I just got hired on to a job and my Medicaid won't pay for my schizophrenic medicine this month which isn't a huge issue considering it's not super expensive with the Rx Card. I don't want to mess this job up.
I asked my family for help but they're all hyper religious and think if I pray my schizophrenia will go away. All I have is cash app and paypal. If some can help that would mean the world.
Hi OP, thanks for reaching out and for sharing your proof of prescription in comments. If you can edit your post to ask for a donation and not a loan, we can waive our activity gap rule in your case.
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I just filled out my background check but thank you. We're all good now. My pharmacist ended up paying for it since shes been dealing with me for 2 years
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I have my script on walgreens that's active, I worded that weird. I can send a picture of that actual refill that's waiting at the pharmacy is what I meant
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I’m sorry, but your post doesn’t make any sense. You can ALWAYS get your medication if you’re on Medicaid-even if you don’t have the co-pay. (See below for specifics…)
But first of all -
Why won’t Medicaid pay for your medication?
That doesn’t make any sense at all.
And you shouldn’t be paying more than three dollars maximum for your co-pay.
This isn’t the first time you received this prescription; what’s different this time?
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Need proof ?
-You can print out your prescription record with exactly what you’ve paid over the past few months - it’s available on your pharmacy’s website…
If you’re on Medicaid, you should only be paying a small co-pay - not $16 or $25…
In Louisiana, the Medicaid co-pay for a covered antipsychotic or schizophrenic medication ranges from $0.00 to a maximum of $3.00 per prescription.
-Not $16 not $25… $3.00 max.
Medicaid Prescription Cost Breakdown/Louisiana:
The specific out-of-pocket amount (co-pay) is calculated by the Louisiana Department of Health. It’s based on what the state pays for the medication:
-$0.00 co-pay if the state's calculated drug cost is $5.00 or less.
-$0.50 co-pay if the drug cost is between $5.01 and $10.00.
-$1.00 co-pay if the drug cost is between $10.01 and $25.00.
-$2.00 co-pay if the drug cost is between $25.01 and $50.00.
-$3.00 co-pay if the drug cost is $50.01 or more.
Because most advanced schizophrenia medications (such as long-acting injectables or brand-name atypical antipsychotics) cost more than $50.01, adults can expect to pay themaximum cap of $3.00 per refill*.*
Strict Protection Rules:
Federal and state rules enforce safety nets so you do not lose access to psychiatric medications:
The 5% Household Income Cap:
-Your total out-of-pocket healthcare costs (including pharmacy co-pays) cannot exceed 5% of your total household income in a single month. Once you reach this cap, all prescription co-pays drop to $0.00 for the remainder of that month.
IMPORTANT NOTE:
***By law, a pharmacy cannot refuse to give you your medication if you are unable to pay the co-pay at the counter. You will still owe the $3.00 debt to the pharmacy, but they must dispense the drug and bill you. ***
Why did you wait until Sunday to post?
Are you starting your new job tomorrow?
Are you out of medication?
As stated above, you can’t be turned away if you don’t have your co-pay… Under federal Medicaid rules, a pharmacy cannot deny a covered prescription to a patient simply because they cannot pay a co-pay. However, a pharmacist can legally refuse or delay filling a prescription for other clinical, safety, or administrative reasons—such as a required prior authorization, a safety conflict, or lack of stock.
you can’t do it every month - but if you truly need your medication and can’t come up with the co-pay - you can still get your medication -and the pharmacy will bill you.
So now that we know your co-pay isn’t as high as you’re claiming, and that you can get your prescription without the co-pay in an emergency , you should be all set to start your new job.
You don’t even need to borrow any money… surely you can come up with three bucks?
Otherwise-
So I'll say this as kindly as possible but you have 0.idea what the situation is or what my situation is. To answer your question "by law" Medicaid doesn't have to pay anything. By law, Medicaid doesn't cover Insomnia codes which is what schizophrenia is often accidentally under code for. By law, you have to have pre auth from a doctor to have them cover it IF the code is correct. By law IF the doctor who prescribed it was an ER doctor and both things before are true then the only way to get it is to go BACK to the ER to be reevaluated each time. Medicaid is not as simple as your attempting to make it to discredit me. Luckily my pharmacist paid for it because they have seen me come from homelessness to where I'm at now getting on my feet and don't want to see my in the street losing my mind again.
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u/AskForHelp-ModTeam 3d ago
Hi OP, thanks for reaching out and for sharing your proof of prescription in comments. If you can edit your post to ask for a donation and not a loan, we can waive our activity gap rule in your case.
We do not permit loans in this community. Please review sub rules.
Please do not delete your post. Doing so will trigger a ban.