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The Crazy Cost Of Accutane

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#1 KatNewby

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Posted 18 March 2013 - 10:37 PM

So, this is my very first post on this forum. I sure wish it were under better circumstance...

 

The Back Story: I have been suffering with acne for about 7 years, and it has gotten progressively worse. I have tried all kinds of over-the-counter things to combat the issue, tried Proactive, & I own a Clarisonic brush. I've been put on Tazorac, Minocyclin & Doxycycline. None of this has helped much at all.

 

Recently: So when I went to a new dermatologist she recommended that I begin Accutane. I was ready to sign the dotted line. I called my insurance (United Healthcare Choice Plus/ Golden Rule)  to be sure it would cover the cost of the the Isotretinoin, and compared the cost of the different brands. I mean, I felt I really did my homework.. I figured out that it would cost me $35 a month for the derm visit, $35 for the blood lab work monthly, and $35-$70 a month for the actual medicine monthly (depending on the dosage). That came out to somewhere between $105-$140 a month. This is certainly not what I consider cheap, but I weighed it out as being do-able.

 

But Then: Just when I'm into the last week of my first month in the course, I get a letter from my insurance stating that they do not cover lab work. Oh, and also, I now owe my local hospital $200 dollars for the first blood test I had done! I immediately got on the phone to be sure, and sure enough I am totally screwed. I started crying immediately. This means that every month my accutane course will cost

$270-$305! I'm an undergraduate student living off campus with my Fiance. How in the world am I going to justify this cost! I can swing it (not easily) but I'm just so freaked out about how much I've already spent, and how much more I will spend before this is over. And there is still no guarentee that this is all going to end up perfectly.

 

Does anybody else have a similar experience? Does anybody else have my insurance? Should I stay on the med and give it my all to try and clear this burden that I've been living with for so long, or do I acknowledge the risk of this and cut my losses now and just stop treatment? Is $200 for a monthly blood test normal!?

 

Please, I am so depressed & I need some advice :'(

 

 



#2 Monkeybeanmagic

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Posted 19 March 2013 - 12:54 AM

Yes, America has a terrible healthcare system. It costs just 10 € quarterly where I'm originally from to see a doctor and do all this stuff. Accutane has the potential to be a permanent cure for you, so if your acne bothers you a lot, then it's probably worth it. It sounds like you've exhausted the alternatives except for spironolactone. Let your doctor know about how your insurance doesn't cover the bloodworm. Maybe he can do it cheaply in his office.

#3 KatNewby

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Posted 19 March 2013 - 01:07 AM

Thanks for the response, LeereWorte. I've discussed it with my Fiance, and he really thinks I should stay on it as well. He certinaly isn't happy about the cost, but frankly acne is an eye sore and I'm sure he is sick of looking at it too. My father said that he would help me if he absolutely had to, but I just can't see burdening him with this when it's not his job (I'm 21). The only way I can justify in my mind allowing him to help me is to think back to when I was under his roof and had acne and how I didn't get it fixed back then like I should have; he just kept telling me I'd grow out of it.

 

It's all made even worse considering I just found out today that my car is going to cost $520 to fix. Naturally I found that out just before I found out that the bloodwork wasn't covered... When it rains, it pours. This whole process will cost be about $2000 when it's said and done. I can't even fathom my reaction if I require a second course.

 

I guess my next course of action is to check around at prices of blood work. Perhaps the place I got mine taken was just really high..? I feel bad bitching considering that there are people out there paying treatment bills for cancer and such...



#4 whatthekell

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Posted 20 March 2013 - 08:56 AM

hey I just wanted to share that I also have crappy health insurance that did not cover a dime of my Accutane course.  I also pay for my lab work. Check to see if your derm can adjust some of the tests they do in the lab. Mine offered to take some off if it was too much. My derm office is also not "in network" with my insurance, which means I paid for my appts out of pocket as well! and here's the biggest one, my Accutane cost me $558/month for my first 2 months, $758/month for 3 months, $558 for my 6th. that adds up to about $4,000 just for the pills alone!  =( it sucks but it was so worth it! it gave me a life I have never had. I am now just completely terrified that it will come back and I will do anything to keep my skin clear! I got a credit card that has 0% interest for 14 months. so that way I pay about $200/month instead 



#5 Someclearday

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Posted 20 March 2013 - 10:23 AM

Ugh what a pain. I just started Accutane and I'm so worried about my insurance. I have Blue Cross and its a pretty decent plan. I got on this insurance because I got kicked off my parents when I turned 26. Luckily, the day I got my approval packet in the mail was the day that I finally was offerd Accutane.

I went through the process and so far my appointment, bloodwork, and Accutane has been fully covered. I couldn't believe it because I told them I had acne as a pre existing condition basically but they didn't think much of it I guess in the initial phone questions. I'm not 100% sure how insurance works anyway. I'm still expecting to get some kind of bill in the mail unexpectedly :/

I'm so worried they're going to call and be like wtf and drop me/ charge me out the ass when it's time to renew or something. Honestly I've wanted this for so long I would consider paying out of pocket for it. If I were you I would ask for help with it. My derm said to let her know if it wasn't covered, so I'm thinking there is something they can do as an alternative for you:) good luck!

#6 KatNewby

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Posted 20 March 2013 - 01:24 PM

Thanks for the responses guys!

 

This has been a very difficult situation for me, and although I am sad that I'm not the only one who has had to deal with something like this (or experienced anxiety over the possibility of it), I am comforted to know that I'm not alone.

 

My only real line of defense at this point is to stress to my doctor the severity of my situation and hope that she will either help me get it worked out with insurance, or request a higher dose & shorter course (by doing this, I would need less monthly blood tests). I've figured out that if I did 3 more months at 80mg I would meet the 120mg/kg requirement for the whole course. My doctor seems fairly aggressive, so I'd be content with the situation if she would accept my idea and run my course this way.

 

Thanks for the story, whatthekell. I really really feel for you. I can't believe how much you had to spend. You were clearly very commited and I will certainly pray that you remain clear and happy.

 

And someclearday, Bluecross seems to be a fairly recognized and decent insurance company, so I think you should be fine. My insurance is pretty cut-rate and crappy. My dad told me that the whole "pre-existing condition" thing is no longer valid in healthcare because of the new Obama-care laws. I haven't verified this myself though, and I'm sure their are rules about it. When I get married in July I will switch to Bluecross under my Fiance, so luckily if I require a second course then I may have better coverage.


Edited by KatNewby, 20 March 2013 - 01:26 PM.


#7 KatNewby

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Posted 21 March 2013 - 03:01 PM

Just wanted to come to vent and say that the inability of my doctors office and my insurance company to communicate is downright pitiful and it makes me so F****ing mad I could scream!

 

Found out that if my blood test was submitted to insurance under different coding it would be covered by my insurance, but I since I'm not a doctor I obviously can't tell my derm how to code it in a way that is not insurance fraud, and in a way that will get my insurance to cover it. These are things that my fricken derm needs to figure out and she isn't do that! I called my derms billing department and they told me "Why don't you not get your blood test before your next office visit and your derm can write a letter to the insurance company to try and get them to pay" to which I said "Okay, but that means I won't get my next script for accutane and that I could have to come BACK in for another derm visit in order to get the next script, so that means I've spend even more money for two doctors visits. Why can't she just talk to me over the phone and write the letter so that on my next visit she could write me the script?"

 

The response? Well, the derm is busy at the moment. How F****ing convenient..



#8 accutastic

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Posted 21 March 2013 - 07:08 PM

I am sorry to hear of your troubles! I am not having much luck getting the drug covered either. With a 30 day supply costing $150~ for 40 mg at Sam's Club, my next financial pill to swallow will be the blood tests. I was preparing for a $500 bill but when I saw that you paid $200 that has given me some hope that my $2000 accutane budget won't be completely depleted.

 

I called United Healthcare to see if they would cover any cost of the medication. The lady on the phone said "Sir, the medication is not covered. The reason for this is that acne is not covered for this policy." I want to copy every receipt I have from this whole ordeal at the end of my four mo's, and mail them, in a box, to the CEO of the insurance company, along with a photo of my middle finger.

 

Thank goodness for health insurance! NOT.



#9 KatNewby

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Posted 21 March 2013 - 10:57 PM

Accutastic, what plan do you have with United Healthcare? I have the Choice Plus plan. I made a lot of calls before I had my derm give me the script so that I could be sure I told her which brand was covered and what not. My plan caused me to pay $235 the first month for the pills (because I have a deductible to fulfill) and then every month after that it was supposed to cost $35 for up to 40mg, which (if I'm correct) means that if/when I get upped to the 80mg it will be $70. In talking to United Healthcare, I was told some mumbo-jumbo about how blood work would be covered if it was taken for a routine physical/preventative reasons, but not if it is coded as a diagnosis, whatever that means.. I had my blood drawn a number of times to check my iron levels because I am anemic, and that was always covered. So perhaps when you talk to your derm about putting in the lab order, let him/her know that it should be coded as something preventative. United Healthcare it total crap and I can't want to get married about switch to BlueCross.!

 

I hope you don't run into the same problems as me! I think $2,000 *might* happen, depending on how quickly you finish your course. I'm finding out that the longer the course, the more money because of more testing and such.

 

Best of luck, buddy!


Edited by KatNewby, 21 March 2013 - 10:58 PM.


#10 Green Gables

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Posted 22 March 2013 - 09:13 PM

If you have a valid prescription you can fax it to a Canadian pharmacy and have it filled and mailed to you for something like $50 a month.

 

Right now it's a bit of a legal gray area, but as far as I can tell it is still legal to do this provided you have a valid prescription from your doc. I know people who have been getting their necessary meds mailed from Canada, or even driving across the border and picking them up, for close to a decade. 



#11 KatNewby

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Posted 23 March 2013 - 10:19 AM

If you have a valid prescription you can fax it to a Canadian pharmacy and have it filled and mailed to you for something like $50 a month.

 

Right now it's a bit of a legal gray area, but as far as I can tell it is still legal to do this provided you have a valid prescription from your doc. I know people who have been getting their necessary meds mailed from Canada, or even driving across the border and picking them up, for close to a decade. 

 

Thanks, I appreciate the info. However, the cost of the medicine is not too expensive for me, it is the cost of the blood work that is doing me in.



#12 Green Gables

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Posted 23 March 2013 - 11:48 AM

If you have a valid prescription you can fax it to a Canadian pharmacy and have it filled and mailed to you for something like $50 a month.

 

Right now it's a bit of a legal gray area, but as far as I can tell it is still legal to do this provided you have a valid prescription from your doc. I know people who have been getting their necessary meds mailed from Canada, or even driving across the border and picking them up, for close to a decade. 

 

Thanks, I appreciate the info. However, the cost of the medicine is not too expensive for me, it is the cost of the blood work that is doing me in.

 

Sure, but if the actual med cost went down to $50 a month, then the blood work wouldn't be such a big chunk of the total you're spending. 



#13 Florencienne

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Posted 25 March 2013 - 03:35 AM

Wow. (((((((Hugs)))))))) to you, first off. I'm really sorry that you have to go through this burden. 

 

I live in Australia so my experiences are not identical to yours, but I too have felt guilt over the costs of Accutane. The drug itself is only $35 a month for me, and fortunately my blood work is all bulk billed, but my dermatologist appointments (monthly) are $150 a pop. That, as a uni student, sucks. To put it frankly. On top of that I am receiving a treatment from my dermatologist at $130 every 4-6 weeks for 4 sessions. It's physically and financially painful, haha. $200 for a simple blood test seems ridiculous to me, but like I said, I'm not in the US. Are there any organisations that can help in covering costs? I'm unaware as to how things work, so not really much help. My dad has offered to help ease the burden of some of the costs & it looks like you have some support structures that are there for you also. You don't need to burden this all on one shoulder. Even if your dad were to pay now, would it be feasible to pay him back later when you were more financially stable and did not have your car payment? 

 

If I were you (& it's hard to say considering I'm actually NOT in your shoes) I would continue with the Accutane. It's corroding your confidence and joy, which is more valuable than any monetary amount. The long-term benefits outweigh the short-term costs & so I would encourage you to budget carefully and try and make it work. Good luck with it all, keep us posted. x 



#14 ls206816

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Posted 25 March 2013 - 11:36 AM

For Accutane It's not required you get blood work every month it just recommended by some doctors. I only got bloodworm before starting and once during. So maybe ask your doctor if you don't have to get the blood work every single time. Also sometimes the office has coupons for different brand of Accutane where you can get the prescription for under $20 so ask about that too! I know I was going to be put on a brand called Absorbica and they gave me one of those cards but I ended up being on Claravis because my pharmacy didn't offer it. Hope this helps!

#15 Tristen420

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Posted 15 April 2013 - 01:52 PM

   Don't know if i'm a little late to the party but if you look around at local colleges you can find free blood tests, i'd look into it.



#16 CelineCarey

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Posted 17 May 2013 - 07:16 PM

Don't know what final decision you made OP, but I would suggest you try going to a dermatologist in private practice as opposed to one who works in a hospital. Hospitals are notorious for charging exorbitantly high fees for lab work (over $1,000 for something basic like CBC and CMP).

 

My private practice dermatologist had me go to Quest Diagnostics for my blood work. I paid anywhere between $50-70 for my monthly labs, depending upon if the nurse chose blood draw for my pregnancy test or a urine sample. If I went to a dermatologist with an office in a hospital, I would have been paying $500/month with insurance (Aetna) for lab work done at the hospital’s lab. Unacceptable!

 

Google a website called “save on labs.” The company LabCorp is similar to Quest Diagnostics, providing lab work at dramatically reduced cost.

 

By the way, the ICD-9 code my dermatologist used for my blood work was V58.69.

 

HTH!



#17 Grandpa2905

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Posted 07 February 2014 - 05:39 PM

Now that Obamacare has kicked in, all the insurance coverages are virtually gone.  So, get ready to be put in bankruptcy for Accutane.  My 17 yr. old grandson has sever acne.  Nothing seems to work, and they are still messing around with the other stuff instead of just going to Accutane.  Why?   My son-in-law's company (Huntington Banks) dropped their prescription coverage and tossed everyone out the door to Obamacare.  They now have NO prescription coverage and their family copay/deductible jumped from $1300 per year to now $7000.  Their plan now pays NOTHING until they go past the $7000 mark.  The kid have other health issues as well as my daughter and son-in-law, and are currently paying hundreds in additional medical costs out of pocket now before any thoughts of having the grandson go on Accutane.

 

So, how do you all like the "Hope and Change" garbage now?  The Obamunist took a reasonable healthcare system for about 85% of the population and trashed it to please his narrow, minority voting block.  Thanks you (unprintable) idiot.






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