Insurance that won’t cover medication

May 10, 2019

I have always been financially independent, meaning I supported myself. I worked in nonprofit for my entire career, so I never earned a lot of money. Still, I lived frugally and made it work, while managing to save money. Then I became too sick to work. Suddenly, money became a big problem.

Social security, fuel assistance, and food stamps helped, but they weren’t enough. I was pulling money out of savings every month. Thankfully I had savings, and enough that I wasn’t on the verge of ruin, but not enough to last me indefinitely. I tried to work multiple times. Each time I increased my hours, I got sicker. Some weeks I could manage 5 hours of work. Some weeks 10 hours. But if I tried to work 10 hours per week for two weeks in a row, it was a disaster. Even 5 hours per week wasn’t sustainable over time.

Then last year, I got Section 8! (For those outside the U.S., Section 8 is a housing subsidy. These days, the wait list to get Section 8 can be 10 years or more, and the restrictions for using it are very strict. With this type of Section 8, you pay no more than 1/3 of your income on rent, and the government covers the rest.) I was in shock. I thought I would be on the waiting list for several more years, but out of the blue, I reached the top of the list. Finally, I could cover all of my basic expenses with my benefits! I would still have to take money out of savings if I wanted to go to the theater, eat dinner with friends, buy clothes, or pay for car repairs, but this was still a huge improvement. It lasted about a minute.

Less than two months later, I got kicked off of food stamps. They said I earned $20 per month over the limit. I had no idea where that number came from, because I wasn’t close to the limit. So I did the paperwork and sent it in. I got food stamps back, but the same month I started a new prescription. It has to be compounded, as probably all of my medications will have to be from now on. That’s the only way to get this particular medication without any corn or gluten in it, which is a medical necessity for me.

Unfortunately, Medicare doesn’t care that it’s a medical necessity; they refuse to cover compounds. At $150 per month, this is obviously not in my budget. I appeal and was denied. I found an amazing patient advocacy group that helped me with a second appeal at no cost. My patient advocate helped me in many ways and this time my appeal included a 1000 word letter about why I need this medication and how it helps me, a more thorough letter from my doctor, and more of my own medical records.

And I was denied. Again. I can continue to appeal but it won’t help. Compound medications by their very nature are not FDA approved, and Medicare won’t cover anything that isn’t FDA approved. So I’m stuck.

Again, the good news is that I can afford this. I have savings. The bad news is that savings only goes so far. And every time I need to add a new prescription (I will probably have another in the next month or so) it will most likely need to be compounded. The costs might vary, but it won’t be cheap.

I take a lot of supplements and visit a lot of medical professionals. I spend about $600 on healthcare despite having great insurance. I take only ONE prescription medication and yet my insurance won’t cover it, so now I need to increase my medical spending by 25% to cover this additional $150 per month.

For a few weeks I could cover my expenses without dipping into savings or having to ask my parents for money. It was glorious. If only Medicare worked the way it should, I would still be in that position. Instead, I am watching my savings slowly go down month after month and it’s terrifying. But I need this medication to live.

Now please excuse me, I need to go call in a refill of my medication.


Normalizing the horrid ways I’ve been treated

April 13, 2019

For seven months my therapist has spoken with a woman who fights hard for her health, who does her own research, fights with insurance companies, argues for the tests she needs, pushes her way in to seeing the best doctors. So it’s no surprise that when I expressed my fear that I might one day just give up the fight, my therapist asked a question to which she thought she knew the answer: “But is there really any chance that you will give up?”

She definitely looked surprised when I said yes, but it was the look on her face when I told her why that surprised me.

Here in Massachusetts, there’s a large doctor network (Harvard Vanguard now, previously called Harvard Community Health Plan for you local folks) where the doctors refer patients within the network, read each other’s notes about patients, see each other’s patient test results, etc. These days this isn’t so unusual, but back in the 80s and 90s it was. Going to these doctors seemed like a good thing, because they communicated with each other. I spent my entire childhood and my early adulthood there.

When my therapist asked if I might really give up I said yes, because it’s so exhausting to keep fighting. And who knows if getting better is even an option? Sometimes I really want to just give up, to say that this as good as it’s going to get and I’ll maintain what I have, but there’s no point in trying for more. And then I do it anyway. Even though it’s exhausting and all-consuming and overwhelming. But maybe one day I won’t. After all, I gave up once before.

I’m not talking about taking short breaks, while knowing I will resume the fight again in a few weeks or a few months. I’m talking about actually giving up, choosing to stop trying altogether. After all, it’s what the doctor told me to do.

I had been undiagnosed for around 7 or 8 years. I had seen many doctors and even had exploratory surgery which yielded no answers but did manage to permanently increase the pain. Sadly, one downside of that doctor network is that I only saw the doctors that I was referred to, and I was referred to the ones who could properly diagnose me, like a rheumatologist. That would have been very helpful. Instead I saw surgeons, orthopedists, and other specialists who didn’t have any answers. Of course, I was also sent to a psychologist, but that didn’t help the pain for now-obvious reasons.

I will never forget the day, almost 20 years ago now, when I saw yet another doctor for yet another opinion, endured yet another painful examination, and was told to stop coming in. She didn’t mean I should stop coming to her office, but to the entire network of doctors. She made that very clear. And since the other doctors hadn’t been able to help, had been condescending when I suggested that perhaps my different symptoms were related (it was years later that I found out they were in fact related, and earlier treatment could have helped a lot,) and generally hadn’t tried to help me if there was no immediately obvious problem they could name, I gave up. I was done.

For a couple of years I stopped seeing doctors for anything more than annual checkups and acute situations. I didn’t even consider attempting to get better. I would simply be in horrible pain every minute of every day for the rest of my life.

Obviously that didn’t last forever and one day, practically out of the blue, I decided to take advantage of my ability to see a doctor without a referral for the first time in my life. I found a rheumatologist and was diagnosed within a week of that visit with an autoimmune condition. It was my first correct diagnosis. But before that, I had given up.

You would think my point in telling you this would be to show the value of self-advocacy, doing our own research, etc. That’s not my point today. That has been my point in many other posts and it will be in many more to come, but today my focus is on how I have normalized that horrible incident with the uncompassionate doctor. When I casually mentioned that the doctor had said I should stop coming in, I saw the look of horror on my therapist’s face. She’s not naive. She has worked in the medical system for many years. She knows this kind of things happens, but she hasn’t normalized it like I have.

That’s not to say I think it’s ok. And if someone dared say that to me again, I would react very differently now, that’s for sure. I certainly wouldn’t stand for anyone saying that to someone I care about. But back then, I was scared and shy and tired of trying, so I accepted it. And over the years I have seen and experienced so many forms of terrible treatment by medical professions and by the systems that are meant to support our health that I am no longer stunned. I am sickened and angry, but no surprised.

I don’t like that I have become so jaded, but I guess that is what 27 years of chronic illness does, at least in the U.S. medical and benefits systems. And what I find even sadder is, I know I’m not the only one.

Fallout from the mystery trigger

March 28, 2019

It started with horrible eczema on my hands. All day they were fine, then they were dry, tomato red, painful, cracked, and bleeding. Later there was gas. Then abdominal pains. Then constipation. Finally diarrhea, as my body got rid of the offending element and everything else I had eaten.

Clearly I ate some gluten or corn at some point. But I wasn’t all that sick, all things considered. This didn’t last as long as some other episodes. Plus, I’m super careful. Still, I had stayed over at my parents’ house, and even though I tried to be careful, there were crumbs everywhere, and we all pet the dog before and after meals. And we ate out at a restaurant that has always been ok for me, but maybe they made a mistake? I just don’t know, and not knowing makes it even harder.

The next day I was fatigued, but that makes sense. After all, my body had been through a lot. I had turned off my alarm clock and slept much longer than usual. Still, I was worn down, so I spent the day watching tv. I didn’t eat as much as usual, but I ate. I figured I would be fine by the follow day.

Yet I woke up today still feeling fatigued. It’s close to noon and the fatigue and brain fog are both intense, and much worse than what I typically experience. I am having trouble thinking clearly, and I wonder how much sense this post will make when I read it in a few days. Assuming I’m feeling better in a few days. Because who knows?

Now I am wondering how long this will last. I already canceled my therapy appointment tomorrow, but I have a big family event the following day – should I go? Even if I’m feeling better, would I be up to the hour-long drive in each direction? And to make it even worse, I finally scheduled that iron infusion, and that’s just 5 days away. I want to get it over with, but will my body be strong enough?

I don’t need to decide these things yet, but I will have to soon. If I skip the family event, I need to give another person time to make alternate travel arrangements. If I reschedule the iron infusion, I can’t do that at the last minute, especially since a friend is arranging her schedule so that she can go with me.

I have no idea when I will feel better. It could be later today or in a month. And what’s especially frustrating is that I don’t know what caused this! I wish I knew. Was it corn? Gluten? Something else I can’t have that I’m not even aware of yet? Was it the restaurant or my parents’ house or somehow something else?

I’m frustrated more than words can say, but there’s nothing I can do. Which is why in about 90 seconds I will once again be sitting on the couch, watching hours of tv. Because I just don’t have the energy to do anything else. Not even the many things I wanted to do today. And it’s all because of something I ate, even though I don’t know what.

I don’t know what to hope for

March 21, 2019

I read a lot of stories about patients improving to the point of their symptoms going into remission and even being able to take a jog or get a job. Of course, I also read stories about those who get much worse are are unable to care for themselves. Right now I fall somewhere in the middle, and I very much want the former but worry about the latter.

It’s hard to be involved in the chronic illness community and not hear these stories, I suppose. I read blogs and follow various Facebook groups. I imagine I would see a lot more if I was on Instagram on Twitter, but that’s more than I can manage right now. So often I worry about getting permanently sicker. It’s one of my biggest fears. But every now and then, I wonder, could I get better?

Now I’m not fooling myself. I will never job – my knees are permanently unable to support jogging. I can’t imagine how my symptoms would ever go fully into remission. But what if I could still get significantly better? Is that even possible?

When you sprain an ankle, your expected outcome is to completely heal. When you get a cold, your expected outcome is to completely recover. But when you have chronic illness, there simply is no “expected outcome.” I read stories by thyroid patients whose symptoms went into remission, but they usually caught it early on and immediately treated it properly. I did not. I read stories about folks with adrenal insufficiency who recovered completely, but they usually caught it early on and were able to remove the offending stressor. I did not catch it early on and my stressor is my chronic illnesses, which will never go away. So what is realistic for me?

There are no answers. I know that. But that doesn’t make it easy to wander through this maze of diagnoses, doctor appointments, and tests, constantly striving for better health but not knowing what to aim for. On a scale of 1-10, the year after I started this blog I was probably at a 3. Now I’m probably at a 5 or 6. I know I will never be at a 10, or even a 9. But is an 8 possible? Is a 7 possible? Already I wonder if I have reached my maximum possible health. But at the same time, I keep trying.

I keep trying because I see the possibility. I have given up many times over the years. I stopped trying to get better because I didn’t know what else to try. Now I have a list of things to try. I don’t know if any can help, and some may even hurt, but how can I not at least try? Some are obvious, like my upcoming infusion (yes, I’m doing it) for anemia and low ferritin. Increasing my pregnenolone makes sense, because blood tests show it’s low, and it’s necessary for progesterone and cortisol production. But should I take Cortef to treat my adrenal insufficiency? Or maybe my fatigue isn’t from adrenal problems at this point but from something else? I continue to find and elimination sources of corn in my diet, most recently realizing that my calcium and vitamin C supplements contain corn. I stopped those a couple of weeks ago and already feel much better. Maybe there’s more corn sneaking into my diet? I have no idea how careful I need to be and don’t want to go overboard, but eliminating corn seems to help. I want to try LDN (low dose naltraxone) which some patients report has helped with their autoimmune disease.

There are more specialists I want to see, supplements I want to try, dietary changes I am considering. Each of these takes ages, and can easily be derailed. I was going to try increasing my pregnenolone this week, but then I found out my compound thyroid was made as a slow-release version, which no one told me (and the doctor didn’t order!) and that explains some of my current problems. I am going to start the correct version of the medication in a few days, and by the time I have adjusted to that, it will be time for my iron infusion. I will need to wait a few weeks after that to see how I’m feeling and if I need a second infusion before I consider other changes.

Any time I make a change, I wait for weeks, sometimes months, to make sure I still feel ok. And so often, some other symptom or reaction gets in the way and I need to delay my plans. That means it will probably take me 2+ years to get through my current list of 9 things I want to try.

It would be so much easier to give up. I’m in a pretty good place, and maybe I should just be happy with where I’m at. But then I think about having to miss my very close friend’s surprise party last weekend because I didn’t feel up to going. And I think about the pain several days ago that was so bad, I had trouble functioning. And I think about those days that the fatigue wears me down unexpectedly. And I think about what happens if one day I want to get married, and I can’t even have the kind of wedding I want because I won’t have the energy for it. And I think about how much I want to spend the entire day with my nieces and nephews but I don’t have the energy for it.

And then I decide to try again. Because maybe I won’t get any better than where I’m at right now. Maybe this is as good as it gets. But maybe it isn’t. Maybe I can nudge my way up to a 6.5 on that scale, and wouldn’t that be worth all of the effort?

Between a rock and an iron infusion

March 12, 2019

I feel so stuck, and I can’t get this out of my head.

It’s pretty apt, as you’ll see.

I have been anemic for ages, but mostly it was ignored. Whenever I tried taking iron supplements they made me sick, and eating iron-rich foods didn’t help, so instead I did nothing. After all, most of my iron tests were fine, it was only my ferritin that was low, and that wasn’t a problem, right?

Then back in 2012 I started doing my own research into why I was so sick and I found all sorts of useful answers. I would be so much sicker without that research (shout out to public libraries!) Among other things, I learned that low iron levels would impede my thyroid improvement via medication, so I had to address it. My regular doctors weren’t helpful, but I managed to see a hematologist in 2013. He prescribed iron infusions and those more than did the trick – my ferritin levels went through the roof.

Over the past six years my ferritin levels have slowly come back down to within the normal range, then lower within that range, until finally 10 months ago I became anemic again. Oy.

I put off dealing with it while I managed some other health issues, but finally I took iron supplements that my naturopath recommended as being especially easy on the stomach. We started out with 1/2 the normal dose. At first I felt ok, so I figured there was no problem. But after weeks of feeling sicker than usual, I finally realized the problem had to be those iron supplements. Within a few days of stopping them I felt a lot better, but I had lingering symptoms for another month and a half.

After that experience, I didn’t want to try iron supplements again. My naturopath suggested taking an even smaller dose, but I had been so sick for so long that I just couldn’t bring myself to do it. Some folks recommended cooking with cast iron pans, but they’re too heavy for me to lift. A friend found something called Lucky Iron Fish and I actually bought one. It’s like cast iron pans, but you boil it in water and then drink the water to get the iron off of it. I chickened out and it’s been sitting in a drawer for months. I don’t want to risk getting so sick again.

But I have to do something. That’s the problem. I made an appointment months ago with a new hematologist, and it’s finally coming up next week. I made the appointment with the idea that I would get iron infusions again but now that the time is here, I’m hesitant. What if the infusions make me really sick? Back in 2013 I don’t know how they made me feel. I was doing so poorly that it was impossible to tell. I had only started seeing my naturopath two months before, had just being adrenal supplements, and hadn’t even started natural dessicated thyroid as my new medication yet.

Now I am in a better place. Overall I feel hugely better compared to where I was in 2013. On the other hand, I’m still struggling every day, and the tiniest thing can make me feel like crap for weeks or months; like those iron supplements I took last fall. So I want to risk a major setback? And unlike supplements, I can’t change my mind and stop. Once I have an infusion, that stuff is in my body.

And what’s in the infusion besides iron? Chemicals? Additives? Other things that could make me ill? I already have a long list of things my body reacts badly to: everything from the dye used in brain MRIs to lavender, corn, various medications, gluten, the pesticides on apples, broccoli, and so much more. And those are only some of the things I’m aware of. I have been thinking lately that there are probably more things I am reacting to. What if some of those things are in the infusion?

So I’m rightly scared and I don’t know what to do. I’m hoping the hematologist has some brilliant idea that I’m currently unaware of, but otherwise, I’ll have to make a tough decision soon. Should I risk the infusion? Try the iron fish? Remain anemic?

For anyone who has dealt with iron infusions, I would love to know what you think! Making medical decisions is often hard, so this is nothing new, but that doesn’t make me feel any better about it. Because no matter which option I choose, I know it could potentially be very bad.

I just want to be me

February 24, 2019

There are so many big, obvious ways that chronic illness can stop us from doing the things that make us feel like ourselves. Like not being able to work or having to give up a favorite form of exercise. But then there are the smaller things that most people don’t think about. And lately those have been bugging the hell out of me.

Don’t get me wrong. Not being able to work really sucks. And I should have a dog. I adore dogs. I dog sit a lot. And yet, I can’t manage having a dog every day, so no dog for me. And yeah, that sucks. Then there are things like no longer being able to dance. I miss that. And I wonder if I get married one day, will I not even be able to dance at my own wedding? That idea is so sad that I don’t like to think about it, and get it comes to mind anyway. Then again, will I even be able to have a big wedding? My guess is that my adrenals wouldn’t be able to manage that. Those are big things. Then there are smaller things.

Like I was telling a friend about how I hadn’t kissed anyone in 6 months. He suggested that if I’m on a date with someone I like then I should just go for it. But I pointed out the big problem: gluten. I can’t kiss someone who has eaten or drunk gluten. Or who is wearing lipstick or chapstick that might have gluten in it. So I have to tell them, which can be awkward on a first or second date. Like, there was the woman I mentioned it to on the first date. She was all done, with nice clothes, makeup, lipstick. On our second date she was dressed up with nice clothes and makeup, but no lipstick. And when we ate dinner, she ordered hers gluten-free also. Ah hah! Clues! And yes, we kissed that night. More recently I went out with someone and managed to bring it up. But then he ate gluten with dinner anyway. So obviously, no kissing there. I used to make the first move all the time. In fact, the first few people I kissed I had made the first move. I can’t do that anymore, not unless I know they are gluten-free. And that totally sucks. I can’t simply be me.

And there’s the money thing. I want to try and earn some money. Not only does my health not allow me to do much, but even when I can work a little bit, there’s the issue that my government benefits prevent me from earning a little money. I need to either earn enough to get off of benefits, or earn nothing at all. Because if I earn $1000, I will keep about $250 and the rest will get eaten up by a reduction in benefits. And that sucks.

I want to play with the kids in my life. I am auntie to 11 wonderful kids, and I’m too tired to do much with them. I have managed to host a couple of sleepovers, but even those were exhausting. I want to babysit more, chase after them, take them for outings. And it hurts that I can’t do that.

There’s a list of projects sitting next to me. Things I really want to do, if only I could manage to do them. If only I had more good hours in the day. These are the things that make me feel like me. I do enough to hold onto my sense of self, but there’s so much more I want to do. There’s so much my health won’t allow me to do.

I think about the kinds of things I have done over the years, back when I was healthier. I think about the kinds of things I would like to do now. I want to go out for drinks with friends in the evening, go out dancing, ride a bicycle. But mostly I want to act naturally, follow my instincts, and just be myself. And I find it incredibly frustrating that I can’t do that basic thing: just be me.

Panic, thyroid, and medications

January 24, 2019

The thing about thyroid hormones is that they are needed for every part of the body to function. When you look at the list of hundreds of hypothyroid symptoms, you can see exactly what I mean. We need thyroid hormones.

It took too long for my hypothyroidism to be diagnosed. I am certain that the years-long delay in diagnosis and treatment led to some of the long-term damage to my body. Eventually I was diagnosed and put on medication.

Nine years later I did my own research and realized a lot of my ongoing health issues were untreated thyroid symptoms. I switched to a different class of medications altogether called Natural Dessicated Thyroid (NDT.) Instead of synthetic, human-made hormones, I was no taking pills formed from pig thyroid. You see, pigs produce the same thyroid hormones as humans, and in similar proportions. Many hypothyroid patients see huge improvement on these medications. Eventually I even got my father to switch to NDT and he also found improvement.

Things went well until several months ago. After years on Nature-throid I was suddenly hypothyroid again. What the hell?! I read on a hypothyroid blog that a lot of Nature-throid patients had seen a resurgence of symptoms since they changed their manufacturing process last year. At the time they swore they weren’t making any changes other than switching to a bigger facility. We’re now learning that there were changes to the ingredients after all, and that these were having unintended consequences for many patients.

I spoke to my doctor, who gladly wrote me a prescription for another NDT called NP Thyroid. But when I called the company that makes NP Thyroid I learned that it contains cornstarch. I react badly to corn. This would be a tiny amount but even so, I would eventually have issues with it. So we turned to compound medications.

The compound pharmacy is horrible. I won’t detail the issues now, but they suck at filling a prescription. I should have had this prescription last week but they keep having delays. My old Nature-throid prescription may not work well but it’s better than nothing so I figured I better get a refill, since the new compound wouldn’t be ready before I ran out of medication.

And then I got the call: Nature-throid is back-ordered until March. They don’t know why. No one has it. I asked around and learned more. The raw ingredients are back-ordered so it’s not just Nature-throid but all NDT medications! I even called a different compounding pharmacy and they said they can’t get their hands on it either.


So now I’m panicking, because I need my thyroid medication! And remember how I said thyroid hormones effect all parts of the body? Well, they affect mood, too. I have been more emotional lately due to being in a hypothyroid state. So while the issues with the compounding pharmacy are rightly upsetting me, I am getting even more upset than I usually would. I don’t have the capacity to properly react to things right now. This means I’m extra stressed out.

And ironically, the thing that is currently causing me the most stress is my inability to get my hands on the medication that would fix the problem that is causing me to be so emotional.

There aren’t a lot of options here, and things could get very bad. If I can’t get more NDT (I’m cleaning out every pharmacy that I can right now) then I will have to go back to synthetic medications. But those probably contain corn in the fillers and might not even be gluten-free. Not to mention, they simply don’t work as well as NDT. There’s a good reason I stopped taking them. But my thyroid can’t produce enough hormones on its own, so what choice do I have?

For any of you who take NDT, stock up now! Get extra refills if you can. Because the next few months could be rough for anyone with hypothyroid who takes these necessary, life-saving medications. And if you know anything about why this back-order is happening, please comment below or email me at msrants at gmail dot come because I would love to know.

Good luck to all of us. Let’s hope they bring our medication back soon. Because our lives depend on it.

%d bloggers like this: