Fighting Drug Company?
I recently had a daily lifesaving med change from 360 pills taking 2 pills twice a day 50 mg each = 200 mg TO 180 pills taking 1 pill twice a day 100 mg = 200mg. The price from MEDCO went from $20 to $410 because it was no longer the generic drug and a different mfg. made it. When questioned if they contacted the Dr about the change in order we were told YES but they never mentioned the cost increase. I have to take these for life due to a liver transplant three years ago. I have been on them for 3 years. Any lawyers with a good plan of action? I'm 26 days from medicare and will still have the same insurance co because medicare pays less. HELP PLEASE
- abijannLv 79 years agoFavorite Answer
Transplant Patients should never have a change to the drugs they use
unless the Transplant Team of doctors approves of this. This means
that the pharmacy should not dispense a generic (in place of a Brand
name drug)or change the manufacturer of the drug made unless the
patient has time to check with the TransplantTeam first to be sure this
is appropriate for them.
The doctors office can contact the Insurance Agent of the Part D Plan
you will have and request a "tier exception" be made to give you a
lower cost on your particular anti-rejection drug and can also give
the needed information to them, so that you will have a longer "term of
Approval" for you to have the drug through them without having
to get one every year. [ However, if Medicare paid for the transplant
itself...then your medications may be under Part B instead of Part
Medicare also have a program where you can ask for help, if you are very
low income, and be placed in a prescription program where you pay
I'm not sure what drug you are on or what kind of transplant you have had.
So, I'm taking a well known anti rejection drug, Prograf, as an example.
Here they have a prescription value section where a patient can save up
to 200 dollars off the cost of the prescription for a year.
Also, they have different programs to help patients who have a
financial problem, if they talk to the doctor about this:
Many drug companies who make these anti-rejection drugs have programs
similar to this. I definitely would check with the doctor and others at his
office about this.
All drugs have an Brand Name and, also, a generic name. The drug
manufacturer who did the research and development (making and testing)
of the drug, places it under patent for a period of time so that they can
receive the money back not only for the drug made, but also for
developing the drug itself. After that patent runs out, then other
manufacturers (who don't have these high costs because they
didn't develop the drug) then can take the formula and make these
drugs at a cheaper cost to the patient.
When you choose a Part D plan...the insurance should give you a list of
pharmacies where you can get these drugs from. Medco is usually the
one used for mail order; but you still have the option of using another
pharmacy close to home. This may not be the case with every
provider in the Part D plan...but most of them are like this.
Hope this information gives you some options to consider
Best wishesSource(s): caregiver to a liver transplant patient
- Baa BaaLv 79 years ago
Do some pill shopping with someone else. If the med was $20, there should not be a big increase. Most all transplant drugs are in generic form now. If one pharmacy can not get the generic med, find another pharmacy that can. I had a transplant and have no trouble getting the generic transplant drugs at just about any pharmacy. Don't think you need a lawyer, just a good pharmacy. Change in dosage should not cost that much and they should always carry the generic drug.
- Anonymous9 years ago
The drug company has nothing to do with this. Either your doctor needs to prescribe another medication that is covered by your plan's formulary or you need to find another drug plan that covers the drugs you need. Go to Medicare.gov and use their part D plan finder to find a plan that works for you.
What is the med anyway? Prograf? I'm pretty sure that's generic by now.