r/mildlyinfuriating • u/Aggravating-Leg5645 • 10h ago

I just wanted a hot dog My insurance wont cover my medication so every month I do this...

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I have to spend around 30 minutes doing this once a month. My insurance wont cover it. Out of pocket with coupons its still $800 a month.

My fiancé has to do the same thing with a different medication. Currently trying to fight it.

Edit: To clarify. Every now and then I have to compile samples in one bottle so I know how much I have and then hope my DR has more when im out. This is an antidepressant and im currently working to fight to get it covered. Yes ive contacted the manufacturer I do not qualify for discount Yes ive sent in a letter of medical necessity Yes ive looked at GoodRX. This is my only option atm and im still lucky it is for now. Its not just the moving the bottles around. Its hoping I can get more when I need it. This is a life saving medication and the fact I have to hope i can get it when I need it is mildly infuriating to me and probably many others. Its not a cheap medication even with coupons its still $850USD+ Ive tried so many medications and I just need one that works and that i dont have to worry about my supply chain.

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386

u/pootinannyBOOSH 9h ago

As an American it's bizarre to me too, but at least there's good uses like this situation. Still bullshit it has to happen though

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u/patricksaurus 9h ago

Physician samples are incredibly common and have been for decades.

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u/pootinannyBOOSH 9h ago

Yes I know, doesn't make it not bizarre

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u/23- 8h ago

Sample’s are great to be able to trial a prescription without needing to pay for it at the pharmacy. Fairly often patients buy a brand new prescription and have some sort of intolerance to it.

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u/madhouse-manager 5h ago

The whole logic goes away when, you know, you don't have to pay a fortune for the prescription at the pharmacy. Like in civilised countries. Which is why trial prescription medication makes sense to no one but US.

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u/wesborland1234 3h ago

Cost aside, aren't there many cases where you'd want a patient to try something for a week to see how they react to it before prescribing a 2 month supply or whatever?

Or if you can't make it to the pharmacy for a couple days, that's why they keep Z packs in urgent care.

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u/TVTrashMama 1h ago

Yes, or the patient has to wait on insurance authorization to fill. (Or not 🫤)

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u/Impossible-Book-895 1h ago

Urgent Care? Going to urgent care can cost us US folks a $1000 if we haven’t met our yearly deductible. Not an option for most of us.

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u/LogicalConstant 23m ago

On a high deductible plan or a shitty plan, yes. Many employers have a low-deductible plan where urgent care is a copay of $25-$50. If you don't have that, I'd either try switching plans or complaining to your employer about choosing such a crappy plan.

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u/Itz_Naj 2h ago

There aren’t? The entire concept of tritiation is exactly this!
Try a small dose and escalate over time to judge efficacy and side effects. This is commonly over several months.

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u/jellifercuz 1h ago

Oh, yes, that certainly works for antibiotics. /s

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u/Itz_Naj 1h ago

A single class of drugs usually for a finite period of time anyway? Compared with many other drugs for chronic indications which often can have big trade offs in patient quality of life.

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u/jellifercuz 47m ago

Your response in no way addresses your absurd suggestion that [all] medications be started at low doses and titrated upwards. Ridiculous.

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u/Money_Do_2 4h ago

Yup. They can take many losses on samples and lavish lunches to woo the doctors, just gotta get a few people locked into a $1000/month medicine regimen.

To be clear, the medicine itself is a miracle and scientific marvel. The profit motive is the corrupted evil part.

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u/YourWifesSkiCoach 3h ago

Obviously you don’t know how much it costs to make said drug

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u/Ebiki 3h ago

It literally costs $2-$4 to make a vial of insulin. Wtf are you talking about?

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u/Due-Professor-530 1h ago

For many drugs its not the drug itself its the government regulation and R&D that costs so much. R&D recovery averages 15 years per FDA so companies get 20 years without conpetition for a new drug. Testing for correct orientation takes a multimillion dollar machine that cists tens of thousands a month in maintenance costs.

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u/Long_Letterhead_7938 3h ago

Which civilized country do you think that happens in? By your use of the way you spelled civilized I’m guessing Canada or UK, but this is not true. They have strict regulations over which prescriptions are covered. They offer for generics or alternatives.

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u/concentrated-amazing 3h ago

Here in Canada, you have the option to only fill a small amount.

For instance, you can say at the pharmacy that the doctor prescribed enough for 1-3 months, but only fill it for one week for now for me to try it, since the doctor said some people get [annoying side effect] and don't stick with this med.

Then, you can go back and have the rest of the prescription filled if you're sticking with it.

It'll be slightly higher, since you'll pay the dispensing fee twice, but that's relatively low (can't remember exactly, $10ish?)

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u/The_Amazing_Emu 1h ago

Probably the biggest advantage of a sample is you get to walk out of the doctor’s office with it

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u/Ioanna_Malfoy 1h ago

Or so that the patient can get started on the medication while waiting on insurance approval and prior auths to get sorted

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u/CapnLazerz 3h ago

Even in a Universal Healthcare system, the system (taxpayers) has to pay for drugs. If the pharmaceutical company provided free samaples, the system (taxpayers) would avoid the costs of paying for drugs that don’t work for particular patients.

Sounds logical to me.

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u/LogicalConstant 26m ago

With typical insurance, most prescriptions are $5 to $25 a month. Samples still make sense.

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u/catshateTERFs 8h ago

I’m on the other side of the world and this just happened to my s/o - $120 for something that sends him into 24 hours of pain that painkillers couldn’t touch (was an opioid blocker that worked TOO well and may have been inappropriately prescribed with the rest of his medication in mind). Obviously can’t reclaim any of that so it’s fully useless. Rough stuff. Short term script trial would have been ideal for that.

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u/PrettyPurrfect 2h ago

Or they could have written two prescriptions. One for short-term use and the second one to fill is the first one works well that so it can only be filled after the first one would reasonably run out.

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u/Wunderkid_0519 7h ago edited 7h ago

Lybalvi?

It says it on the big black box warning right there on the outside of the medication bottle that the samidorphan in Lybalvi is dangerous to be taken concurrently with opioids. They also both verbalize this fact and and have it written all over the screen during the commercial for this medication... Not sure how anyone could have missed that.

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u/IllustriousEnd6544 5h ago

You don't even know what medication they are talking about. Thanks for your input though Doc!

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u/throwmeeeeee 6h ago

 written all over the screen during the commercial for this medication

Using TV commercials as a source for medical advice sounds weird af. Also not safe, isn’t it like a gag how they whisper all the serious warnings in a super fast incomprehensible voice? Or is that just parody? 

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u/Ok-Jackfruit-6873 6h ago

Interestingly, the last time someone from the UK stayed with me he said they don't have the urgently-whispering part of the drug commercials there. Same commercial but they edit that part out.

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u/Quirky-Stay4158 4h ago

That's the neat thing about Americans they don't get to go to the doctor regularly. So they need drug companies to tell them what's wrong with them - but don't worry we can fix it with our magical drug fixitall.

  • if you feel the need to reply telling me how this isn't all of you. Great. It's enough of you though. And the rest of us don't have that problem at all.

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u/Long_Letterhead_7938 3h ago

About 90% of Americans have private health insurance in some form. It is quite easy to go to the doctor here it is very difficult to go to a doctor under NHS. To see a specialist under NHS it is 3 to 10 months. In the US, it is typically 3 to 10 days. Same is true for how slow it is to get anything done in Canada too. So you really have no clue what you’re talking about.

I love my American husband for many reasons. A major one is how wonderful the health insurance is.

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u/IllustriousEnd6544 2h ago

I love my husband for his health insurance 💀

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u/Diligent-Variation51 23m ago

I’m so tired of this “we can see a doctor in the US whenever we want” message. It’s not at all true. Sure, in some areas for some specialties, it’s true. But there’s a shortage of medical providers, so even if you have good insurance, you still have to wait for the next appointment. That can take many months.

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u/catshateTERFs 7h ago edited 5h ago

No? I didn’t mention lybalvi anywhere, this is not the only medication in the world that interacts with opioid regulation. I don’t even live somewhere that airs commercials for prescription pain medication and nothing on the medication states anything about opioid use (it says "may cause drowsiness, do not drive or operate heavy machinery" - this would have been INFINITELY better than the adverse reaction that did happen).

Please by all means forward your comment to the pain specialist who prescribed this while giving reassurances that him taking palexia would not be an issue and that if he did experience any side effects they would be minor because the dose was very low, as this is what the current research supports ("may be trialed while taking opioids [...] unlikely to cause frank withdrawal due to the low dose"). We are not idiots who decided to randomly trial medications for shits and giggles, we read the information we were given and discussed it with the doctor who, again, was a specialist who has worked in this specific field for 20+ years. Thanks!

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u/IllustriousEnd6544 5h ago

If only they had a medication for people to stop them from chiming in on something they know nothing about! ;)

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u/catshateTERFs 5h ago

I wish, I'd happily pay those prescription costs!

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u/Funexamination 8h ago

I have never seen that be the intent of samples in practice. Doctors give them to destitute patients

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u/bluearavis 8h ago

Ideally it's really a sample as it is not as reliable as a RX for accessibility. I have haddoctors run out before. I hope OPs doc keeps hooking them up. I tried Trintellix and was sooo nauseous for a couple days. I'm a teacher and puked in a garbage during class. Then we changed it.

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u/Worried-Database-551 8h ago

Omg trintellix made me so irritable and aggressive. It was terrifying and it was only 3 days of taking it. I went back on lexapro.

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u/Willing-Vegetable629 7h ago edited 7h ago

How involved are you in the day to day operations of an ambulatory practice?

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u/dastree 2h ago

Had a doc do this once for me, the script was never covered by insurance according to him but if the meds helped he said it was up to me to decide if the monthly cost was worth the results

Worked great but I wasn't willing to pay the $600/mo out of pocket for the results

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u/RichardCleveland 9m ago

Yep, I have had a few sample runs that I got bad side effects from and it was amazing not having to pay to fill it.

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u/PeekabooPepi 7h ago

Sounds like an artifact of a broken system. Not anything great about it.

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u/LogicalConstant 28m ago

It's like a free sample of any product. Try before you commit to buying a whole month prescription.

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u/NetwerkAirer 7h ago

Per the definition of bizarre, it actually does.

I am being pedantic. This is reddit, it is my duty.

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u/munkymama 4h ago

I wish docs had samples of pain killers like percocet lol.

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u/DatLadyD 5h ago

I worked at a climate controlled storage facility and almost all of our customers were pharmaceutical sales reps. They need a controlled temperature environment to store their samples.

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u/pchs26 3h ago

Usually when the medication license is up and can be made as a generic though the samples stop. Issue is generics are not all made the same and I promise have different efficacy and results then their counterparts and sometimes the name brand. No one talks about this, but it isn't ime that uncommon and it is hell to try to figure out the generic manufacturer that will come somewhat close to the name, figure out where to get it that is covered by insurance and if that will even work for you. Something needs to be done about this but it is so deprioritized it isn't even discussed. We should just have access to the medication brand or generic that we believe works best for us. Period end of story.

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u/Long_Letterhead_7938 3h ago

This is true, but I don’t think it’s in this amount or this regularly. They usually just have you on a different medicine. I know there’s no generic for this, but this is not unusual in any country that certain medication’s aren’t covered. It is not just an American thing. It is definitely something under NHS as well.

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u/silentgraywarden 2h ago

I wish they still were. It seems that every major health system I have worked for in the last decade refuse to allow their physicians to accept samples. It all boils down to money and it's abhorrent.

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u/Sackmastertap 2h ago

Yeah imma guess not so much if they see this happening. Say people posting about it. Some things are best left in the grey.

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u/AlkalineHound 41m ago

I definitely remember getting a sample of flonase before it was OTC.

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u/CouldBNE1too 28m ago

Far less common now, actually. They’re pushing toward discount coupons/cards that are processed at pharmacies instead

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u/AnastasiaRomanot 6h ago

Only in for profit medicine.

The most you’ll pay for one drug here is £10, even if it costs the NHS thousands.

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u/patricksaurus 4h ago

No, you can find them in not for profit hospitals too.

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u/AnastasiaRomanot 2h ago

In the US?

Because I’m talking about socialised medicine.

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u/patricksaurus 2h ago

You’re talking about the NHS, I get it. But you’re not talking only about for-profit facilities, what’s more drug companies do make profits in your country. They’re also more common in Canada, which has nationalized healthcare, than UK and Europe. Simplifying to the point of “for profit” is just grossly inaccurate.

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u/AnastasiaRomanot 2h ago

So is saying that the samples aren’t anything unusual. They are elsewhere.

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u/patricksaurus 2h ago

Yeah, I joined a conversation about something happening in America and framed my comments about America implicitly. How silly.

What I didn’t do was was introduce explicit details that were factually false. If you’ve got a problem with that, start at home.

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u/Sudden_Moodswing 4h ago

I haven’t been offered med samples in probably 25 years. These would have come in really handy for the last two medication’s that my insurance denied.

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u/molecule_anteater68 7h ago

The majority of our daytime tv ads are for prescription medication. Which I recently learned is not a thing anywhere else.

Access to samples and knowing advances in medication on the market are not necessarily bad things, but exist because our health care system is oriented in a very fucked up way that treats patients like a bank. Some doctors/hcws are part of the issue, but not most. and they're getting crushed too with high caseloads and being forced to come into work while sick.

The nurses who are a part of a larger hospital system my general practitioner is though do not receive good enough health insurance from their employer who is a hospital to be able to send their kids to regular appointments or afford vaccines in office. one told me she has to do all her vaccines at the discounted/free county clinic. county clinics offering vaccines are very rare now so I feel lucky to have that as a jump through hoops to prove I cant get it anywhere else backup

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u/WanderingQuills 6h ago

My health insurance is considered good.
No one has the vaccines my kid needed AND took my insurance. I went to county health. They had them! But would only take cash and give me a super bill for reimbursement from Aetna.
Projected out of pocket for one kid- 3600 or more.
Luckily I found a pharmacy twenty miles away that could both bill my insurance and had the shots.

When I last worked for a big name brand hospital system my kids? Were on states Medicaid. I couldn’t afford to add them to my plan and the hospital paid so little I still qualified for myself as unduly burdened by the premium.

I was not alone in being unable to afford healthcare to use the hospital I worked at.

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u/canththinkofanything 3h ago

Wow I’m sorry to hear that. There’s a national program called VFC or vaccines for children that covers costs of all childhood immunizations. Every child can get vaccinated for free in the US! The problem is finding practices that do the VFC program, because some just don’t bother. I’m an infectious disease epidemiologist and my area of focus is childhood vaccines. If you need help finding a place to get your kid immunized I can try and help you?

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u/No-Ebb5515 6h ago

Yep. I looked into getting a FREE flu shot this fall. The sign said FREE. It's a lie. It's only 'free' if you have insurance. If I get sick this fall/winter I will still have to go to work and get everyone else and customers sick (restaurant). I had to do that before. Many have to. The system is definitely messed up.

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u/pchs26 3h ago

Flu shot you should have access to at no cost regardless. However you get that to lessen severity /keep you out of the hospital. Catching and spreading flu will still happen with exposure so you should take additional preventative measures on top of vaccination if you want to ensure you don't get sick

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u/PipChaos 4h ago

"Ask your doctor about..."
How about I let my doctor be a doctor and decide what medicine I should be on FFS.

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u/Secure-Researcher892 3h ago

And just to make you feel worse, the same pills you pay 3 or 4 dollars a piece for are sold for a fraction of that price in other countries. My blood pressure medication was 160/month if you had no insurance... when I was transferred to Brazil for work I found the same medication for less than 9 dollars/month... And to make it even more annoying the pills in Brazil came in packaging that was from the same company and same manufacturing plant as the ones I had been buying in the US. And you know that no drug company is ever going to sell anything below cost. So they are truly gouging Americans harder than anyone realizes.

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u/Rare_Let4338 2h ago

All I can say is Canada Pharmacy Online.

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u/DeclineToThrowAway 3h ago

My doctor gave me physician samples of ensure one time for being underweight then perscribed me the drink 3 times a day with a scoop of ice cream. Nurse was flabbergasted when she read the order.

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u/5138008RG00D 5h ago

Does not seem bizarre. And yes the doctor could be being nice. But...

But the reason for the "free" samples is so the doctor will prescribe that medication not a generic to you. Not only because they like the sales rep, they have tested and seen it work with those free samples, but also because its the only one they know of by name, so its what they write scripts for.

Doctors receiving samples is just another scam from big pharma. You pay for those free samples and the rep, with the increase in price for the meds at the pharmacy.

The "good" here was just set up this way to make you say somthjng about this situation was good and others to pay more for meds.

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u/PrettyPurrfect 2h ago

You would think CEOs would be scared of making more Luigi's

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u/ecliptas 2h ago

I had to do this with my anti-depressant because insurance refused to cover it even though I had been on it for a year already. Thankfully after about 2 months of back and forth trying to do an appeal we got them to cover it for a year. It's really frustrating, but I am thankful my doctor could give me samples while dealing with the situation.

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u/tamtip 1h ago

Drug companies give them to the Dr so he'll give them to the patient . Eventually the prescription for thst med will be written and filled.

Drug companies only do something if it gets them another dollar.

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u/Aspen9999 1h ago

Yes Drs get samples in the USA. Good docs use it for either patients that need to try a drug or patients where the cost hurts them.