STYLETHREAD -- LET'S TALK SHOP!

wetbandit42 · Marc Jacobs

Does insurance cover antidepressants?

pollyjean23 · Marc Jacobs

It's priced like that, probably, because of the brand name. Most insurance plans make you pay out the you-know-what for brand name prescriptions. Usually the levels run from (cheapest to most expensive) generic to preferred (cheaper name brand) to drugs without a generic available to brand-only requests (when a generic is available), non-preferred (crazy expensive--no matter what) and so on.

Even when the generic doesn't work as well, and the doctor flags your prescription dispense-as-written (DAW), insurance will still punish you for getting the name brand.

With the economy, many people's prescription coverage has eroded over the past 3 years. So, what were once $10 co-pays for generics are now $25, and moderate brand names that were $30 are now $50. You can ask your doctor if she knows of any alternatives to Effexor that will still work well for your situation but are less expensive.

I swear, many doctors just prescribe the most popular, most recently advertised prescriptions floating through the air at the moment you happen to be in their office. It's like you say, "hey doc, I think I might be depressed." The doctor scratches his or her head, looks longingly into the distance and catches site of a stirrup cover sponsored by Zoloft, and says, "here, try this."

Consider making an appointment with a very good psychiatrist. They are usually more willing and able to try prescriptions with you in order to get it right. Takes time. Most health professionals recommend that you mix drug and talk therapy. Your talk therapist--unless he or she is MD--won't be able to prescribe. Depending on the state, most talk therapists have master's degrees in counseling, psychology, and social work, PhDs in psychology and counseling, or MD for psychiatry--although - these days- psychiatrists seem to focus mostly on medication management. That's been my experience anyway.

-- Edited by pollyjean23 on Sunday 31st of January 2010 11:01:49 AM

Kelly · Hermes

I'm on elavil, but I take a low dose (10mg/day right now) for pain, not depression. My health insurance right now is 100% crap so it doesn't help with prescriptions it until I hit my deductible, but when I was still on my parents' good insurance it was covered. It is much less expensive than yours though, so I don't know if that had anything to do with it.

Maybe you could call your doc's office and explain the situation and ask if there is a reason that she chose Effexor or if you can start out trying something less expensive. She might have just sort of chosen the brand out of a hat.

-- Edited by Kelly on Sunday 31st of January 2010 05:25:12 PM

KaffeeKlatsch · Marc Jacobs

Could you maybe request a list of covered prescriptions from your insurance company, and then check which of those your doctor thinks might work well for you?

Starstuff · Kenneth Cole

pollyjean23 wrote:

The doctor scratches his or her head, looks longingly into the distance and catches site of a stirrup cover sponsored by Zoloft, and says, "here, try this."

This is so funny!

I don't have anything else to add, except to ask your dr. for samples. If they are pushing the latest and "greatest" then they should have samples they can give you, which should buy you a couple of doses, at least. Good luck!

-- Edited by Starstuff on Sunday 31st of January 2010 10:46:19 PM

relrel · Marc Jacobs

leah_leanna wrote:

Could you maybe request a list of covered prescriptions from your insurance company, and then check which of those your doctor thinks might work well for you?

I agree with Leah, check your insurance's drug formulary and then talk with someone who can really tailor your symptoms with the best drug. The formulary will list what is covered and not covered and when generics are going to be given. But beware, just because it's covered doesn't make it cheap. You can also see what type of mental-health visits would be covered.

I know you didn't really ask this question, but I would caution you about taking an anti-depressant if not under the care of a psychiatrist or other specialist. Were you seeing your primary care doc? No offense to the, s/he might be the best doctor in the world, but Effexor has some pretty hard-core side effects (but to be fair, so do most anti-depressants).

Good luck with how you are feeling! Luckily I haven't had any issues with depression or anxiety but most of my patients have and I've seen what they are going through and it's pretty tough for some of them.

greendiamond · Marc Jacobs

Most insurance does cover them, but at what percent is a whol eother story. Try to get some detailed info from your insurer and then call your doctors office and see if there is a cheaper route to go that will still give you the effect you need. Sometimes doctors offices have samples, and you can look at the drug manufacturers web site for coupons to help you pay for their product. It may take some doing, but you should be able to pay less than $90/month through on means or another.

Good luck!

wetbandit42 · Marc Jacobs

Thank you so much ladies! I don't know why I didn't think to call my insurer. I went online and I don't think mental health services are covered, so I'll probably have to pay to see a psychiatrist out-of-pocket, but I'll double check on that too.

I'll try and get some samples, too. I don't know why my doctor didn't give me any - I should have maybe asked her for some.

Do you know if you can split time-released pills? I think the one I am on is time released, but I do know a lot of times it can be cheaper to get a higher dosage and split the pill in half, so I'll ask whichever psychiatrist I visit about that.

As for the generic, I don't know why they gave me generic at the pharmacy. Perhaps my doctor didn't specify a preference, but I have it on my record at the pharmacy that I want brand only, so I was mad when I realized it wasn't Effexor. I do not like nor do I trust generics.

pollyjean - I wrote therapist, but I meant psychiatrist. I don't know why I do this when I know they're different, but I use the terms interchangeably. And your observation about the doctor staring into space is too funny. smile

relrel - yep, she's my primary care doctor, which means I see her about once a year. I hate going to to doctor.

Kelly · Hermes

wetbandit42 wrote:

Do you know if you can split time-released pills? I think the one I am on is time released, but I do know a lot of times it can be cheaper to get a higher dosage and split the pill in half, so I'll ask whichever psychiatrist I visit about that.

I'm pretty sure you can't split time-release pills, because the way they make them time-released is by putting a special coating on the outside of the pill

wetbandit42 · Marc Jacobs

Thanks Kelly, that's what I thought.

Apparently, Venlafaxine ER is a brand name. Venlafaxine is also the generic name for Effexor, which makes this quite confusing. The makers of Venlafaxine ER apparently thought it was a good idea to use the generic name as their brand name. confuse

carmenb513 · Coach

leah_leanna wrote:

Could you maybe request a list of covered prescriptions from your insurance company, and then check which of those your doctor thinks might work well for you?

My thoughts exactly.... Also explore rxby mail w/ your insurance company.. Mine is always cheaper.

For example I use Tazorac on my face... It is $25 a tube at CVS... Mail order its $50 fot 3 tubes and they ship them to me at a time... Its going to take me FOREVER to go thru one tube so its very very cost effective.
They discount it because they get it directly from the "supplier"

carmenb513 · Coach

and by the way.... hope you get some relief soon :)

relrel · Marc Jacobs

wetbandit42 wrote:

Thanks Kelly, that's what I thought.

Apparently, Venlafaxine ER is a brand name. Venlafaxine is also the generic name for Effexor, which makes this quite confusing. The makers of Venlafaxine ER apparently thought it was a good idea to use the generic name as their brand name.

Careful, Venlafaxine ER is a generic form of the original branded medication, Effexor ER.

Venlafaxine (hydrochloride) is the drug's chemical name.

wetbandit42 · Marc Jacobs

relrel wrote:

wetbandit42 wrote:

Thanks Kelly, that's what I thought.

Apparently, Venlafaxine ER is a brand name. Venlafaxine is also the generic name for Effexor, which makes this quite confusing. The makers of Venlafaxine ER apparently thought it was a good idea to use the generic name as their brand name.

Careful, Venlafaxine ER is a generic form of the original branded medication, Effexor ER.
Venlafaxine (hydrochloride) is the drug's chemical name.

Oh, thanks relrel. Do you know why my pharmacy would have given me it? I have it on my record there that I want brand name only.

-- Edited by wetbandit42 on Tuesday 2nd of February 2010 05:48:05 PM

wetbandit42 · Marc Jacobs

Hmm, I found this on the internet:

Venlafaxine ER is considered a brand-name medication in national drug files.

Venlafaxine ER is used to treat depression and was launched in October 2008. The ER means extended release, so the medication slowly releases into the body over several hours. Venlafaxine ER contains the same active ingredient as Effexor XR, but in tablet form versus capsule form, which was enough of a difference for the Food and Drug Administration (FDA) to grant approval. The manufacturer of Venlafaxine ER launched their product using the generic name as the brand name. Venlafaxine is the generic name for Effexor, which adds to the confusion. The class overview below details all forms of Effexor and Venlafaxine.

I guess it is considered brand name, which is prob why my pharmacy gave it to me.

Aurora · Marc Jacobs

I was on that medication from October to December. It didn't work for me but I hope it works for you. I don't know the difference in our insurance coverages but I paid around $25 for the brand name. I was on the 37.5 and the 75mg. I filled at Walgreens.

I'm on Lexapro right now and it has made me better but I still cannot sleep and I get tired alot more than usual so I still don't think that is the right one for me. That one is $40 on my insurance for 10mg. I think it is newer so it costs more.

My therapist told me it takes time, patience, and switching around until you find the right one. So if this one doesn't work don't be afraid to switch. My doctor said 1 month should be enough to tell if it is going to work for you or not.

Effexor is time released so you can't split dosages especially with the way the capsule is. The Lexapro looks splittable but I haven't asked or tried to split it. It is more of a tablet with a split like on it. Those two medications are in two different classes so if Effexor doesn't work switch to a different class of antidepressants. Let me know if you want to talk any more about this stuff.

relrel · Marc Jacobs

wetbandit42 wrote:

Hmm, I found this on the internet:

Venlafaxine ER is considered a brand-name medication in national drug files.

Venlafaxine ER is used to treat depression and was launched in October 2008. The ER means extended release, so the medication slowly releases into the body over several hours. Venlafaxine ER contains the same active ingredient as Effexor XR, but in tablet form versus capsule form, which was enough of a difference for the Food and Drug Administration (FDA) to grant approval. The manufacturer of Venlafaxine ER launched their product using the generic name as the brand name. Venlafaxine is the generic name for Effexor, which adds to the confusion. The class overview below details all forms of Effexor and Venlafaxine.

I guess it is considered brand name, which is prob why my pharmacy gave it to me.

The medication that is in Venlafaxine ER is the generic form of the medication of Effexor ER. The only reason that it's not considered a true generic is because the way that it is taken (tablet versus capsule). The company that manufactures the V.ER got around the patent laws by putting the medication into a different form. Effexor ER's patent will run out this year which is when true generics will be able to come onto the market. However, the patent on the actual medication (the venlafaxine hydrochloride) ran out it 2008 which is how the company was able to manufacture it, but in a different form.

Whew, sorry. I just get really frustrated around drug patents and generics. The whole system is f*cked, but both ways: it works against both the original drug company and the companies that make generics. Ultimately, it's patients who are paying.

I'm just pissed, because you're getting screwed: you are being forced by your insurance company/drug store to take a generic form of the medication that you need and there's nothing that you can do about it because of the tablet/capsule shenanigans.

wetbandit42 · Marc Jacobs

Thanks relrel, I was really confused. You're not the only one who's pissed (although you understand it a lot more than I do!)! I really hate generic prescriptions, and I'm miffed that I have to take one for something as important as this.

Aurora - thanks! I started with 37.5 mg the first week, and this week I started 75 mg. So far I don't feel any different, but like you said, it can take a month or so. I'm sure I'll have some questions, so when I do, I'll definitely pm you!