Obama Care and Promacta

I signed up for Covered California health insurance this week. Its the Calif. version of the Affordable Care Act. Anyone else signing up? How was your experience? I certainly couldn't have done it without a counselor.

My concern is that I currently get Promacta for free from GlaxoSmith's Commitment to Access program, but with the new insurance I might not be able to afford the copay. I really wanted a plan with NO prescription drug coverage but all plans had a drug copay and percentage copay for "specialty drugs".

So I ended up getting Silver 87 for $82. a month. Its a good plan and a good deal(as far as I can tell) and I do really appreciate it, except that I have to pay 15% of specialty drugs. And with Promacta being around $5000 per month... well, I can't afford the Affordable Care!

I'm planning to sign up for GlaxoSmith copay program and so it may all work out, hoping to qualify. Anyone else had experience with Commitment to Access copay program??

Healthy holidays to all! p

I don't have that particular problem, but we're experiencing another one.

Due to the new regulations, both my husband and I have had our policies cancelled. We don't qualify for ObamaCare, so have to pay regular rates. Our rates have doubled.

On the one hand, this is good because we will have better insurance that has been more or less forced on us. I was stuck with a Conversion Plan after COBRA and couldn't get anything better due to pre-existing conditions. On the other hand, it's more expensive and the rate goes up every year when we turn a year older.

I hope this doesn't turn out to be a problem for you. I'm starting to see things fall through the cracks that were not anticipated.

I ended up on my employers plan.my copay was 250 for Promacta. I spoiled for GSK copay assistance and it's not 75 bucks a month for me. It would def be worth it for you to apply and they respond within 48 hours which is nice.

The big thing is you have to be making less than 48,000 a year. I'm a teacher so it worked for me.

Thanks for the info Vdeutsch! Thats a good savings for you. I will put in my paperwork to GSK soon as I actually get the promised insurance.

Now I'm hearing that just because a person signs up for ObamaCare doesn't mean that they'll get it- huh?! I was supposed to get a bill in Dec for my first month premium so it can begin on Jan 1st- haven't received anything. And now its the end of the year.

Yes, fortunately(or unfortunately) I qualify for the GSK program. I work in home health for hospice patients 40-50hrs week, the pay is pretty low. Like you said the GSK program is great, so fast. It took longer for the doctor to sign my paperwork(4 days) than it did for Glaxo to process it and ship the Promacta!

update: I've been on Promacta 25mg this time for about 3 mos. I'm slowly tapering prednisone because I was on it for over a year and it can take time for the adrenals to get back up to speed. They seem to be working, thats good. I had read that they atrophy after a while and that was a worry. I'm down to about 3-5mg pred. yay! Sometimes I get so fatigued- thats probably the pred taper. I often wake up with a morning headache and dry mouth- that I believe is the Promacta.

I think my platelets are around 20K. I'm planning to get the flu shot this week, and that usually knocks them down. So I'll be watching for signs. **happy healthy new year! toot!**

Steroid tapering is the pits. I think that can account for headaches. I'm also wondering if the low platelet count is causing the fatigue. It is different for every person. If I'm below 30ish I feel pretty lousy. Has your doctor considered upping your Promacta ? I'm on 50 mg and stay in the 51-115 range. I got a flu shot in October and luckily my counts were at 51 when checked.

I'm wondering if everything is delayed with Obamacare. It would make sense since the website and getting people registered was so delayed. I wouldn't freak out yet. Have you gotten a card yet? Maybe you can call and see if you have an id number at least?

Happy New Year!

I called Anthem Blue Cross today, New Years Day, and got through. I tried yesterday and was on hold for over an hour before I gave up- and yes I was freaking out! haha No, I hadn't gotten an ID or anything because I hadn't received a bill, so hadn't given them any money. Today I was able to pay by phone, I'm all set now- yay. Should be receiving a card and all the stuff soon.

I've been around 10-12K platelets for years so 20K is not low for me. I don't seem to have fatigue from low platelets, can't really tell the difference. Though I do get bruising when I'm in the teens, when I dip down below 10K the bruises go away. Its odd but has happened so many times that I'm certain something is going on when I'm in the very low numbers. My lowest recorded count was 1K with no bruising, felt totally fine, no signs of bleeding at all. I was so surprised when I heard the count was that low!

I like your suggestion that the headaches might be prednisone taper- they occur randomly so maybe thats it. hope so, and hope they go away soon. I was on 50mg of Promacta in 2011 and started getting symptoms of clogged arteries, possibly the beginning of a blood clot.? My counts were 50-100K. Also was having memory lapses. I quit taking it and the symptoms went away the next day. So I'm trying to stay with a lower dose 25mg this time. Also will be looking into getting tested for a clotting disorder.

Headaches and memory problems also go along with APS, the clotting disorder that commonly goes along with ITP. Easy to check for APS with a few blood tests.

Poseymint,

Your story all makes sense to me now of why you can't have a higher level of Promacta. The way you explained the headaches was exactly how I felt when I came off prednisone. Just all of a sudden boom head pain and then quickly go away. I also had the fatigue. I could barely stay awake driving to work even after 8 hours of sleep. I hope your symptoms subside quickly.

It's crazy that you were at 1 with no symptoms. I was at 3 with petichae, bruising and feeling fatigued. I didn't feel like I was " deathly ill, but was put in icu anyway. I have never hAd bleeding but have petichae and bruising sometimes as well as fatigue.

I'm glad you were able to reach blue cross blue shield. I was actually very happy with them when I had it last year. They basically gave me everything the doctor wanted to give me without any battles. I'm with united now, every little thing has been a battle. Now you can get your GSK stuff rolling. I think you need to send in 4 pay stubs or a w-2 along with your doctor's info, prescription and signature. Hopefully they will get yours done fast.

I think ann might be on to something with APS. It might be worth checking out. There are other disorders as well. It's crazy to think you can have a platelet count so low and yet have a blood clot. The body is one complex thing.

V:

I used to have this really good article about ITP and blood clots. It was on the old board which was dismembered before I could get to it. Anyway, it stated that the body compensates in many ways, and there was a theory that the body lowered platelets on purpose because the patient may have a propensity to clot. There is so much coming out now about ITP being not only a bleeding disorder, but a thrombic one as well. The info is dribbling out very slowly.

I think that because I tend to think that way, I don't see the excitement in getting counts over 200k. Mine have been 250k+ and I am not comfortable with that. I'd prefer 50k to 75k, especially since I have had APS Antibodies. I found that out 8 years after having ITP. My Hemo would never test me because he said my 'counts went too low' and those with APS tend to have moderate ITP. Well, I proved that wrong. My Rheumatologist ended up ordering the test at my request.

I've said this before and I don't really like the Chicken Little title, but I think it's best to be aware of these things. Facts - people with ITP tend to have microplatelet fragments, which have been known to cause clots. Splenectomy has been shown to raise the risk of clots. People with ITP are more apt to have APS which can cause clots. The TPO's carry a risk of clots. Higher platelet counts in ITP patients even without a known risk have been known to cause clots. That's a disgusting word, isn't it? I didn't like saying it so many times.

The articles are out there and if some of the doctors are unable to keep up with the research, it's up to us.

I'm usually in the 51-77 range on 50 mg of Promacta, I feel good and no symptoms,

I know my great uncle and grandfather both had clots in their 70's. My great grandmother had a stroke. I understand why you are nervous about being over 200. For me I need to be at a level where I am bit fatigued but realize clotting can be an issue.

Thanks for sharing this info. I was interested in hemophelia the other day so started reading that people with no factor 7 or not produce enough have major bleeding issues. If you have high levels of factors of 7 and low platelets are you less likely to bleed?

My bf who does not have itp gets nosebleeds nightly. Could his factor 7 be low?

Sandi,

I'm gonna be snowed in tomorrow so I will do some research pretty crazy stuff!

I don't know much about hemophelia, so can't answer that question. If your bf does not have any other bleeding issues, ie bruises, blood in urine, bleeding gums, etc...it's unlikely that he has any issues. My niece also used to have horrible nose bleeds all the time. The blood would gush if someone just touched her nose. She got a blood vessel cauterized and has been fine since. Maybe he just needs a visit to an ENT.

If that fails, he could go on to be tested for bleeding disorders. Anything is possible.

Found out I can no longer get Promacta through the GlaxoSmith program because I now have Obama Care insurance. I just took my last pill- wah depressing because Promacta was easy, no real side effects and it was working! Finally felt like I'd found something I could live with.

back story: Because my income is low and I didn't have health insurance, I was getting Promacta for free from the Glaxo Commitment to Access program. Now that I have "insurance" my copay for Promacta is $452. a month! And the Glaxo copay program denied me because they don't accept anyone who has insurance from the Affordable Care Act.

It really doesn't make sense. I'm already in the program and still have the same income. They would give the meds for free but if my insurance will cover $4000. of the cost, they don't want to do it!?

$452. copay plus my monthly insurance premium is so much money for me, theres no way. I have a maximum out of pocket that is $2250. per year. (I think that applies to specialty drugs??) That would make the yearly cost less, but still don't see how I could swing it.

I've been tapering off prednisone for months, am down to 3.5mg. yay! but wow, at these numbers I have to go sooo slow. (I've been on it over a year) If I go too fast it feels like I'm coming down with the flu- body aches, painful joints and fatigue.

Anyway... I don't know what to do, so I'm not going to do anything just yet. Will see the hemo week after next- get his advice. In the past when I quit taking Promacta my counts went down slowly. Will likely not crash, but drift down again.

I thought Glaxo had a copay assistance program for people who do have insurance but can't afford the copays. Did you ask specifically about such a plan?

Edit: Just read more carefully what you wrote. That's crazy that they would discriminate against Obamacare. I cannot imagine any justification for that.

Rob16 wrote: Edit: Just read more carefully what you wrote. That's crazy that they would discriminate against Obamacare. I cannot imagine any justification for that.

Unreal! They took the word 'affordable' much too seriously. Nothing is affordable any more.

I was wondering how much all of this would affect overall health care. I'm finding out.

My doctor prescribed a lung CT because I have a nodule on my lung. It's supposed to be checked yearly. I'm four months overdue. I've been trying to get the CT scan authorized by my insurance company (Highmark) for over a month. They keep denying it, even with appeals.

Before all of this, I never needed pre-authorizations for any tests. I have MRI's and CT scans all the time for various things. Getting a pre-auth is fine, I'll wait for it and don't have a problem with that. But is the new protocol to deny, deny, deny until the patient just goes away or dies? This remind me of the book Rainmaker. I never thought it would come to this.

I do not have Obamacare and pay a hefty premium every month. I have the Platinum Plan which is the best they offer. So what is up with this?

Posey mint,

I have insurance through my employer. I am not eligible for the GSK access to care program , but I did qualify for co-pay assistance. It's a completely different plan with GSK. They didn't make it easy to understand, so when you call make sure you say co-pay assistance. My co-pay with insurance was 250 bucks which is challenging on my teacher salary. I qualified for assistance with co-pay and now pay $75 which is affordable for me.

Just kidding. I read your post. I'm going to call and see what I can find out. I'm quitting my job in April and wondering if I should just get an individual plan that is not part of the affordable healthcare act. Maybe I can call a broker and GSK to see what is best.

When I told the staff at my hemo's office that I was denied because of having insurance issued through the Affordable Care Act, they didn't believe it, esp since I had already been in the program. They said they would file the papers and seemed confident it would go through. Nope.. 3 days later denied.

I thought I could get NPlate instead through their copay program. I haven't done the paperwork but it doesn't sound good after reading their website:

Are there any eligibility requirements for the Nplate FIRST STEP™ Co-Pay Coupon Program?
...Patients enrolled in Medicare, Medicaid or any other federally funded healthcare program are ineligible for program benefits.

With ObamaCare I actually have Anthem Blue Cross insurance, a standard policy. Its simple really, Blue Cross has made a deal with the government to offer it at a discount. That seems different from Medicare to me, but hey no ones asking me! The only reason I can think of that GSK wouldn't accept ObamaCare Blue Cross but would accept the same policy through an employer is that maybe the government has restrictions and hoops that they have to jump through.

Yes, VDeu you should run the numbers. Private pay health insurance is expensive too, but you may find something that works. good luck! From what I know of Blue Cross, it would cost me more than $500.mo to get the policy plus $75. Promacta copay... and other copays and deductibles and on..

Sandi that sounds like frustrating. As you know, it doesn't save money to not do preventative procedures.

does anyone have info on Obama Care Promacta with KAISER

I tried to find the answer to Promacta from Kaiser through ObamaCare insurance. Sorry I couldn't find the information on the (most irritating) website. I'll ask my insurance counselor next time.

I decided to pay the Big Buck$ and get Promacta through my ObamaCare insurance. My copay this month is $452. yow! But out of pocket maximum for the year is $2250. so... that works out to about $225. mo for this year (10 months). and a bit less for next year. I figure if I quit buying food and gasoline I'll be able to afford it. just kidding, sort of.

My hemo's office staff signed me up for the NPlate copay program First Step just as a back up. Seems like a good program. I found amusing- they give you an NPlate credit card, a Master Card that you use to buy your NPlate with. Just charge it to Amgen! The copay was $25. per dose and office visit copay was $40. But that being every week plus labs.. I would have again reached my out of pocket maximum.

So I decided to go with whats familiar. For me taking a pill is easier, plus fewer office visits (every 6mos) and labs (once a mo). I noticed on day 3 of Promacta all bruises went away so I know its working. yah!

krisy if you are with Kaiser and have a hematologist then email him/her and ask - call or email Member Services. As with any insurance they should be able to tell you if it is covered, and how much, or if it isn't covered.

This is my first time on the site in 3 months, and boy have I missed alot!! Anyway, I'm trying to understand what people's problems are getting meds through Obamacare, which I signed up for in January. Sandy, if I understand your situation correctly, you have continued on your old insurance through Cobra so you are not covered under Obamacare; your insurance company can do the same garbage that they did before 1/1/14, including avoiding pre-existing condition coverage. That won't happen if you change to Obamacare, whose rules don't allow exclusions. As for other persons with Obamacare issues, I learned that all coverages are month to month, meaning that--in theory anyway--you can change your plan monthly if necessary until you find one that works for you. All providers have the Bronze, Silver, Gold options that have different combinations of deductible, copay and specialty medications coverages. Obviously, if you have already met your maximum OOP (out of pocket) cost for the year, you won't want to do this until next year. FYI, I had a terrible time finding info on the details of each plan online--it seemed to take hours. But I did chance upon a simple brochure at a local Krogers that outlined each of the 12 Anthem plans so that you could compare and calculate the comparative costs for each plan. This after consulting with plan specialists and the Internet for hours!

Luca:

Not quite. Pre-existing conditions do not matter, even for non-Obamacare insurance. That's not my problem anyway.

My COBRA ended last October and I had to take Conversion Insurance. It was a cheap, crappy plan but because pre-existing conditions did matter in October, I had to take it...could not upgrade. It was less than $300 a month, so that should tell you something.

In January when Obamacare took affect, I was able to choose any type of insurance that I wanted. We didn't really qualify for financial aid through Obamacare, so we (my husband and I) chose Highmark's top platinum private plan. Highmark requires pre-authorization for certain tests and they would not approve my CT scan. My Rheumatologist appealed several times; they still will not approve it. I saw my Pulmonologist this past week. He is reviewing two chest x-rays. One was taken a over a year ago and one was taken in January. He is going to let me know if he thinks the CT scan is necessary and if so, we will battle more. Pre-exsting doesn't matter; they are still covering all of my other problems. I have never had a test denied before. I had Highmark for years until last January. I was still on COBRA and my ex-employer changed companies so I had to switch too.

Luca that Krogers brochure in worth its weight in gold! What I really wanted was a plan with NO prescription drug coverage so I could stay on my GlaxoSmith Promacta program- its so easy and free. But my counselor told me their were no plans without prescription coverage, so I got one with the lowest out-of-pocket.

My plan has a 15% copay of specialty drugs like Promacta. All the plans I looked at from Anthem had the same 15% copay. I think? hmmm... now I'm not sure. I want to talk to my counselor again now that I know more. Didn't know about the month to month thing. thanks for the info.

I looked up the lowest cost Anthem med/drug plan option for you in my handy dandy Kroger's summary; I think they are the same across the country but FYI, I'm in KY. Anyway, the plan entitled "Anthem Core Direct access with HSA (Anthem code letters are "caar") is a Bronze plan (least expensive) yet it provides for no copay on Tier1-4 drugs (Promacta is Tier 4) once you meet the deductible (which is a whopping $6300 or roughly the equivalent of $500/mo). So, it looks like the plan you have which nets out to $225/mo. for Promacta coverage is the best for you. Of course, this all assumes that you are not eligible for your state's subsidy program...(if they have one!)

Luca- thanks for the info. Always nice to feel like I'm getting a good deal while I'm paying these huge copays! hey, it could be worse! Here in California we have Bronze HSA that is $6350. max out of pocket and $5000. deductible. Plus 40% for prescriptions, office visits, labs, hospital stays. wow

My income is fairly low so yes, I do qualify for a lowered monthly premium. I am signed up for Silver 87 and pay $82. mo. It seems like a good plan and a great deal overall. Interesting, even though the policy says $15. for labs I am charged $7.50. And it says $20 for specialist visit, I only pay $15 to see the hemotologist. Also a normal cheap prescription is supposed to be a $15 copay but I only pay $5. Hey, I'm not going to argue. I just have to accept that if I want to stay on Promacta I will be paying the max out of pocket plus the monthly premium. Thats a big chunk out of my puny yearly income. But I can't see any way around it.

I have a feeling that after Obama leaves office this could all change, so I'm just thinking about what to do THIS year. Not thinking too far into the future.

The Pulmonologist wants a high resolution CT with contrast. Off he goes to fight the insurance company once again. I hope it gets approved this time. I'm tired of it hanging over my head.

What a pain Sandi; please know that we are all rooting for you (will this medical meddling never end??!!)