piles of how many I could swallow at one time!
I came home in a very positive frame of mind, pleased that my 300mg/day of Lyrica was exactly the right amount of medication I needed to mitigate the pain enough to be able to function in everyday life! Then the bombshell struck.
August 16, 2018
I logged on to my Kaiser pharmacy page, intending to order meloxicam, Flexeril, and Lyrica. My plan was to pick them up in San Leandro as soon as they were ready. The sticker shock was seeing the co-pay amount for Lyrica: $564+! That was for Danny’s revised prescription for 200 150mg capsules, taking a 150mg capsule twice a day, for 3 months. I backed out of the online order, far enough to take off the Lyrica, and then changed method of delivery to postal mail since there was enough time to do that.
I sent email to Dr. Kalra and to Danny about the Lyrica situation. Someone, who thought it would be helpful for me, revised the pharmacy request to 60 capsules (a 30-day supply) for $174+. I only found out about this when the San Leandro Pharmacy texted me that my prescription was ready for pickup. I went to the Pharmacy (on my way back from Harborside) to find out what the prescription was. When I told the cashier that I was not able to pay the co-pay, he suggested I talk to Member Services (or that was what I thought he said) and he told me where their office is (in this same building). I found the office, which I knew would be closed, and I wrote down a 24/7 800 number listed on the door, along with their office hours.
August 17, 2018
I received email from Dr. Kalra in response to my email to him, asking what other alternatives I have to Lyrica. He said gabapentin is the only one. I reminded him that I cannot take gabapentin! His only advice was to use the remaining Lyrica I had, tapering off to half dosage (150mg/day) until it was gone.
I called the 800 number for Member Services. [Member Service Call Center at 1-800-464-4000 (toll free)]. The young man I spoke to said that Kaiser no longer handles requests for patient financial assistance but uses a third-party service called My Advocate, to which he transferred my call. The young woman who answered was pleasant and did her job well. But, based on our combined income, it was “too much” to qualify for any of the possible financial assistance sources.
I spent the rest of the day researching on the internet but came up with nothing positive. With more than a little digging, I found that Pfizer has a lengthy application for financial assistance, requiring the compilation of multiple documents, including tax returns, and requires a lot of information from the “prescriber.” And, at the bottom of this horrendously long application, it says that it will take 2-4 weeks to be processed and, if approved, you will be notified. In 2-4 weeks without Lyrica, I’ll be back in the throes of chronic pain that I was before I started on it!
August 18, 2018
At church today, I found out that another Kaiser member who had a procedure done recently had received what he called MFA, Medical Financial Assistance.
August 19, 2018
Even though it is Sunday, I sent email to Dr. Kalra (knowing he or one of the pain pharmacists would see it first thing Monday morning. I attached the PDF for the $25 copay card from Pfizer. The first question is whether or not a Kaiser physician is willing or able to write a prescription for a patient to fill at a non-Kaiser pharmacy.
August 20, 2018
I received a response from Amy Li (one of the pain pharmacists who does not have an online page with her picture). She pointed out something I had missed (or interpreted incorrectly) that said the $25 copay card from Pfizer is only available to people who have no insurance at all. Not even Medicare. So that is another dead end.
