‘This is the fifth blog in the Caregiver Series that discusses medication.’
When you are younger, you marvel at the medicine bottles that your grandparents and parents have and then suddenly….
…you use the cabinet over the microwave for your medicine bottles!!
Being diagnosed with IPF (Idiopathic Pulmonary Fibrosis) there are two medications that doctors start you on to slow down the progress of the scarring. They are OFEV and Esberiat and both are expensive. Last December my husband was put on OFEV and then the lessons begin!!
For these medications, the doctor cannot write the script and send it to your pharmacy. Your insurance company must approve the medication before he/she can write the script. The retail price of one month was $12,000 in 2021 and $13,000 in 2022 ( no typo there! )
The first month my husband started the medication he was still working so his insurance covered all except $2,200. Our contact at the doctor’s office was able to search available foundations that are set up to help pay for these drugs. One of the foundations paid $2,000 and our portion was $200. Although $200 sounds expensive, it is a far cry from the retail price of $12,000!!
The second month my husband had a change in his insurance that went from employer insurance to Medicare Part D (pharmacy) plans. This change took place in January of this year and of course the price increased to $13,000!! The pharmacy plan paid all except for $3,300. One hard lesson is that the foundations from the month before had dried up and don’t apply for Medicare patients. Enter the discussion of the Donut Hole!!
Donut Hole 🍩
So what exactly is the donut hole? The below chart tells it the best. Once you have paid the deductible and you have met your initial coverage, you are in the coverage gap commonly referred to a the ‘donut hole’ and the patient pay 25%. When you exit the donut hole, you are at the catastrophic level and the patient pays 5 %. Unfortunately, on January 1st it starts all over again. For these specialty drugs, the payment could be $3,000-$4,000. Usually after the second month, the payment drops to about $650. Even in the final level, these drugs are very expensive!!
Side Effects 🤢
So you have navigated the price and have received your medication. Now what? Side effects come with any medication however the side effects can be rough. The medications have to be taken 12 hours apart with eating protein. My husband started on his first month last December while on Christmas vacation (exciting, right?). The first side effect was drowsiness which is coupled being tired with more energy expelled in breathing. The second side effect is major and is stomach issues which covers a wide range. This could be stomach pains, diarrhea, gas, or bloating.
The first side effect can be managed by resting until your body adjusts to the new medication. The second side effect is a little harder to manage. This side effect can be further complicated by other medication that you are taking. To help with the stomach issues, a review of your diet can help out by adjusting what you eat and when you eat it. If you are used to eating a big meal for dinner, you might have to switch that big meal to lunch when you are not taking your medication.
Adjusting to your medicine is a long process and it is best not to rush it. If after months of trying to manage the side effects, talking with your doctor on adjusting the dosage is always a possibility.
- Checking with your insurance is a must.
- Research, research, research!
- Read about the Donut Hole if that applies to you.
- Read about your prescription’s side effects (try not to panic!)
- Pay attention to diet and timing of your meals.
- Check with doctor about adjusting dosage.
- Take a break from the doctor appointments and stressing about the medication and go on a trip or day trip.
- Patience is key!
Taking a break from the caregiver series for a little vacation time so tune in for that. Will be back to the caregiver series shortly.’