I get all my psych meds paid for am I lucky here in Canada?

[Thunderstruck]

I get all my psych meds paid for am I lucky here in Canada?

[jarn]

Since Canada doesn't have national pharmacare, yes, you are.

[0112358]

Lucky to be in Canada, or lucky to be someone in Canada who gets their meds paid for?

I'm in the USA and I pay very little for mine - that's just because my income is so low, however. I'm lucky, but only because I'm unlucky.

[echolocation]

i'm in BC, and because I don't make much money, pharmacare covers my meds entirely (except when i was on abilify, but i think that's because it was brand name). pdoc visits also don't cost me anything. i think i'm lucky. 

on the other hand, i pay entirely out of pocket for therapy, so that sort of evens the scale.

[Complicated toad]

In the U.S. with insurance through my employer, my regular refill of two medications runs around $200 (mind you mine are both generic.  I had a third generic for a while that was also over $100, it got to be a lot).  I have had the pharmacist put a few I hoped to try back, especially when the prices ran $800 to $1000 (or more).  My daughter had one med last year, and that was over $100 a month.  Thankfully the one she is on now is only about $8 - as long as we get the capsule & not the tablet.  Same dosage in tablet form was $130.  None of this makes a while lot of sense but I also know I have it a lot better than some people who have to pay much more.  

[Thunderstruck]

Thanks for the great insight guys!

[Gearhead]

I’ve had monthly med bills run as high as $1200/month.

[saintalto]

Paid 1300 dollars for the first month of Latuda this year. After I meet my deductible it runs about 150 a month. 

 

[Iceberg]

I had really good insurance.... until I had to switch. Same exact meds - triple the cost. 

[CrazyRedhead]

I have to admit I get a pretty good deal on my medications because I'm on a  Medicare Advantage plan....My Trintellix I did have to get a PA for, but the insurance company approved it no problem............I do have to pay a small co-pay on all my meds though, but it's very affordable.

 

Edited February 10, 2020 by CrazyRedhead

[Will]

So, it looks like a generic for latuda will not be available until 2023?  Decipher this for me:

"The acquisitions of Boston, along with Sepracor, Cynapsus and Tolero, were driven by realisation that the patents on Sumitomo’s schizophrenia blockbuster, Latuda, would soon expire. At present the Japanese group seems to have delayed this threat until 2023 by striking authorised generic deals."

https://www.evaluate.com/vantage/articles/news/corporate-strategy/back-drawing-board-sumitomos-deal-making

"After a long wait, generic Latuda (lurasidone), used to treat schizophrenia and bipolar disorder, has been approved by the FDA and should be available in pharmacies soon, according to manufacturer Lupin Pharmaceuticals."

https://www.goodrx.com/blog/fda-approves-generic-latuda-lurasidone-schizophrenia-bipolar-depression/ 

[argh]

.......

Edited September 16, 2020 by argh

[psychwardjesus]

Truthfully, up until this point, I didn't have a clue how much I spent on my meds. I imagined it wasn't terribly high as, when I would glance at the charges, they never seemed to amount to much individually.

I think the most expensive one migh'tve been pregabalin (Lyrica) because it was brand name and hadn't gone generic yet, but I didn't stay on it very long anyway since it didn't seem to do anything.

And I know it sounds utterly stupid and clueless, but I knew there had to be some kind of annual deductible because usually later on in the year when I would go to pay for a prescription and they wouldn't charge me anything. 

I did a little looking — nothing crazy 'cause I didn't want to go digging through my prescription insurance paperwork — but I found through the billing and itemization of PillPack that my deductible must be $250 a year, as that's the amount the charges to my card stops at since 2013 or '14.

Then that amount gets taken out of and paid for by the healthcare fsa (flexible spending account) my employer allows us to set up if we want to. The money is all pre-tax and automatically deducted from our pay checks; and it's only up to a certain amount (but you can always select to set aside less) set by the IRS every year. I think this year it was increased to $2,750.

It can be used for quite a few things other than prescriptions too, like medical, mental health, and dental co-pays, a whole bunch of healthcare-related equipment (but there are specific rules for some things like having to treat a specific disorder or illness and not just for general health as well as possibly a prescription [like for a CPAP machine for example because it's a regulated medical device] and sometimes a LMN, a letter of medical necessity, which is kind of like a doctor's note/unofficial prescription, and obviously receipts and whatnot, whether you're using the debit card they provide or your card and then filing for reimbursement from them). 

I'm still learning more and more about it as the resources the 3rd-party company provides are pretty vague — not so much for the specific, clear cut things they allow or not allow, as those aren't even set by them but the IRS — but more the gray area stuff that they say you might be able to get approved with an LMN, but they don't say definitively, even when I've talked to people there. 

It still could be potentially worth it for you though, if you have access to a healthcare fsa through your employer or maybe your significant other or parent if you're a dependent, and you don't mind a little risk with that won't get automatically approved.

Like, for example, I'm in the process of buying a water flosser because my gums and teeth suck and my dentist brings it up every time I see her. So, she wrote me a letter for it and I had a chat with people at the 3rd party fsa administration where they gave me a pretty vague okay. Now, I'm just waiting for enough money in my account to buy it because it doesn't immediately count as fsa eligible and I'll have to file for reimbursement with them later on. 

[shesellsseashells]

I'm in the US and was on Medicaid for a bit, paying nothing for my meds.  I was so fortunate: I was never turned down for any prior authorizations and was approved for many meds not in the formulary, like Vyvanse and Latuda.  Now that I'm receiving SSDI (for which I am also lucky) I pay for health insurance through my state's health care exchange at a discounted rate due to my low income.  I looked into Medicare once I was eligible, but it was so expensive!

Sorry if I went off on a tangent, but yes, Thunderstruck, you are fortunate!  Hooray for social programs that help people who need it!

[0112358]

3 hours ago, shesellsseashells said:

Now that I'm receiving SSDI (for which I am also lucky) I pay for health insurance through my state's health care exchange at a discounted rate due to my low income.  I looked into Medicare once I was eligible, but it was so expensive!

Not to hijack the thread, but I'm on SSDI and I don't have a choice but to be on Medicare, as in the government doesn't give me the option, they enroll you automatically. I don't think I'm mistaken... I haven't found Medicare to be all that expensive, also... you just need a Medigap plan and a drug insurance plan (the Medicare advantage plans didn't seem all that advantageous to me when I did the math). I'm sure I'd pay more if I had insurance through the exchange. With my income, I also don't have to pay any of the premiums, just the premium for the Medigap plan.

[shesellsseashells]

@0112358  Individuals receiving SSDI benefits are eligible for Medicare after receiving benefits for two years.  EVERYONE is enrolled in Medicare Part A (hospital benefits) but one has to enroll to receive parts B, D, etc.  I sat down with an insurance navigator as well as researched the matter on line.  At my SSDI benefit, Medicare Part B would cost $146 alone, an advantage or supplemental plan was a couple of hundred dollars in addition to med and doctor co-pays (I take some $$$ meds) of additional hundreds of dollars per month.

My health insurance through my state's health care exchange is $127 per month.  My med co-pays are about $80 per month, and my physician co-pays are perhaps $200 per year.  My health insurance doesn't cover all of my doctors, so I self-pay approximately $300 per year.  It was a no-brainer for me to stick with my insurance through the exchange.  I'm glad Medicare is working well for you, however!

[0112358]

@shesellsseashells Thanks for clarifying that, especially for others stumbling on this thread - still not sure if I'd be eligible for insurance on the exchange in my state. It's such a #%*#$% quagmire, right... I'll stop myself there.

[Banana Smurf]

I have medicare but my state has a separate stopgap medicaid for individuals who are on medicare and are not fully vested or something, I don't really understand it.  They have other forms of the medicaid insurance if you are disabled and working with low income.  

It might be something to look into because nobody at a government agency told me about it, someone else on SSDI did.  They paid my Medicare costs and copays.  I don't know how widespread those state programs are.

It is income based and I found a link about it for anyone who is interested

https://www.benefits.gov/benefit/6177

Edited April 2, 2020 by Banana Smurf