Medication frustration 7

A heartbeat monitor with heart beat peaks before and after a heart drawn in the same red line.
A heartbeat monitor with heart beat peaks before and after a heart drawn in the same red line.

I started Latuda a little over a month ago.  Pretty much from the first day it worked.  I have been very stable this past month!  I think I’ve only been suicidal once!  And my anxiety is down, too.  Latuda is one of the three medications approved to treat Bipolar depression.  The other two work, but give me a voracious appetite that is not controllable.

The Latuda is not without side effects, though.  I only get about 6-8 awake hours a day.  But they are good hours!  They are hours where I can think and do things, and not be paralyzed by my depression and anxiety.  It’s an OK tradeoff for me– stability for 6-8 hrs a day and a lot of sleeping is much better than unstable for 12 hours a day (the amount of awake time I had before Latuda).

My psychiatrist gave me samples of Latuda for the first month.  20 mg samples.  The bad nurse practitioner gave me samples, too, but they were out of 20 mg samples.  They only had 40 mg samples.  The nurse practitioner told me to cut them in half, but I looked it up online and you aren’t supposed to cut them.  When I complained to my psychiatrist, he called in a prescription for 20 mg Latuda to my pharmacy.

I went to pick it up today and found out that my insurance does not cover it!  The pharmacy had contacted my doctor to see if they could do a prior authorization for it.  I called my psychiatrist as soon as I got home to tell him about the prior authorization need, but he never called me back.

So I looked it up online.  How expensive could a month’s worth of Latuda be?  Well, turns out it is $1200 a month on  That’s the cheapest price.  That is more than we take in a month from SSI, total!

Next I researched the patient assistance programs.  The company that makes Latuda has two programs for financial assistance.  I don’t qualify for either of them because I am on medicaid.

Finally, I looked Latuda up in my insurance’s formulary.  The have preferred and non preferred prescriptions that they cover.  Well, Latuda isn’t on the formulary at ALL!  They just flat out say they don’t cover it!

I’m still hopeful that my psychiatrist will do a prior authorization, and that insurance will pay for it.  But my crazy mind goes to the what-ifs.  If it’s not covered, what should I do?  I don’t think there is any way I could afford $1200 a month for the rest of my life!  But so far it is one of the VERY few meds that have worked for my bipolar disorder (out of about 30 medications tried).  There are three others that have worked in the past.

First the two approved for bipolar depression, zyprexa and seroquel.  They make me fat and hungry.  The other is Lamictal, which gave me Stevens-Johnsons’ Syndrome (life threatening rash of the mucous membranes).  I am so happy to have found something that works!  Even if it only gives me 6-8 hrs a day.  

In the meantime, I have the 40 mg samples.  I have asked my psychiatrist what to do about them, as I am out of the 20 mg samples.  But of course he hasn’t told me yet.  So I am just taking the 40s that I have.  

So does anyone have any advice on how I can think and plan about this?  Is there any way that anyone knows how I could get Latuda at a cheaper price?  Or any tricks to getting my insurance to cover a med not in the formulary at all?  There is no generic version.  

Leave a Reply

7 thoughts on “Medication frustration

  • Kathy Hays

    I just did a search of “latuda not covered by insurance” and found this web page. You qualify as far as income is concerned. I hope this can help. They say it’s $50 a month.

    I also tried Latuda. I don’t know if it would have worked for me as I had to stop because I’m allergic to it. I’m glad you’ve found something that works.

  • Team Blue

    fight for the prior auth. be a GIANT pest. had to do things like this in CT. appeal, appeal, appeal with Medicaid too, and if there’s any way to throw a patient advocate into this to help you with it, grab one. also, there should be a Medicaid hotline, and I would call them also just to find out if maybe the doc shows that nothing else has been successful they will cover it because you have no other med options.

    here’s directly from the Latuda site. if Medicaid is not paying for it you actually CAN do the patient assistance thing.
    “Offer not valid if prescription is paid in part or full by any state or federally funded health care program, including but not limited to Medicare, Medicaid, VA, DOD or TRICARE, or where prohibited by law”
    so if Medicaid is completely NOT going to pay for it, you CAN pursue this.

  • CJ

    Veronica, have you considered contacting you congressperson? They are there to help people in situations like yours. I know you can advocate for yourself!

  • Veronica Morris Post author

    Thanks for all the support and advice everyone! My doctor was able to convince the insurance people that with my medication history, a prior authorization was warranted. It was approved for a year! I am very excited!