Posted by Reggie BoStar on September 17, 2009, at 23:31:19
In reply to Re: From Pristiq to Effexor, increased exhaustion?, posted by West on September 17, 2009, at 21:04:46
Hi West,
Discussing the politics of healthcare reform is a risky business here in the US. It could easily start a really nasty thread here, which I'm sure Dr Bob would not want to see, so I'll stick to the facts of our Medicare program.Medicare is government funded healthcare for people aged 65 or older, and for those who are disabled. I'm in the latter category for mental health reasons though I'll be reaching the age qualification soon anyway.
You've more or less guessed right about the drug coverage for people on Medicare. Starting at the beginning of a calendar year, medications are covered until the covered amount exceeds a maximum. I'm not sure Dr Bob wants us to talk numbers here so I'll leave at that. It's not a very high amount for people on expensive psychiatric meds. Many of us reach that limit only a few months after the start of the year. After that, a everything must be paid out of pocket (or with expensive private insurance) until another maximum is reached. After that second maximum is reached, "Catastrophic Coverage" kicks in for the rest of the year.
The second maximum (total out of pocket expenses) that must be paid before coverage starts again is about twice the maximum that's covered at the start of the year. It's a huge amount. For all intents and purposes, most of us simply aren't covered for the rest of the year once the first maximum is reached. If we can afford it we buy "Medicare Supplemental" insurance which provides limited coverage during this gap. The most affordable plans typically cover generic drugs but not name-brand drugs. So you're out of luck if you need an expensive name-brand drug for which there is no generic.
There are more expensive supplemental plans which do cover name-brand drugs but no one I know can afford the extra cost of the premiums.
That's roughly how it works. So yes, unless an expensive medication has a generic form, you really can't rely on being able to take it for a full year if you're on Medicare. Some other kind of coverage will have to be procured somehow.
I haven't said anything about Medicaid, another type of government-funded healthcare, because I know little about it except that I don't qualify for various reasons.
You said your brother was diagnosed BP2, "always a project on". That's exactly my situation. It's finishing the projects that's the problem. I multitask constantly, but before I can finish any one project, I start another. At this point my house is a museum of unfinished projects.
It's actually kind of funny. Whenever I walk in the door after I've been out all day, I do get a chuckle out of what I see. The unfinished state of things is on every scale you can imagine. I'm sure your brother understands perfectly what I mean here. I have many bookcases, at least 10 floor to ceiling, none completely finished. There are hundreds of books in stacks on the floor as I move them to one set of shelves, decide I don't like the arrangement, and move them to another set of shelves but sorted a different way. About halfway through each cycle, I change directions to go back some other way. There are unfinished hanging shelves, some consisting of only wall brackets and loose boards. The "office" (a small spare bedroom) where I keep my PC has trails that must be negotiated between piles of things left out of arrangement and waiting to be stored. In the cellar, I have a massive model train table, the size of two ping-pong tables in an "L" shape with another half table at the corner of the "L". It too is only half finished, though I've at least got all the legs and platforms in place.
I could go on, but - no, really I COULD go on. I'd also never finished this message. I should at least finish this. For now I'll end by saying that I have to go check on some of those drugs you've named. I've heard of Provigil, Effexor, and Nardil. I'm not sure about some of the others or whether or not they're even available over here. Once I figure them out, and assuming I remember this thread, I'll try to keep it going.
Thanks for your post and talk to you soon!
Later,
Reggie BoStar
poster:Reggie BoStar
thread:914590
URL: http://www.dr-bob.org/babble/20090912/msgs/917534.html