Posted by Simcha on December 20, 2006, at 0:00:29
In reply to I'm curious....$$$....£££....$$$.....trigger.., posted by ronaldo on December 19, 2006, at 13:25:14
Ronaldo,
It's pretty depressing even with good insurance here in the good ol' US of A, IMHO.
I have a PPO. That means that I can choose my doctors and specialists. If I choose doctors and specialists on my PPO's list (in-network) I pay one set of co-pays. If I choose docs and specialists not on the list (out of network) I pay higher co-pays.
So, here's the breakdown for what it costs to get my meds on my plan. The rest of it is complicated and isn't on topic.
I'm actually pretty fortunate compared to most Americans...
First, I pay $75 per month in premiums. My employer pays $300 per month.
For drugs on the PPO's Formulary:
$10 co-pay for generic drugs
$20 co-pay for brand name drugs (drugs whose patent has not expired)Non-Formulary drugs:
$35 co-payA formulary is a list of drugs that the insurance company has approved for reimbursement. Anything that is not on the company's formulary is a non-formulary drug.
It seems rather arbitrary what is and what is not on the formulary. When you look at my formulary you notice that drugs that are more expensive that do close to the same thing as other drugs are not on the formulary. So, it's not just doctors deciding what is covered and what isn't, it's accountants too.
So, currently my monthly prescription costs:
$10 Gabapentin (generic Neurontin on formulary)
$20 Wellbutrin XL (Brand on formulary)
+$35 Cymbalta (Brand not on formulary)
--------------
$65 total monthly on medsNot bad, but add:
$75 for monthly premiums
-----------------------
$140 per month (meds + premium)Then consider that I have a $15 co-pay when I see the pdoc every quarter and I pay my therapist $75 per hour for therapy every other week and treating my depression is quite costly. Therapy is not covered under my plan. Thus I cannot afford weekly therapy.
($75 X 26 sessions per year = $1950 per year in therapy)
$1950/12 months = $162.50 per month in therapyGrand Total:
$140.00 per month (meds + premium)
+$162.50 per month in therapy
------------------------------
$302.50 monthly personal cost to treat my depressionAnd that's without considering however many times per year I need to see the pdoc at $15 a pop after a $250 deductible
As you can see, these costs add up quickly.
I've been pretty lucky. I've responded to almost every med I've been on. I have asthma and fibromyalgia too though. Perusing through my medicine chest you will find:
Wellbutrin SR, Effexor XR, Klonopin, Alburterol, Q-Var, Prednisone, Advair, Singulair, Flonase, Nasorel, Vicodin, Tylenol 3
Simcha
poster:Simcha
thread:715014
URL: http://www.dr-bob.org/babble/20061217/msgs/715156.html