A new year, a new beginning…. of my deductible

Every January starts out with anxiety, and not the “what’s my new years resolution going to be and can I hold to it” kind. The “my $3000 deductible starts over and I need to figure out how to pay for it” kind.

The past few years I have been extremely lucky. A few years ago, probably when I was 19 or 20 I signed up for this grant program at my cf clinic that pays for any out of pocket costs when I attend cf clinic. So every year I scheduled my appointment as early as I could in January so that whatever out of pocket costs aka my deductible I incurred was paid for by the grant program. Even if it was 10-15 days into January it didn’t really matter because it was worth waiting for. The reason my appointment costs so much in January is because the way my cf clinic operates is that during your birth month, they do annual blood draws, x-rays, sputum cultures, and pft’s. So by the time this is said and done, my deductible is paid for and my insurance pays 100% the rest of the year. This is awesome cause that means the only out-of-pocket I have during the year is the $1000 pharmacy deductible which is paid for by copays so its not all due at once. Not only that, the plan I have through work gives me $600 a year at $50 a month to help pay out-of-pocket costs using a health savings account. So in total my out-of-pocket for the year comes to $400. This is an estimate because if my insurance decides not to pay for something then it could be billed to me, but for the most part it usually works out that way.

Well this January was different. Since I am on treatment for my mycobacterium abscessus(MAB) I have ongoing antibiotics and home health and was freaking out how I was going to come up with $3000 first thing in January so I could continue home health and get my antibiotics from the pharmacy. My anxiety level rose, which is probably another reason I got so sick from the stress. I didn’t feel good on top of having to figure out what to do. I talked to my home health and they are going to work with me, with billing so I don’t have to worry about paying them my deductible. Hopefully between Amanda and I we will have enough meds to cover me until my appointment with cf clinic on the 15^th in which my deductible will be met, grant program will pay it, and I can get all my meds again.

Even though I had this all figured out, I forgot one thing. Zyvox. One of the antibiotics I have been on for MAB is only covered for 11 days at a time through insurance. This means I was going to have to miss days because my cf appointment wasn’t until the 15^th. So I started getting frantic, I didn’t want to compromise my MAB treatment by missing days, so I started trying to figure out what to do. Zyvox is $160 a pill, so even if I miss a few days I'm still out almost $500. That’s a lot of money, not just for cfers, for anyone. So I asked Amanda if she could get more, she couldn’t, luckily her previous cf nurse pointed her to Pfizer health. They have a program that helps pay out-of-pocket costs for zyvox and many other antibiotics. So I got on the phone with them immediately, Friday afternoon I sent in the paperwork and had to write an appeal because I make too much money, or so they say.

I hate that programs get to say that you make too much money when you really don’t. I could understand if I made hundreds of thousands of dollars a year, but how can they tell me, a cfer, that I make too much money? Its not fair because I am trying to be a “normal” citizen by working and paying bills just like everyone else on top of having a life threatening disease. I know plenty of people a year that get more help a year and are perfectly able to work and be normal citizens but don’t cause they are lazy or like getting a free ride.

Life isn’t fair. Your parents don’t tell you that as a kid just to shut you up, it really isn’t.

Anyways, Pfizer health approved my appeal and is going to help. All the hell and stress I've gone through taking on IV antibiotics for a year has made me realize that social workers don’t point out all the programs to help you get assistance. I think if I get the time and energy I will start researching all the assistance programs and pharmaceutical companies that help patients out and set up an informational website. We need something that all doctors and cf clinics can point their patients too for information just incase they forget to mention something. The cystic fibrosis foundation is great, but it doesn’t have everything.

Anyways, I'm getting tired and need to go to bed. Hoping these allergies don’t turn into an infection.