BCBS Double Copay On Thyroid Meds

Mary is freaking out because BCBS of Maryland just doubled the copay on her thyroid meds. Times are tight, and Mary doesn’t have a thyroid. The insurance companies have been telling her for years that Consumer Reports Best Buy Drugs is a generic, now BCBS has classified it as not being generic. She’s pretty ticked, and considering getting married to her fiance early just to get on his insurance. Her letter, and how she might save $200.32 a year, inside.

My thyroid medication, having been around for 40+ years, has been considered a generic for years by every insurance company I’ve had in the the past five years (same employer, but the plans keep changing). The costs for my usual three-month prescription have been going up, from 15$ 5 years ago up to 30$ for the past couple of years. So I was a little surprised that yesterday BlueCrossBlueShield of Maryland would only pay $14.92 on a $75 total for my usual 3-month prescription, leaving me to pay $60.08 as a co-pay.

Now an extra 30$ extra every three months won’t make me broke, but I do wonder why I’m paying 120$/month for insurance that is basically useless to me. I called BlueCross and their response was that my prescription isn’t considered a generic anymore but a “nonpreferred Tier 3 medication” (whatever that means) with a copay of $100. Since the total cost of my prescription is $75, they “pay” a pro-rated percentage. When I asked about my limited options were since I’m already taking a “generic”, their response (and this is a quote) was “we can change our copays at any time”.

I can’t be the only one in this situation, since thyroid hormones are among the most prescribed medications in the country. Since I don’t have a thyroid, not taking medication isn’t an option for me.

I also wrote to my employer: it’s a small company, so BCBS is the only option we have for insurance. We all just renewed our insurance on 5/1/2008, and the paperwork we were all given in April to mull over said my prescription would remain @$30 for a a three-month supply.

I do have an out as far as changing insurance companies, since I’m getting married and my future husband can add me to his insurance. The wedding isn’t until next year, however, so we may have to go to the courthouse in the very near future – like next week – so I can get better health insurance.

First, the bad news. Along with Synthroid, Levoxyl is actually brand name (source: Drugs.com, Medicine.net). I don’t know whether the insurers in the past mistakenly said it was a generic or what, but it looks like BCBS is right.

Now, the good news. The generic for Levoxyl is levothyroxine, and Target will sell you a 3-month supply for $10. So will Wa-Mart.

Even if you’re paying for this out of pocket, it’s cheaper than your copay was even 5 years ago. Hope this saves you some money, and a trip to the courthouse. Of course, consult your doctor first before switching out any medication (especially as some commenters are saying generics can actually vary subtly from the brand name, and some patients can have adverse reactions to different kinds of thyroid meds). Here’s another potentially useful idea from commenter Bohemian:

“Some people can’t take the generic versions of the brand name thyroid medications. They do actually have a different formula to them so some people are unable to properly absorb the generic drug.

She could try disputing the BCBS change. Most BCBS plans still consider synthroid to be a lower tier medication so the copay is cheap. Sometimes a doctor’s note stating that the patient can not take the generic alternative is enough to get an exception to the increase thus putting the drug back to the lower tier pricing.”

(Photo: trekkyandy)

Comments

Edit Your Comment

  1. missdona says:

    If you live with your fiance, you can probably do a domestic partnership to bridge you until your wedding.

  2. The Great Aussie Evil says:

    Wait, what? no thyroid? How’s her blood calcium levels going to stay even then?

  3. SaveMeJeebus says:

    Why would you not have a thyroid before getting married? Piss poor planning is not an excuse to game the insu… wait. Wrong article. I agree–go to WalMart/Target. They are doing what the government can’t and won’t do.

  4. Carabell says:

    @missdona: That’s actually highly unlikely. Insurance companies won’t do it unless you live in certain states (Texas is one) And even then you have to get a certificate from the state to even apply.

  5. speedwell (propagandist and secular snarkist) says:

    I don’t personally take thyroid medication, but a co-worker does, and she says that generics are actually different formulations, despite having nominally the same active ingredient. This doesn’t usually make any difference when you’re taking “acetaminophen w/hydrocodone” instead of Vicodin, say… but the body is more sensitive to formulation differences when the thyroid hormones are involved. Thyroid medication users frequently have to try several formulations before finding the right one, and then it’s not uncommon for them to need to switch formulations from time to time.

    What I’m saying is that it’s not enough to blithely wave your hand in the air and say, “Take the generic, babe.”

  6. Raziya says:

    BSBC…thankfully we have not had an issue with them yet, but I’ve read the horror stories. :P

    Go get your drugs from Wal-mart. 10 bucks for 3 months is a steal!

  7. milk says:

    Marriage is a business transaction. Go for it. If you’re into the headache of a formal wedding, reception, blahblahblah, just do that when you have the time/money.

  8. Sassafras says:

    FYI…I have a hypothyroid and when I was in the hospital recently haven given birth I had a conversation with one of the maternity nurses who had the same condition.

    She told me that she was mistakenly given a generic version of Synthroid and had a sever negative reaction. Her doctor told her that sometimes the generics are wonky (of course he could be on the drug companies pay roll).

    But either way please be careful if you do change over just in case it happens to you.

  9. tande says:

    @The Great Aussie Evil: I’m going to guess through medication

  10. Sassafras says:

    @speedwell: You beat me to it!

  11. MitchV says:

    My family is dealing with the exact same issue. Recently my wife’s Synthroid co-pay went up. I’m glad to see this posted here.

    The funny thing is that this story is a good reflection of one of the many things that is wrong with health care in the United States. Consumers (like this woman and myself) aren’t price-shopping when it comes to medications… it doesn’t matter, we only pay attention to the co-pay amount.

    Now, if we were paying full price for the meds I would have found a place selling the $10 prescriptions a LONG time ago.

    Throwing money away on a brand name drug is yet another reason insurance premiums continue to increase. You’ve got drug reps essentially bribing doctors and doctors prescribing things that cost the insurance companies a fortune… which they gladly hand down to the insurance subscribers.

    If at the point of purchase the consumer says “Hey, this is costing me a fortune!!” the cycle has a chance to stop.

  12. squatchie44 says:

    @The Great Aussie Evil:

    thats what the meds are for, and as stated above some people CANNOT take the generic. Generics are not identical, just rather close.

  13. SkokieGuy says:

    @SaveMeJeebus: I laughed out loud. Best Consumerist chuckle in a long time!

  14. HeartBurnKid says:

    @speedwell: I’m not an expert on thyroid medicines or anything, but a generic for a given drug must, by law and enforced by the FDA, have the exact same amount of the exact same active ingredient released in the exact same manner as the name-brand drug. The only thing that can be different are the fillers. Meaning that, while different brands can and will have different formulations, anything that claims to be a “generic for Levoxyl” will have to have the exact same formulation as Levoxyl. Any differences in effectiveness can be pretty much chalked up to the placebo effect.

  15. tcp100 says:

    You’re paying $120 a month, but not getting that much back? Um, that’s how insurance is supposed to work.

    Man, I hope most months I pay my insurance premiums for “nothing”.

    Insurance is intended to be there for catastrophic occurences.

    The OP would be much better served to go through a prescription discount plan or to Wal Mart, but honestly, she’s really not paying that much for her meds.

    Everyone who expects to get drugs and such basically for free through insurance is part of the reason health care costs are so high.

    I’m insured in an individual plan, and as a healthy 30 year old I’m paying $180 for a plan with a $2000 deductible. It’s hard to feel the OP’s pain about an extra $10 a month for her medications.

    The insurance is not “useless to you”, they’d have to pay hundreds of thousands if not more if you had a serious illness or an accident; that’s why you’re paying $120 a month for insurance.

    I know many people will disagree, but it’s like the folks who carry a $100 deductible on their car insurance, get scratches and dings repaired under claims, and then wonder why their rates go up or when the company gives them a hard time when they have a real claim.

    Mary, BCBS increased their co-pay because they’re not making any money on you. It’s that simple. I know such a thing is tantamount to evil on the consumerist, but insurance companies are not non-profit organizations or charities.

    Until the government does something about universal healthcare, that’s what we’ll have to deal with.

  16. joebloe says:

    Try Walmart or Costco for their $4 drug prescription.

  17. bohemian says:

    Some people can’t take the generic versions of the brand name thyroid medications. They do actually have a different formula to them so some people are unable to properly absorb the generic drug.

    She could try disputing the BCBS change. Most BCBS plans still consider synthroid to be a lower tier medication so the copay is cheap. Sometimes a doctor’s note stating that the patient can not take the generic alternative is enough to get an exception to the increase thus putting the drug back to the lower tier pricing.

  18. speedwell (propagandist and secular snarkist) says:

    @HeartBurnKid: “Fillers” apparently do matter, Kid. Think about it… do you even know what the “fillers” are? They aren’t necessarily inert materials. The quality control of the cheaper generic may also vary.

    What if you were a doctor and your patient was, for example, allergic to one “filler” but not another? What if they couldn’t stabilize their hormone levels adequately because the generic was made with looser tolerances? Would you tell them it was just a “placebo effect?”

  19. HeartBurnKid says:

    @tcp100: Thank you for nicely summing up why healthcare should not be a for-profit enterprise in this country. Everybody wants to just leave things up to the insurers, but the insurers are in place to make a profit, not to ensure your well-being.

    I do think you’re wrong on your point regarding her medications, though. The entire point of health insurance is that it’s supposed to pay for your treatment if you should get sick. Said treatment often includes the use of prescription medications. A company changing its co-payment in the middle of said treatment, thus altering the terms of the agreement ex-post-facto, does indeed make them useless.

    To put it another way, suppose you have car insurance with a $500 deductible. The day after you get into an accident, the insurance company decides to raise it up to $1000 because “they’re not making any money off of you.” And, since they haven’t cut the check for you yet, this new rate affects your accident. Would you not be angry?

    So why do we put up with this treatment from our health insurers, when we wouldn’t from our car insurers?

  20. HeartBurnKid says:

    @speedwell: Oh, I know fillers matter; my own grandmother was allergic to a filler that was used in generic insulin, and so was forced to use the name brand. But allergies are a very specific and very different thing from what you’re claiming, that the generic is somehow less or differently effective just because it’s generic.

    You have no idea how strict the FDA is on prescription drug companies. Generics are not made with “looser tolerances” than brand-name drugs. They can’t be, or else fines start getting handed out, and, in extreme cases, people go to jail.

  21. Uriel says:

    @speedwell: @

  22. WraithSama says:

    Mary is freaking out because BCBS of Maryland just doubled the copay on her thyroid meds.

    How dare they try to screw with Mary in her own land. Ultimately, this isn’t a big deal. The follow-up shows that the insurance company is in the right, Mary admits she can handle the higher cost, and also notes she’s about to get married and can then switch to a better insurance provider. Next!

  23. Uriel says:

    @speedwell:

    sorry, donno why what i wrote didn’t enter my last post.

    “Sugar”.

  24. HOP says:

    my bride was put on a medication tha,in some states is prescription,and others it’s over the counter….the prescription plan would only say it was over the counter, even tho here it’s prescription….

  25. tcp100 says:

    @HeartBurnKid: I agree, however I wouldn’t say car insurers don’t do that. They just do it after the fact.

    Even if you get in an accident that’s not your fault, in many instances, you can count on your premiums going up – and being in a higher “risk group” even if you move to another insurer.

    I’m healthy, but my individual plan was tiered up from $150 to $180 because I went to the ER due to a cut I got when slipping on ice.

    I guess they figure I’m accident prone, and therefore a risk.

    Insurance companies will use ANY excuse to raise premiums, and in many cases, it’s legal – and “switching companies” is not an easy option.

  26. Zyzzyva100 says:

    @The Great Aussie Evil:

    When they get rid of your thyroid (usually via radioactive iodine) it preserves your parathyroids, which regulate blood calcium.

    And as for everyone else saying generic = the same, speedwell is correct, fillers do matter. It took several different tries of cox2 inhibitors before I found one that didn’t make me sick. Active ingredients and mechanisms of action for the different drugs were basically the same, the real difference was the fillers. Sometimes the other ingredients in pills also make a difference in how the active drug is absorbed or initially metabolized.

  27. bohemian says:

    For some people the generic (at least with thyroid meds) really does not work right. Target accidentally gave me 90 days worth of generic Synthroid. Since it was at the same time I had the dosage increased I didn’t realize they gave me generics. I was miserable for those three months, having no clue why I felt like crap. Next refill they got the correct brand name and the symptoms went away.
    I always thought the “brand name is better” in relation to thyroid medications was BS and just used to make money. I take generics for everything else. The claim that thyroid meds are different in brand vs. generic is an accurate one.

  28. Tracy Ham and Eggs says:

    @speedwell: Synthroid actually caused me to have hallucinations and increased heat sensitivity a few years back. It was horrible.

  29. Juggernaut says:

    Sharon Stone just called and said something about “karma”

  30. jimv2000 says:

    I wonder how much she pays for TV each month…

  31. JiminyChristmas says:

    I was wondering what sort of lame-ass contract the OP’s employer has with BCBS (assuming they have one at all) that allows BCBS to change the terms at will.

    At my place of employment the insurance policy is contracted annually, i.e: premiums, co-insurance, deductibles, and co-pays can’t change until the contract is renewed. Of course, in the good ol’ days we used to be able to get a two or three year contract. Now we get to go through the whole insurance shopping song and dance every single year and the insurer gets to raise their prices two or three times as often as they used to.

    I think one of the most effective insurance reforms that can be made, short of universal coverage, is community rating. That means everyone in the same market pays the same price and the insurer can’t refuse coverage to anyone. That way, individuals and small businesses don’t get shafted on rates and everyone at least has the chance to buy a policy.

  32. jimv2000 says:

    @JiminyChristmas:

    Who said they changed it at will? Maybe this WAS part of a negotiated contract.

  33. Zyzzyva100 says:

    @bohemian:
    @Tracy Ham and Eggs:
    Several patients that I have seen (I’m a med student) have said the same thing regarding the generic thyroid hormone. I don’t know what the difference is, but the people even had blood tests that indicated the generic version just wasn’t working, so it certainly wasn’t a placebo effect in this case.

  34. bohemian says:

    Some benefit plans also don’t let you drop your coverage for a set period of time. One employer I had, had a fine print rule that once you signed up for health insurance you could not drop it or switch between the two offered plans for 2 years. About three months after I signed up for their health insurance they announced a 30% increase on all employees health insurance deduction. I couldn’t drop the insurance for 2 years. I was stuck paying for it at a 30% higher rate.

  35. Tracy Ham and Eggs says:

    @Zyzzyva100: Yeah, I was 19 or so and never heard the stories until afterwards. . (To be fair, I havent ever reacted well to the name brand either, though not that bad, and am not taking any, much to my detriment Im sure).

  36. Snowblind says:

    @Zyzzyva100:

    Yep, and if you are milk allergic or gluten intolerant it can really play hob with the system.

    Quite frankly, of the 4 people I know who take thyroid, 3 find the natural pig product to be the most effective and reliable. Primarily because it contains all the various thyroid byproducts and derivatives the body makes in the thyroid, not just T4.

    Stuff is practically free, being a byproduct of making pork products. I kid you not, my wife’s bottle has the cheery Armour (as in hot dogs) brand label on it.

    It presents a problem for the vegans, and practicing Jewish/Muslim populations, but it does work very well.

  37. johnva says:

    @HeartBurnKid: Actually, it’s NOT necessarily the exact same dose. The FDA still considers generics “bioequivalent” if the levels in the body are within a certain tolerance level of the brand-name drug. Add this onto the fact that a certain dosage difference is legally tolerated between different pills already (to account for manufacturing imperfection) and you may see a slight difference. For most drugs this isn’t an issue at all, but it can make a difference, in particular for hormonal drugs where the dose is only a few micrograms. For example, sometimes generic and name-brand birth control pills will have slightly different levels of side effects because even a tiny difference in the hormone levels can greatly affect this. Add to that the fact that the generic makers may be erring on the upper side of the legal hormone range (for birth control pills, since they would rather people have more side effects than unintended pregnancies) and you may get a detectable difference.

  38. mbd says:

    What she should do is ask the insurance company what their plan’s “prefered” drug is, have her doctor issue her a 2 week prescription, and try it. If it works ok for her change to that drug.

  39. thegirls says:

    Synthroid sucks and it’s over priced. The best thyroid medication is Armour Thyroid. It’s cheap, been around forever and is way more effective on regulating your thyroid hormones and alleviating all thyroid related symptoms.

    The problem is that most docs are married to Synthroid for some stupid reason!

  40. dreamcatcher2 says:

    @MitchV: You seem like a smart fellow. Have you read “Crisis of Abundance”?

  41. nikiv says:

    I don’t think we’re looking at a changed co-pay here. What we are really looking at here is a formulary issue. A formulary is a list of drugs that an insurer will cover, and they will vary between insurers. In nearly every insurance contract, the insurer reserves the right to change the formulary as often as once per quarter (and this is most likely in your received paperwork somewhere – in really fine print). This allows them to change their terms when a drug goes generic, or even over-the-counter. An example of this is Zyrtec, which recently went generic and then a month later went OTC. First our insurance would charge you the 3rd tier rate for the brand name, then they wouldn’t cover it at all, since it was OTC. All of this is made possible by their formulary.

    Apparently BCBS has decided that your medication is available in a cheaper form, and that they will still allow you to have the more expensive form, but you will pay for that privilege. They call this a “generic push”, since they’re trying to push you to using generics by the best incentive of all – money. In my experience, it is basically impossible to get the insurer to override the formulary. They’re in business to make money, and as long as they will pay something toward your drugs, they think it’s up to you whether to choose brand or formulary. While that’s sometimes true, it doesn’t always work this way.

  42. chiieddy says:

    I pay $4/mo at Target for my levoxythrine. Worth looking to see if they offer your levels (mine are 150 mcg) in their $4/mo program. It’s cheaper than my copay.

  43. Gari N. Corp says:

    Yeah, I was able to argue my doc down from synthroid (this was before a generic was available), and didn’t experience much of a difference either way. I’ve got maybe a quarter of a gland following surgery, but have never been that sensitive to the different types. While I’m not saying that no-one will be, it’s worth trying the generic. More annoying is that it’s really easy to find cheap thyroid hormone, but calcitriol/rocaltrol, the parathyroid booster, is much less commonly found in cheap drug offers. Still, not complaining.

  44. nikkimarie says:

    @tcp100:
    Not that much for her meds? Do you have a thyroid problem or a medical condition that requires you to take medicine every day for the REST OF YOUR LIFE?

    I am 24 years old, have been taking thyroid medicine everyday cine I was 15 and I will continue to take it every single day of my life until I die. $60 a month x 60 years is quite a lot of money.

  45. missdona says:

    @Carabell: I work in NY, but every company I’ve worked for has provided benefits if you certify with an affidavit. It depends on his corporate policies.

  46. Spamboy says:

    @thegirls To say that Synthroid sucks because you perfer Armour doesn’t take into account individual’s reactions to either drug.

    When I first went on thyroid hormone replacement theraphy, Armour was the first one I tried, and it didn’t offer the consistency in hormone levels that Synthroid (later levoxythrine) offered me.

    What works for one person may not work for another. But the good thing about either drug is that they’ve been around for quite some time and are proven quite effective when administered correctly. Fewer things are as simple as such a hormone replacement theraphy.

  47. When my employer renewed our CIGNA coverage this year, CIGNA gave us the exact same coverage–except that no, maintenance prescriptions would not count towards the copayment. Previously, when you reached your copayment limit, CIGNA paid the entire cost of the prescription. A good deal if you or a family member needed a specific brand drug that cost a lot. One covered employee was on anti-HIV drugs that were covered. He went from paying $3000 a year to over $12000 a year for prescriptions.

  48. satoru says:

    Probably the best thing to do is to go to your doctor with their list of 3rd tier medications and see what generic options there are. I’d assume that it’s through some big vendor like Caremark, which should be able to provide you with a pamphlet with the listing you need.

    BCBS won’t be able to do much for you since they are within their rights to up specific medications to the higher tier. If the drug plan is administered by a 3rd party, then BCBS might not be to blame at all, but rather the policy of the 3rd party such as Caremark.

  49. satoru says:

    I recall that my friend who moved from Canada to the USA indicated that her thyroid medication jumped from costing almost nothing, to a copayment of like $30.

    Though I don’t really condone using those internet retailers for medications. You just never know where they’re coming from! It’s worth it if you can physically go to Canada though. Since you’ll be getting your medications from a real pharmacy, and the drug standards in Canada are just as high as in America.

    On a totally unrelated note! A doctor I know says that his older patients are always requesting perscriptions for Viagra. They take these back to Asia as gifts, since counterfeit drugs in Asia is extremely rampant even at chain pharmacies, and counterfeit Viagra is extremely common. Just a weird way of how drugs move around the world.

  50. UltimaHyperion says:

    Hi, just a follow up,

    As someone that used to work for one of the companies making a certain
    thyroid medication involved. Definitely consult with your Dr about the
    change. While there are generics with the same active ingredients,
    there are certain other aspects of the drug that affect its
    bioavailability (in theory). That said, your Dr should just be able to
    monitor you to make sure you are getting the dose you should from the
    generic, or different brand. We had people working at the facility
    that actually had to decrease their medication because they were
    breathing so much of it in the air. Be careful, they are powerful drugs
    meant to screw with your hormones!

  51. SuffolkHouse says:

    Blue Cross/Blue Shield is a monster. It does nothing to enhance health. It is a profit-raking middle-man that, as a corporation, could care less if its customers live or die. The dying ones cost money, so the quicker they go the better.

  52. Ein2015 says:

    From dictionary.com …

    in·sur·ance
    -noun
    1. the act, system, or business of insuring property, life, one’s person, etc., against loss or harm arising in specified contingencies, as fire, accident, death, disablement, or the like, in consideration of a payment proportionate to the risk involved.

    Therefore, insurance != universal healthcare.

  53. johnva says:

    @Ein2015: Which is why insurance should not be the way we provide universal health care, unless it’s single-payer social insurance, which doesn’t quite fit your definition.

  54. krispykrink says:

    BCBS pisses me off to no end. My mother had a kidney transplant a few years ago, back then Medicare covered her medications. When they forced her into Medicare Part D she was auto enrolled with BCBS. All of a sudden her once covered CellCept went from no charge to $165 a month.

  55. camille_javal says:

    Consumerist: far be it from me to controvert medicine.com and drugs.com, but Levoxyl is treated as a generic. The Costco pharmacy website, for example, lists it as a “generic alternative” to synthroid. I’ve been on Levoxyl for thirteen years, and it has always been a generic.

    I’m actually quite thrown because I’m wondering who is hosing Mary by charging $75 for 3 months of Levoxyl. 100 pills of Levoxyl at 200 mcg is $48.22 on Costco’s website (I don’t think you have to be a member to use the mail-order pharmacy); it’s $49.95 on drugstore.com’s pharmacy.

    It should also be noted that a number of doctors (I’ve heard it from GPs and endocrinologists) recommend staying on the same thyroid medication, whether prescription or generic, because there is some difference between brands (I don’t claim to know what), and if you switch, you could have a bad reaction/not respond as necessary. So, especially for a woman without a thyroid, she shouldn’t be leaping over to levothyroxine without talking to her doctor; health insurance companies should not be making the drug decisions.

  56. okvol says:

    I had Grave’s disease in the past, about 15 years ago. I was given radioactive Iodine for treatment, and now also have no thyroid.

    Most thyroid patients are female (70% according to Wikipedea). And, thyroid problems magnify emotional issues. Synthroid actually settled a suit where they were accused of exploiting emotions to convince folks that the generic wasn’t as good. And, the myth continues. I’ve used generics for years with no side effects. Different shapes, different shades of color. But beware the colors – that is how you can tell different strengths of the drug. Full normal replacement, 125 micrograms (yes, it’s that small) is beige. I was moved to a 137 strength, blue, and the generic brand just made it thicker to not change the formula.

    So, Obama is not the antichrist and levothyroxine is just fine for me.

  57. Corydon says:

    @MitchV: Your point is well taken. I’m always a bit uneasy to see all of the various doohickeys in my doctor’s office covered with drug company advertising. In my case, I don’t think it makes a difference; if I need a prescription I always ask if a generic is available. But it still makes me uneasy.

    That being said, there are a number of reasons why the more expensive medication may be the best choice. We’ve had some people talk about that in the context of thyroid medication.

    The same is true of treating other things like HIV. While there are about 20 or 30 HIV drugs on the market, only a couple of the oldest are available in generic form. Finding an effective treatment “cocktail” can take time and some experimentation to keep side effects tolerable and adherence high.

    But in general, I agree that consumers, doctors and pharmacists all should be much more proactive about using generics as a first step and moving on to more expensive drugs only if generics prove ineffective.

    And this method should be applied to all kinds of medical procedures. If a simple X-ray is good enough to diagnose a problem, why spend money on an MRI? If a chiropractor can control back pain, why not go with that instead of jumping into surgery? Explore the cheapest, least invasive procedures first and then escalate as needed.

  58. chrisjames says:

    @tcp100: There are non-profit insurance companies, though. In fact, BCBS of Maryland used to be non-profit, and may still be for all I know. That wouldn’t change how they operate though, and I would argue that it would make situations like this even more likely. It’s the unfortunate truth of insurance, and you just have to deal with it.

  59. ninabi says:

    Normally I say “no difference” with generics but then I was given generic thyroid medication one month. Within days it was obvious that the formulation was quite different- it was as if I was not taking medication at all.

    I’ve had pharmacists bark at me, “They are exactly the same drug, maybe the dye is different but they are fine.” No, they are not.

    But this woman should not be screwed like she’s been on the co-pays.

    Crap, I look at the cost of meds in other countries and want to cry. My child’s seizure med is $850 a month in the
    US- it’s half of that in other places.

  60. simplekismet says:

    I worked in retail pharmacy as a technician for a year before switching to hospital. I don’t have to deal with insurance anymore (and it’s fantastic) but from what I remember..

    Levoxyl IS a generic of Synthroid; this is what pharmacy staff will tell you. Sythroid was first, Levoxyl came around after the patent ran out but gave it a trade name. This happens sometimes and it’s just a drug game. BCBS isn’t “right” they are being jerks to get money (we knew that already). I have skimmed the comments but haven’t read each word for word; I understand that messing with something that works and has worked is really scary, but maybe try the generic levothyroxine for one or three months. In the hospital I work in, we carry whatever’s cheapest when we order levothyroxine and dispense to all patients without discrimination. Maybe it doesn’t matter because it’s short term or maybe it doesn’t matter because it really doesn’t matter. If the only reason you’re getting Levoxyl is because that’s what the pharmacy had in stock the first time you filled it… you can consider giving it a chance.

    That said, if you aren’t already, try asking your doctor to write “DAW” or check the “Dispense As Written” box on your prescription. This changes the way the pharmacy submits your claim to the insurance company, basically saying “The doctor says the patient must have this exact med” instead of “The patient requests brand”. I am not sure if it will force BCBS to allow you to have it at generic pay but worth a shot?

    You can ask WalMart/Target what they will dispense for their $4/$10 generics but it will likely be whatever form of levothyroxine is cheapest when they order it.

  61. AnonyLawyer says:

    Look, OP had to have her thyroid removed for whatever reason. This isn’t a trip to the dermatologist to get a wart frozen off. It’s a serious surgery with serious implications, and serious recovery time. It’s usually not elective. You start whatever hormone your doctor prescribes pretty much right after your surgery. Because hormones are so finicky and reactive with your body and affect different physiological functions, if you find one that works (esp with no thyroid), you stick with it. Switching to the generic from the brand usually isn’t an option with thyroidectomy patients after they’ve already started on the brand. It’s absorbed differently by your body and can alter your hormone levels (which a patient already has to fine-tune over several months past surgery). OP might not be poor and may be able to ultimately absorb the cost, but the paradox that exists on this board of attacking the OP while perusing a blog about consumer protection is weak.

  62. majortom1029 says:

    First of I take levoxyl and i only pay $10 for a 3months supply.

    Also like other people have stated with Thyroid hamrones you can’t just switch to a generic brand. Every brand is actually different no matter the formulation and everybody reacts differently to each one.

    I had to switch to levoxyl because my body absorbed it better then Synthroid.

  63. majortom1029 says:

    @majortom1029: I mean harmones.

  64. nasturtium says:

    I have been using generic for years, I believe that Synthroid has been pushing the narrative that it is better with no basis. I had a doctor who suddenly, after 5 years, change my prescription from generic to Synthroid. When I was in the office to speaking to a nurse who said the doctor would not change my meds back to generic, we were rudely (and no doubt illegally) interrupted by a cheerleader drug rep who started handing me samples and saying that generics are not reliable.

    When I told my doctor about the incident, she blamed me for coming in without an appointment and she would not give me generic because they don’t work. I reminded her they have worked for me for the past 5 years. So I left her and get my generics from a doctor who does not entertain drug reps.

  65. halftank says:

    @WraithSama: @HeartBurnKid: @tcp100:

    @AnonyLawyer: Thank you. I’m the one who made the original complaint. I really don’t give a shit about the douchebags who are saying that I’m ripping off the insurance company, since they know nothing about me or my situation.

    I don’t have a thyroid because 5 years ago a doctor found a golfball-sized cancerous tumor on it. I was 33. That’s the first and only major surgery I’ve had, and hopefully it will be the only one for a very long time. I take good care of myself and I’m a part-time fitness instructor.

    Dealing w/cancer isn’t supposed to happen to someone in their early 30s, but shit happens. Insurance exists because shit happens.

    No, an extra $120/year for meds won’t send me to the poorhouse, but this is a very common prescription and there are other people out there who don’t have extra $$ for their medicines, so I decided to raise some hell.

    My employer just renewed our insurance w/BCBS in May and /then/ jacked up the prices once everything was signed. It sounds like bait-and-switch to me. Having a signed contract isn’t a license to get jacked.

  66. gritsnyc says:

    As both a thyroid patient and someone who was involved with the FDA deliberations regarding generic preparations of branded thyroid medications, I can say unequivocally that generic and branded levothyroxine sodium (LT4) are NOT the same, even at the same dosage level. The reasons for this are complex, but primarily have to do with differences in how the fillers interact with the active ingredient (LT4), as well as storage during and after production.

    The bottom line is that once you are stabilized on a certain brand and dose, you should STAY on that exact prescription — dispensed as written — unless you talk to your endocrinologist. The reason generics are problematic is not that they are ineffective, but because there’s no way to know which manufacturer’s generic is on the pharmacy shelf from month-to-month. Business-wise, the pharmacy will stock the cheapest one available at the time (this is standard practice and not necessarily a problem for most drugs…it’s a huge problem for such tightly titrated and/or narrow therapeutic index drugs like LT4).

    But don’t take my word for it. Talk to an endocrinologist or read here:
    [media.aace.com]

    Mary: If Levoxyl works for you, get hitched and switch your insurance or find a way to pay the extra cost. Your health is worth much more than a co-pay, though I understand your very valid frustration with BCBS.

    FYI to all — and to end the debate — Levoxyl is a brand drug, even though some pharmacies have listed it as a “generic” because SOME (not all!) dosages are considered therapeutically equivalent to Synthroid and Unithroid by FDA…which means it can be legally substituted when filling a prescription unless the doctor notes otherwise on the scrip. Actual generic versions of drugs are always known by the generic name of the active compound, in this case levothyroxine sodium. See if you can follow this chart (good luck!): [www.accessdata.fda.gov]

  67. turtyle says:

    I have had hypothyroidism for 11 years and have taken Synthroid, which works well. However, similar to the experience Bohemian had, my pharmacy messed up and filled my prescription with generic. I went to work and I felt drunk/high. My boss asked if I was on something as my pupils were dialated and I was slurring my words. I told her no. She sent me home. While at home, I happened to glance at my prescription bottle and realize the mistake. I phoned my doctor, and he said that some people have bad reactions to the generic. I had the prescription corrected and the very next day I was fine. I relayed the story to my mother and she (having hypo as well) told me she had the same reaction years before. So there is most def. a difference b/t the two. Also, my co-pay has steadily increased by $15, then to $30 for the same 30 day Synthroid prescription. So it is now cheaper for me to pay the real price of the Synthroid at $26 a 30 day supply than actually use my insurance.

  68. Not Alvis says:

    Wow – a lot of people buying into the placebo effect STRONGLY, considering this is the Consumerist crowd.

    Binders are inactive – end of story. Generics are the same as brand-name meds. Bottled water comes from municipal sources. This shouldn’t be news to anyone.

  69. ozymandris says:

    This happened to me as well at the pharmacy. Having my pharmacist dig a little bit, she discovered that the company that makes sythroid also makes the generic. Typical, but there previously was a second supplier of the generic who recently went out of business. Making the remaining company the sole supplier of all things synthroid. As such, since all traffic went through one company. There is no more competitive bids, so insurance companies classify sythroid and generic, both as name brand drugs. So, depending upon your insurance, you may no longer recieve the generic benefits.

  70. camille_javal says:

    @ gritsnyc – I am puzzled by the Levoxyl brand/generic treatment thing, because I’ve never had it treated as anything but a generic, not only by pharmacies, but by insurance companies. Perhaps it has something to do with the price? When I was getting thyroid medication without insurance, at a regular pharmacy, they once accidentally gave me Levothyroxine. When I had them change it for the Levoxyl, the Levoxyl cost less than $3 more. In fact, the “non-preferred brand” payment on my insurance plan would be *way* more than the price of Levoxyl without insurance (my insurance is keeping generics at $10 by raising non-preferreds to $40).

    Hm – perhaps BCBS has decided that the cost of Levoxyl has been inflated enough to justify reclassification. Of course, it depends on what pharmacy you go to – Levoxyl cost $8 more at the Duane Reade I go to in NYC than at the Rite Aid I used to go to in Jersey (it was within the same year that I went to the two, so I doubt there was that much of a jump).

    Mary – if you can’t get the insurance company to budge with some kind of recommendation from your doctor, I really do recommend looking into the mail-order option. I’m really hoping now that Aetna doesn’t suddenly flip the script on me, but it’s nice to know that mail order would mean it would only jump $5 a month.

    And, while I have my thyroid, it’s only because my thyroid disease was caught early, because I had the same doctor as my mother, and he knew about her thyroid history – she has Hashimoto’s (sp), and it wasn’t detected early enough, so her body attacked her thyroid and caused her to develop a serious infection, to the point that she had a lung collapse and had to have all but a fairly useless nub of one of her thyroid glands removed. She’s spent a lot of time without insurance – it’s definitely worth it to shop around, because there are pharmacies (duanereade) that will gouge the hell out of you (e.g., 25% more than you pay elsewhere).

  71. johnva says:

    @Clold: It’s not a “placebo effect”. In MOST drugs, the generic is equivalent. In some drugs, it’s not necessarily exactly the same. This is particularly common among drugs with a narrow therapeutic index. It is FACT that they can legally be a slightly different dose from the name brand drug and still be considered “equivalent”.

  72. camille_javal says:

    @ Clold – I have no issue with generic drugs – but if my endocrinologist tells me that different thyroid meds effect people differently, and tells me to stay on the one that barely costs more than the generic (and not to scale up to Synthroid, the more expensive option), I’m going to trust him on this one. I really doubt he’s getting kickbacks in this case.

  73. bohemian says:

    @Clold: It isn’t a placebo effect. There is something different in the absorption of different brand vs. generic with thyroid meds. This seems to be something unique to thyroid medications and because they are done at such minute doses. This is totally different than a brand vs. an allergy meds.
    I am a huge advocate of using generics. Thyroid meds is the exception.

  74. bks33691 says:

    To all the commenters saying the generics are “exactly the same”…well, they’re not. The FDA regulation is that the generic must attain 80% “bioequivalency” with the branded drug. I learned this one after taking Wellbutrin for years, then switching to the generic version, budeprion. The active ingredient is not the same, but is considered to be bioequivalent. It didn’t work for me (or for many many others, either). One thing that can be done though, is to have your doctor contact the insurance company, and get a waiver put on your record, so he can prescribe the brand name as “dispense as written”. The insurance company can, and often will, reduce the copay for the drug. I am now taking brand-name Wellbutrin again, and am paying non-formulary cost, which is more than the generic, but about 1/3 the price of the branded.

  75. Phexerian says:

    Synthroid medications are classified as a narrow therapeutic index drug. This means that, the range of the drug in your blood is very narrow and minor changes can be noted very easily. Therefore, any switching of Synthroid to a generic is not recommended unless you and the physician are trying to find the correct one for you. In my pharmacy, we never EVER EVER switch someone from Synthroid to Levoxyl or generic and vice versa. This is not only with thyroid medications but with any medication that has a narrow therapeutic index (digoxin, amiodarone).

    Now, as far as fillers, they make no difference generally. HOWEVER, with a medication that has a narrow therapeutic window, they do make a difference as they can cause minor changes in absorption inside the intestinal lumen. Different chemicals are used and different pills have different compression ratios and so they release the drug slower or faster. Some can even be affacted by the ph of your stomach to a degree. So in cases such as this, fillers make a diffence. But when it comes to a drug like Lortab, or tylenol, fillers don’t matter unless you are highly allergic to one of the fillers.

    Going to walmart of target would be a good idea. They may have Synthroid at a good cheap price for you.

    Another idea, is if you are on really really good terms with your pharmacist, or have a friend who is a pharmacist or physician, ask them to talk to the insurance company while you are there. Ask to speak to the insurance company’s “clinical pharmacist” and talk to them. They are generally not drones and understand drugs far better than any service rep you will talk to. They can also decide if a drug is to be covered instantly for you.

    Unfortunatly, insurance companies can change the price of their copays at any time. That is part of the contract you sign with them and nothing can be done about it. They are immune from anti trust legislation and are immune from many laws because of a specific former president named George Bush Sr.

    Good luck.

    -Phex
    -3rd Year Doctor of Pharmacy/MBA Candidate

  76. Phexerian says:

    P.S. Also stated above, get a new script for it and have the physician write a DAW of 1 or basically he signs it as “Dispense as Written”. This may, but may not, cause the insurance company to cover the drug better.

    -Phex
    -3rd Year Doctor of Pharmacy/MBA Candidate

  77. bohemian says:

    @nasturtium: I would have possibly punched that drug rep or at least told them to shove off. If generics work for you consider yourself lucky. I’m really hoping maybe part of health care reform involves banning drug reps and kickbacks.

  78. RetailGuy83 says:

    @tcp100: @HeartBurnKid: Agreed and Agreed. BCBS is an insurance company that is for profit. I pay my $115 a month and am VEREY HAPPY for it to do nothing for me. We do not have universal health care in this county and entrusting for-profit companies to watch our health is like leaving the fox to guard the hen house.

    HOWEVER, knowing that we dont (yet) have universal health care, it is unfair (and quite frankly, ignorant) to expect for-profit companies to act like philanthropic stewards of good health. I expect them to act like insurance companies, and the fact that the OP could get a new plan to cover an existing condition then complain about it being “useless” is rediculous.

  79. kimdog says:

    As someone who will be having most, if not all, of my thyroid out next month, this has been a very, very educational thread. Thanks, internets!

  80. PyRo_DuDe says:

    Not sure if this was already posted or not (I didn’t actually read all the comments…) but I didn’t see any indication from the patient what kind of thyroid medication she was actually taking.

    One possible answer would be the actual “thyroid tablets” made from synthesized animal thyroids. The generic (which has been around for a VERY long time) has recently been pulled from the market. The only variety of it available currently is the Armour Thyroid brand.

    This would most likely be a pretty high copay on her insurance (due to the generic being out so long).

    Again, I could be wrong, but that was what I thought of when I first read it.

    The thyroid smells (and I would imagine tastes) horrendous. The Synthroid, Levothroid, Levoxyl and levothyroxine aren’t too bad.

    If she is on the thyroid/Armour Thyroid, I would recommend she speak with her doctor and see if the l-thyroxine would work

  81. krispykrink says:

    @Clold: A blanket statement like that is horribly incorrect.

    I’ll refer to my mother again, she’s had a transplant and one immunosuppressant they give is Cyclosporin.

    There are 3 manufacturers of Cyclosporin. Sandimune, Gengraf, and Neoral. Each one of these brands all metabolize differently than the other. They produce different blood levels of the drug and each has different dosage to achieve the desired maintenance level within the blood.

    My mother has been on the Gengraf version for years, since the transplant. She can not under any circumstance switch to another brand. If she were to switch it would lead to less than desired levels and organ rejection. Or too high a level leading to liver failure or toxicity to other organs.

  82. gritsnyc says:

    Camille: You’ve hit the nail on the head as to why this is all so confusing. When it comes to purchasing drugs, “generic” is a catch-all term that means both generic preparations AND any branded drugs that are considered therapeutically equivalent to the FDA Orange Book listed reference drug. In the case of levothyroxine sodium, there are two reference drugs: Synthroid and Unithroid. If an LT4 drug is listed as therapeutically equivalent to the reference drugs (as in the case of Levoxyl for some — NOT ALL — dosages), it can be sold as a “generic.”

    (The interesting thing about all of this generic LT4 nonsense is that most generics have only been legal in this category since August 2005. Pharmacies — especially major chains — did substitute prior to this date, but it was illegal and rarely reported.)

    In other words, if your doctor prescribes Levoxyl and does not specify “dispense as written” on your scrip, the pharmacy can legally substitute any LT4 that is listed as therapeutically equivalent — Synthroid, Unithroid, Mylan’s generic, etc. Generally, they will give you whatever was cheapest at the warehouse the last time they stocked up.

    Branded LT4 is oftentimes cheap to buy out-of-pocket because (and here’s some good news, finally!) it is a very inexpensive drug to produce. My co-pay on Synthroid is $15/month, but it’s only about $22/month if I ever needed to get it out-of-pocket.

    Does all of that make sense?

    Thanks to BKS and Phex for adding additional explanation to this incredibly complicated situation. Yes, most generic drugs are fine, but those few NTI drugs are the exception that prove the rule. Unfortunately, because LT4 is one of the most prescribed drugs in the country, it throws millions of patients into confusion about drugs in general. I really wish more doctors and pharmacists took the time to explain this “one-off” situation more carefully to their patients.

  83. Bunklung says:

    @tcp100:

    Mary, BCBS increased their co-pay because they’re not making any money on you. It’s that simple. I know such a thing is tantamount to evil on the consumerist, but insurance companies are not non-profit organizations or charities.

    There are a few non-profit health plan providers, Harvard Pilgrim in Massachusetts is just one of them. I had them for over 12 years until my employer dropped them.

  84. JiminyChristmas says:

    @Bunklung: No kidding. In the State of Minnesota only non-profit insurers are licensed to operate in the state. To tell the truth though, I’ll be damned if I can see what difference it makes because my policy costs more and covers less year after year.

    However, irony of ironies: UnitedHealthGroup is headquartered here and they are forbidden from selling insurance in the very state they’re domiciled in.

  85. WedgeTalon says:

    As a CPhT, here’s the deal:

    Synthroid and Levoxyl are both brand names (with the generic being levothyroxine), just like Coumadin and Jantoven are brands (with warfarin sodium the generic). In both cases, the former is the “real” brand, so to speak. Jantoven and Levoxyl cost significantly less. $75 sounds too much to me for a 90 day supply of Levoxyl. I’m willing to bet you use CVS or Walgreens (hint: they have the highest drug prices 9 times out of 10). Either Walmart or a grocery store chain will likely have a better price.

    As for switching between brand and generic, please do so with caution. Usually it’s no big deal as there isn’t a significant difference. However in cases like Synthroid, there can be. It has what is called a narrow therapeutic margin (it comes in really small dose increments, essentially, which can make a big difference). So whereas 50mg of drug X vs 49mg of generic X aren’t going to make a difference, you will tell a difference between 0.025mg of Synthroid and 0.026mg of Levoxyl. (Which brings up the flip side, switching from generic to brand can cause the same problem.)

    IIRC, the FDA allows drugs to vary within a margin of 20% ie, +/- 10% more/less active ingredient). I could be mistaken on this figure, as I couldn’t find a link to this on google.

  86. spunky_redhead15 says:

    i, as well am a thyroidless person who is insured by BCBS of North Dakota. i’m only 24, had graves disease that was pretty much out of control that was diagnosed when i was 15. my thyroid was nuked when i was 17 and i’ve been on medication ever since. i’ve taken all three, synthroid, levoxyl (which CVS used to try to give to me as a generic), and levothyroxine. my thyroid levels stay pretty much the same no matter what one i’m one, but i do have horrible mood swings when i took levoxyl. i am currently taking levothyroxine and i’m doing just fine.

    my co pay for even a three month’s supply of levothyroxine (used to cost me around $20 went up to over $35). this at first i thought was due to osco drug in my town swapping to cvs (only went up a little at first, but then i really started noticing the difference). not too shortly after, i got a letter in the mail stating that my rates were going up for my insurance. and then shortly after THAT, to be fair, i did get a letter stating that BCBS was no longer covering the brand name of synthroid, but would continue to cover the generic. i am starting a new job that offeres a better plan through bcbs with $3 prescriptions, so i’m hoping i’ll get my thyroid meds covered.

    as for BCBS sucking, i’m going to be the rare one that says they take good care of me. after an emergency room visit that wasn’t billed out to insurance in a proper timeframe, i was left with a sky-high medical bill i’d still be paying off now, but after a call to my insurance company to find out if they had even received the claim and a really nice girl that said she couldn’t do much about it, i got an updated bill in the mail about three weeks later, stating that i only owed the hospital about $250. apparantly there was something that they could do, and i really didn’t have to ask for it to be done, i was just willing to deal with the fact that our hospital and their billing system is shitty.

  87. othertim says:

    This has all probably been mentioned above, but I work in pharmacy and while, of course, taking the brand is stupid when a generic is available, the thyroid medications are one of three drugs I wouldn’t screw with if you’ve been taking them for a while, the other two being Coumadin and Lanoxin. So yeah, the generic is dirt cheap, but a lot of people are stuck taking the brand.

  88. rit says:

    @johnva is very correct. I’ve had thyroid problems since my mid-teens (inherited from my mom) and been told repeatedly in no uncertain terms by not only doctors, but by pharmacists as well that it’s not worth taking a risk with generics on thyroid meds like Synthroid and Levoxyl.

    This is, as stated, an issue of the error tolerance – when you’re getting a 200 milligram pill being off by a few micrograms is not a big deal. However, being off by a few micrograms when you’re already in that level can be pretty nasty. I had a time when my thyroid levels kept bouncing around and the doctor did some trial and error to try to find a good dosage – and a 25 microgram increase made me incredibly sick.

    I have the misfortune now of being at a dosage that requires two pills together (The exact dosage isn’t available in a single pill) and insurance being insurance considers it two separate prescriptions (Doctor’s script says . Pharmacy gives two bottles, as said dosage not available. Insurance charges me double), so I totally feel the OPs pain.

    For as long as I can remember, Synthroid has been a ‘tier 1′ (cheapest) drug on my insurance but I went through the doubling as well and it can hit you out of nowhere as it did with me.

    I would HIGHLY recommend, however, speaking to your doctor – it’s possible they may have recommendations (including slipping you a shitload of the free samples that the drug reps like to dump on them) to help you out until you get things on the level. In one occasion where I ran into trouble I was both surprised and impressed with how willing my physician was to go the extra mile to make sure I got the care I needed.

    It’s also entirely possible that we’re all wrong about the generics sucking, and/or that that fact has recently been invalidated for some reason. Only your doctor can really tell you not only what drug is best for you, but possibly whether your particular thyroid condition can handle a possibly imprecise dosage (I know I am pretty sensitive but it doesn’t mean everyone is!).

    Best of luck.

  89. gritsnyc says:

    For those asking about bioequivalence standards from the FDA:

    The “goalposts” or biequivalence range for approval of a generic drug is 80-125 percent of the reference drug. For a drug titrated so tightly, such as thyroid meds that are dosed to the microgram, you can see where this alleged “bioequivalence” would be questionable.

    (FDA’s website is notoriously difficult to navigate — here is a quick reference that I could find without hours of digging: [www.ncbi.nlm.nih.gov] )

    A clear example: A standard LT4 dose is 100mcg. Using the FDA’s standard, a patient stabilized on one manufacturer’s drug at 100mcg could be getting anywhere from 80mcg to 125mcg per dose if they switch to a different brand or generic. Doesn’t sound like much, but consider that 88mcg and 125mcg are also common dose strengths — if the patient needed these doses, he/she would be placed on them directly. This variance can (and does) wreak havoc with the extremely delicate endocrine system which, in turn, throws the rest of the body off-kilter.

  90. mom22bless says:

    Synthroid sucks. I take Armour thyroid and 300 pills costs me $39 CASHOLA. And it lasts me 2 months.

    Plus it’s a better match to your body since it’s a BIO-IDENTICAL hormone.

  91. CyberSkull says:

    My mom doesn’t have her thyroid either. When the pharmacist switches her to generic versions of Synthroid it just doesn’t do anything for her, so she has to take the brand name.

  92. mobilene says:

    @HeartBurnKid: This may be so, but then explain to me why when I take generic levothyroxine I have hypothyroid symptoms, and when I take the same amount of Synthroid, I don’t? My doctor and my pharmacist have both told me that many people respond to Synthroid but not the generic. So I pay the higher copay myself. That’s life.

  93. pillow_fight_girl says:

    I don’t have a thyroid either (thyroid cancer) and my endocrinologist makes sure my prescription states NO GENERICS. He says that they indeed are different, and inferior in his opinion.

    mom22bless:

    I agree that Armour is better (I take Synthroid), but those pills stink! My endo doesn’t like Armour for some reason.

  94. BrianU says:

    Many major manufacturers of pharmaceuticals have a discount/hardship program. Check the web and the individual medication web site pages. The income versus living costs qualification formula can be surprisingly favorable. A form is signed by their doctor, delivery methods/preferences can vary. Worth a try for anyone in a financial pinch and needing a life sustaining medication.

  95. catastrophegirl chooses not to fly says:

    doesn’t even have to be the fillers and binders. sometimes it’s the packaging. take insulin for example: i can’t take humalog rapid acting insulin because i have a latex sensitivity. the seal on the vial of humalog is latex and when the needle passes through it and then i put it in my skin, i get hives. novolog rapid acting insulin uses a silicone seal and i don’t get a reaction [well, not anymore. i was originally allergic to insulin too and had a hell of a time getting desensitized]