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I have had severe, med-resistant depression for 15+ years. I've been around the block with medications. So this time around we are trying Lexapro/Zyprexa. I go to pick them up at the pharmacy. $101.

Excuse me?

I couldn't even get the Zyprexa. I don't make that kind of money, albeit I do work. I'm the working disabled, a forgotten group who get totally discriminated against. I tried the pharmaceutical company help programs, I don't qualify for any of them. I have 2 kids to support on my own. So now what? The pharmacist said that the insurance company is trying to force me to go to a cheap generic and another medication. Zyprexa is the only med that pulls me out of the black hole of depression I get into. What do I do? Die? My anxiety is so bad, I can't even take my kids outside. What am I supposed to do?

I give up. 'Snap out of it' is my new mantra. I have no choice but to wean myself off of this stuff and try to live without medications because I can't afford them. I feel so helpless.... and I thought I was depressed and anxious before?!!

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oh no! there's got to be a way. have you called the insurance company? of course i'm saying this all the while avoiding calling mine. why wouldn't they approve those 2??? that seems weird. i'm hoping you call the insurance company.... or your doc. maybe your pdoc can help???

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I'd second the suggestion about an insurance company phone call. Frequently the policy is the policy is the policy...

but there's occasionally the chance that you can find a nice soul who's willing to work with you....and that if you get a doctor's explanation as to why the (fairly uncovered) medication is specifically needed and why alternatives won't be sufficient, they might cover it.

as a side note, is there a risk that you're just having to pay down a deductible right now? I wasn't expecting it last year, but my Rxs are included in my deductible...so until I reach that amount, I pay for the Rxs at a fairly high rate. Once I hit it, the prices drop dramatically.

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Have you tried contacting the drug companies that make the meds? Sometimes they have free programs for people who need their meds free.

I ended up telling my pdoc I can try anything that my insurance doesn't cover if she has samples... so she gave me samples for ages

And yes, you deserve free meds...just in case you were wondering ;)

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It's your insurance policy that is blocking you from patient assistance programs. You may be able to obtain a Prior Authorization from your carrier to grant coverage. Your doc will have to submit a form via fax demonstrating prior treatment failures. Also, both Zyprexa and Lexapro are still under patent and hence available in sample packages. Lilly also has a voucher program for Zyprexa. These ain't long term solutions, however.

Your situation underscores one of the lesser known aspect of the current health care/health coverage debacle: the woes of the "under-insured". You are covered, but inadequately so. There is a medication that clearly helps you, but it is all but unobtainable for you. Arrrrgh.

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I second the opinion of getting free meds. The reps keep the dr's well stocked, I was getting free abilify for ages before I switched pdocs. Contacting the pharmaceutical directly sounds like an excellent idea.

Good luck with it, and you deserve the meds, however you can get them. Don't go without them before you explore all the other options. Call the pdoc immediately and explain that you *at least* need samples to tide you over until you find a solution.

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Everyday I try to remind myself how thankful I should be that I'm in school and covered by student insurance. It's a mess out there, that's for sure.

Like others have said, exhaust every possible option. Persistence often pays off in this situation as it's usually easier for the person to help you than keep refusing you.

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I seem to recall that in some cases with some policies, if you can demonstrate that you've tried their preferred choice and it didn't work, you can use one of the ones they don't like. I'm not sure, however, of the details of how this works, and I'm sure they don't make it easy.

Although I don't like the way they do it, I can sort of see why the insurance companies have preferences about which meds. It seems to me that a lot of times docs don't start with the generics, even when some of them can be pretty good. For instance, I wonder why Prozac, which has a generic available, isn't used more?

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It's your insurance policy that is blocking you from patient assistance programs. You may be able to obtain a Prior Authorization from your carrier to grant coverage. Your doc will have to submit a form via fax demonstrating prior treatment failures. Also, both Zyprexa and Lexapro are still under patent and hence available in sample packages. Lilly also has a voucher program for Zyprexa. These ain't long term solutions, however.

Your situation underscores one of the lesser known aspect of the current health care/health coverage debacle: the woes of the "under-insured". You are covered, but inadequately so. There is a medication that clearly helps you, but it is all but unobtainable for you. Arrrrgh.

I'm going through the same thing right now. My first pdoc got me started on Lexapro samples, which was helping me out of depression after a few weeks. But when I took my rx to the pharmacy, I found out that my insurance needs prior approval for Lexapro. This means I have to "fail" two of the generic meds on their list (attested by a physician) before covering. So I went on Celexa for 2 weeks, losing the benefits of the Lexapro and resumption of depression symptoms. After "failing" Celexa, I was prescribed Effexor, which I've been on for two weeks. The Effexor does seem to be treating the depression, although I'm experiencing some unpleasant side effects. Hopefully it'll work out, but it's frustrating knowing that there is something out there that clearly "works" for me and I'm unable to access it.

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