I have a new job that pays nearly 50% more than my former
job. I have a new insurance
provider. Anthem. I have to pay a portion of my monthly premium
as my employer does not pay 100% of the option I chose. I accept that because I
DID chose that more expensive option. So
that comes off the top of my paycheck. I
am on a certain medication that I take once a month. It is called Simponi and it is a single
injection that suppresses my immune system. My disease causes my immune system
to be in overdrive. I have had this
disease now for 18 years. I have been
through the gamut of medications. Some
work. Some don't. Some make me very, very sick. This one -- Simponi --
works. It isn't a medication I WANT to
have to take. It makes me susceptible to
nasty infections (deadly ones) and it opens me up to certain cancers. If I do not take it though I am in agony and
life really sucks. It is that game you
play when you pick the lesser of the evils.
Anthem for me is a joke.
With any injectible medication they are only willing to cover 60% of the
cost. That is okay when the cost is $100,
you or I would pay $40. It is not okay
when the cost of ONE injection is $2500.
Yes, I said $2500 per dose. My
monthly out of pocket expense for ONE DOSE is $1000. That doesn't take into account ANY of the
other accompanying medications -- there are several. This disease is not fun in any way folks - it
is not fun to have and it is no fun to treat.
Simponi is a newer medication so I decided to price Enbrel instead. I have been on it in the past; my results are
not as good with Enbrel as they are with Simponi but I realized that I might
have to be willing to suffer some in order to be able to treat my disease, able
to AFFORD to treat my disease. Enbrel is
a WEEKLY injection but it has been on the market for a decade and half and one
might assume the price had come down.
Um, no. My co-pay on Embrel is
$938 per dose. Multiply that by 4 and we
are looking at $3752 a MONTH! That is $48,776 a YEAR for ONE medication and
that is WITH insurance! Yes there are
"support programs" from the drug companies… Enbrel will help you with your co-pay for a
maximum of $4000 per 6 months. That is
nearly consumed in the first month…
LOVELY, eh?
So I am now simply working to treat my disease. With this new "raise" and new
insurance company and Obama's taxes on the "rich", I am taking home
less than I was with my old job. Why
should a person like me NOT go on disability?
I am working MY ass off so someone else can sit on theirs and collect
welfare, food stamps, medicaid…this is an f-ing joke. I am a department head of a County Government
with a ton of responsibility and a staff to manage. I carry a weapon at times when I do code
enforcement calls. I am giving a lot of
myself to my job and my community and this is what my nation gives me
back. Where is the assistance for the
people who want to stay healthy enough to be IN the workforce? For the people who have invested in
themselves enough to be valuable citizens and valuable employees? I WANT to be a contributor but I don't get
any help until I am not one.
The drug companies are a bad guy in this too. They discount the drug 50% to the insurance
company. THEN they offer, in the case of
Enbrel, $8000 a year in discounts to the consumer. How many products do you know that could
withstand that level of "discount" and still turn a profit?
I found the following on a medical advice website and wanted
to laugh. One-fifty? I would LOVE that co-pay!
"You have insurance and, supposedly, it covers your
medicines. However, you still get stuck with a portion of the bill that the
insurance company calls a “copay.” In some cases these copays can run more than
$150/ month per medication (e.g. Enbrel). If you are on more than one of these
expensive, branded medications the copays can really add up. What are your
options?"
Frankly I have no options.
I have to spend over 25% of my take home pay on ONE dose of one
medication. The intent of the Affordable
Care Act (AKA Obamacare) is to make sure that all Americans have access to
quality, affordable health care," said Brian Rosen, a senior vice
president of the Leukemia & Lymphoma Society. He adds that there is a
danger that the insurance marketplaces "will discriminate against the
patients with the highest medical need. That would completely undermine the
spirit of the ACA."
The group has been joined by Rep. Doris Matsui, D-Calif., in
urging state officials to reconsider the policy. The high copays "could
prevent many patients from receiving the lifesaving treatments they need
because of prohibitively high cost," Matsui wrote to the state. Cancer drugs and autoimmune drugs fall into
the same category of costs and how they are treated in the marketplace.
Leukemia patient Lisa Lusk worries about what will happen to
her. A nursing assistant who lives near Fresno, Lusk is hoping to return to
work in the next few months. When that happens, she expects to lose emergency
coverage she's now getting through the state. And the medication Lusk takes to
manage her chronic form of the disease costs more than $5,000 a month.
I sure can identify with Lisa and her fears. "I'm
scared that when I get a job my co-pay may be more than $1,500 a month,"
said Lusk. "I'll just be working to pay for my medications."
The crux is that I am already there and Obamacare has not
even fully kicked in yet. If this is the
future for people who are NOT yet there, where will that put me?
