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Leora

My medication works but it's expensive

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I'm not sure which forum this post belongs in. I decided this forum might be most fitting since I'm asking about a medication. Anyhow, after searching the forum, I don't think there's a thread for Rexulti. It's new and pretty expensive so the average person would probably struggle to get it. Regardless, I just want some help, because while I'm technically fine right now, this could change in less than a year. This seriously scares me.

Basically, SSI doesn't cover one of my medications. However, I am actually in the process of getting off SSI. It just won't be official until I have gotten a job and I have my first paycheck. Anyhow, I really need SSI to cover my Rexulti until I can get a job. If my first job doesn't work out, I may need further education to get another one.

Here's my main problem. I am prescribed Rexulti for use with an antidepressant. Rexulti is an antipsychotic, but it also improves my cognitive functioning. Without Rexulti, I get into an obsessive thought loop that severely reduces my thinking speed and how I learn, process, and synthesize information. My creativity and problem-solving capabilities also go down without Rexulti. Let's not even discuss the impact of a life without Rexulti. I've lived for about 4 years without Rexulti. My cognitive impairment began in November 2012 and I was beginning to lose hope of ever being happy. Then my psychiatrist suggested Rexulti and it works wonders. I now have hope, but it is being shattered by insurance companies everywhere seemingly refusing to pay for it.

The job I want at the moment depends highly on speed so if SSI won't cover Rexulti, I most likely won't be able to get the job and I'll be, well, stuck on SSI. Rexulti improves my ability to think and I'm trying to take steps toward improving my quality of life and self-esteem. First up, I'm trying to increase my self-esteem by getting a job, because being on SSI has been a huge problem recently. I've seen a sample of what it's like to live on it and it's not pretty. Since around March, my self-esteem has been declining so I really need this job. I don't want to be denied Rexulti. I won't be able to argue why I need it if SSI won't pay for it.

Next year, on May 9th, my mother won't be able to cover me under her insurance anymore. I'll be 26. Problem is, my training will end in April, and even if I finish the training early, that doesn't guarantee me getting the job and getting paid early. Then there's the whole issue around what insurance to get after I'm off SSI. Not many insurance companies seem to cover Rexulti so I'm scared, really scared that my quality of life will decline again next year.

Does anyone have any suggestions? Is there anything I can do to convince SSI that I really need them to cover my Rexulti or am I most likely out of options? I'd be a lot less stressed and a lot less worried if I could at least get them to cover Rexulti for me. Any feedback would be appreciated.

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19 minutes ago, Leora said:

Does anyone have any suggestions? Is there anything I can do to convince SSI that I really need them to cover my Rexulti or am I most likely out of options? I'd be a lot less stressed and a lot less worried if I could at least get them to cover Rexulti for me.

Don't think they'll be too flexible... Your better option may be to participate in one of the manufacturer's assistance programs. If you go to their website there's an offer for their savings card which gives you a free 30-day supply and helps you cover the insurance cost. Not sure what the exact terms are but would be worth looking into. Oftentimes manufacturer's also have additional assistance programs for people who cannot afford a drug so it wouldn't hurt to just call them up and ask if there's any help available. The other option is to ask your prescribing psychiatrist for free samples, I had one who helped me with a ton of free Abilify samples because the drug was just too expensive for me to pay out of pocket. 

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