I lost my job in June. I had wonderful medical benefits and a low co-pay for Copaxone, so I've been very fortunate in being able to remain insured through COBRA and afford the medication while I seek work. However, my former employer has recently filed bankruptcy and I don't know what is going to happen to my COBRA coverage. I'm uninsurable except through my state's high risk insurance pool -- which has very high premiums and astronomical deductibles. I've been "hoarding" my Copaxone by cutting back on dosage and refilling my prescriptions -- while still keeping my symptoms pretty much under control (I have relapsing/remitting). My preliminary research indicates that one has to be virtually without resources to qualify for prescription drug assistance. I have savings, but no one wants to deplete their resources in this economy. I know my story isn't unusual. Does anyone have any wisdom to share about insurance coverage? I think an oral medication is has been through trial and is nearly ready for FDPA approval. I'm sure it will be expensive too. What about alternative therapies? Taking part in trials? (I'm just starting my reseach.) Thanks.
- Resources
Hi Hopeful,
Welcome to Health Central. You've asked an excellent question and I've learned something in researching for it.
It's excellent that you took advantage of COBRA benefits so that you continue to remain insured. The tricky part with COBRA, however, is that it is only available as long as your former employer maintains a group insurance plan.
"If an employer declares bankruptcy, it will generally take one of two forms: reorganization under Chapter 11 of the Bankruptcy Code, or liquidation under Chapter 7. A Chapter 11 (reorganization) usually means that the company continues in business under the court’s protection while attempting to reorganize its financial affairs. A Chapter 11 bankruptcy may or may not affect your pension or health plan. In some cases, plans continue to exist throughout the reorganization process. In a Chapter 7 bankruptcy, the company liquidates its assets to pay its creditors and ceases to exist. Therefore, it is likely your pension and health plans will be terminated."
For recommendations on what to do - read here.
If your employer does cease to offer group insurance, then you should receive a Certificate of Credible Coverage which is necessary to use your benefit under HIPAA to obtain a guaranteed-issue non-group plan, ie. individual health insurance, without exclusion for pre-existing conditions. But it sounds like you already know that within your state, your options are in the high-risk insurance pool.
Now, regarding Copaxone specifically -
If you lose prescription coverage, or end up with an insurance plan which has limited prescription coverage, it's important to know that NORD (National Organization for Rare Disorders) administers Teva's assistance program.
According to NORD's website, you must contact Shared Solutions at 1-800-887-8100 for information. However to qualify, there are strict (undisclosed) rules for determining eligibility. Here's what I found:
1. When my income was ~$27K and I had some (not alot) of resources in a savings account, I received a 50% award which covered six months of medication.
2. When my income dropped below $20K, I received a 100% award for one year.
It seems that the 200% Federal Poverty Level is that magic income level for eligibility. I do not know how they handle loss of a job.
Also, there are co-pay assistance programs which help with high out-of-pocket expenses after insurance has paid their amount. But this is not a reliable system to depend upon. For instance, both co-pay assistance programs for Copaxone have exhausted their funds and are not accepting applications right now.
I like your hoarding idea. If you can refill a little early each time, you may develop a buffer of supply for yourself.
But, no matter what, you MUST stay insured to maintain credible coverage!! Do not allow your coverage to lapse...ever. Good luck and let us know what you learn.
Lisa
I have been through the same thing only my COBRA is about to expire. I tried MHIP too but as you say, it is way too expensive. However, I did find a company that will insure me. What state are in?
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