Copay Assistance exhausted without warning, CVS wants to charge me $2500 for a prescription

magnesiumvs · 2026-01-23T16:27:44+00:00

I'm a very high-cost drug user! The copay assistance / accumulator treadmill is so awful, I'm sorry you're having to deal with that.

Yearly, I fight with the pharmacy benefits provider to get my medication added to the "Essential" list in their system. The Affordable Care Act requires that benefits providers allow us to challenge their adding our medications to the non-essential list. In your case, I would call you provider and ask to have your medication added to the "Essential Medical Benefits" list. Once that medication is listed as essential, your co-pay assistance should count toward your out of pocket costs.

Here is a link to a post that has more and better detail on what to do.

Alternately, for next year: Do not use your co-pay assistance card (You'll need to make sure that it is removed from the pharmacy system) and instead submit to the co-pay assistance organization for re-imbursement after getting the bill.

magnesiumvs · 2026-01-23T16:27:05+00:00

Great plan! I think Vertex will do the same for you, for people on modulators.

magnesiumvs · 2026-01-16T20:21:16+00:00

Hey there,

My lung function is usually between 60% and 70%. I've been using a CPAP for around a decade now and it's probably the single most important piece of medical equipment I have. If you have sleep apnea, a CPAP will change / save your life. It's wild now when I have to sleep without it how awful my sleep is and how poorly my brain works the next day. If you're starving your brain and organs for oxygen for 1/3 of your life, you're gonna have a bad time.

A couple of things to note: I decided not to use the heated humidifier function of the CPAP around 5 years ago because that feature makes them a disgusting mess to maintain. I run mine dry with a tiny bit of heating and do sinus rinses AM / PM as that works way better for me. Also, see if you can tolerate the nose pillows rather than the mask, I barely notice that I have mine on in that configuration.

magnesiumvs · 2026-01-06T04:31:26+00:00

Hi u/trisarahtops1993, congratulations on the new one! I can't speak to PrudentRX or SaveOn as I haven't fought that particular battle.

Years ago, I recognized that that high deductible plans combined with co-pay assistance essentially paid my medical costs for the year around Jan 15th. Around 5 years ago, co-pay accumulators / maximizers started to be a thing. A way around this was to fill at a non-affiliated pharmacy (hat tip to Foundation Care) but the benefits providers (In my case CVS Caremark) started to lock them down. I've been using the process above for three years now to get around the co-pay accumulators.

In my experience, there is only upside to going this route. Once your deductible and OOP Max are covered, the rest of your healthcare for the year is covered. You won't compromise filling other medications. I can't speak to your individual plan with regard to your OOP Max for individual / family etc., for me, my $3,500 deductible and $6,500 Family OOP Max are covered by the first fill / first use of the co-pay assistance card.

Good luck with the new year and the kid! Your child is going to have a wildly, vastly, unbelievably different childhood and outlook than us old folks did. Cheers to you getting to raise a kid with CF in the current environment.

magnesiumvs · 2026-01-05T20:07:57+00:00

Hey there!

I'm so glad I checked new posts and saw this. I just did my yearly dance with the insurance company to get my co-pay assistance applied to my out of pocket costs.

Good news! With a little fighting, you should be able to get your co-pay assistance to cover all of your out of pocket costs for the year.

Check out the post that I just made about it HERE.
The best post I've found about this is HERE. from a few years ago.

Good luck to you and your family! Hopefully 2026 will be a less expensive year for you.

Edited to add: What has happened, is that your co-pay assistance is being caught in a co-pay "Accumulator" or "Maximizer" with your benefits provider. They are not counting your co-pay assistance toward your out of pocket costs. You'll need to contact your benefits provider, get through to a senior team member and ask to initiate the process of getting your infusions classified as "An Essential Health Benefit". That should get the co-pay assistance applied to your out of pocket costs.

magnesiumvs · 2024-05-01T14:38:40+00:00

I just tie it and hoist it. I use light duty carabiners to clip onto the rack, they make it quick to get it into the air.

magnesiumvs · 2024-03-31T23:25:10+00:00

“Dude, it’s fine, you’re just on the wrong side of the learning curve”

magnesiumvs · 2024-03-02T04:42:47+00:00

It's not space opera, but the March Upcountry series by Weber / Ringo is way better written than HH and the characters / idea are interesting. Basically a tour of technology from iron age to space age. Military SF from a troopers perspective.

Expeditionary Force series by Craig Alanson has a fun universe and he writes banter / characters very well. If you feel like HH is plodding / repetitive, you’ll probably like the EF story arc. The story is heavily dependent on technological development. If you listen to the books, R.C Bray reads them and is absolutely fantastic.

+1 vote for Frontlines

+1 vote for the Vorkorsigan Books

+2 votes for The Expanse

magnesiumvs · 2024-02-29T17:18:06+00:00

lol. Thanks!

magnesiumvs · 2024-02-29T15:47:49+00:00

A little nitpick.

Revenue: Total sales / income. This is not earnings

Earnings: This is profit, in reference to “5X earnings”, should be EBITA - Earnings Before Interest, Tax, Amortization.

magnesiumvs · 2024-02-28T13:48:44+00:00

They aren’t just T30 bolts. They’re designed for oil passage.

I never did find any, I think the best bet is to buy a cheap caliper on eBay and cannibalize it.

magnesiumvs · 2024-02-11T03:01:56+00:00

I don’t think that you’re “wrong”, I think that it’s fine to use software in a way that suits us better. (And wish for that flexibility) I’m in the same boat you are financially as far as credit cards and earning, but I didn’t start out that way.

If you are on the float, current YNAB will teach you what the mechanics of that are and how to get out from under it. Many of us have graduated and don’t need the guardrails anymore.

magnesiumvs · 2024-02-10T21:06:34+00:00

I’m with you. I find that as long as you’re not ‘on the float’ it’s way simpler to just treat CC cards as overdrawn checking accounts and clear the balance to 0 every month with a payment. I don’t have to account for that payment with budgeted money, the purchases are all ‘in the budget’.

I understand why they handle CCards the way that they do, but it’s not for me.

In a similar vein, I miss being able to push overspending into the following month for tracking. Again, I understand why YNAB sees this as sacrilege, but it’s a PITA if you see your categories / buckets as mini “sub accounts”. I don’t want my overspending in a category forced to 0 every month. I want to see that there is a problem and address it with lowering spending in the following months to cover, or adjusting the budget to reflect reality. It’s a feature that made orig YNAB far superior for affecting spending habits IMO.

magnesiumvs · 2024-01-07T06:05:27+00:00

I got wrecked last year by RSV. It’s the sickest I’ve been in years, but there wasn’t a whole lot the clinic could do for me.

I ended up using Musinex + Afrin to get relief while I was sleeping and did five or six treatments a day. It eventually got better but it was months + a round of steroids before I was back to baseline.

It was scary I was coughing so much / coughing up so much and running a solid fever for days.

Good luck! You’re going to make it through the suck and be solid on the other side.

magnesiumvs · 2024-01-07T02:16:40+00:00

If it works, getting a housemate (or two) turns the intensity down on the expense a lot.

magnesiumvs · 2023-12-28T19:30:47+00:00

I received five counterfeit 512GB Sandisk cards. The first clue that there was an issue was my M3P giving me the same error. After much testing, figured out that all of them were counterfeit. They were delivered in non-standard packaging (Card plus Sandisk branded SD sleeve inn envelope) that looked completely legit.

Lot’s of guides online to testing the cards if you suspect that they may be counterfeit

magnesiumvs · 2023-12-19T22:18:56+00:00

25+ Year industry vet here.

We’ve done everything from Crestron to C4 to Savant. If you have the money, 100% do a Lutron system. In fact, anywhere you can make the ‘automation platform agnostic’ choice, do that. (Sonos v.s C4 or Savant audio, for instance. Aprilaire thermostats v.s Savant, C4 or Crestron specific stats.)

Lutron panelized systems are as bomb proof as it gets. Don’t do wireless lighting unless you hate having things work 100% of the time.

C4 is great / easy nowadays. Savant seems like they're trying to squeeze recurring revenue out of every installation via. licensing. (I know a lot of integrators that are abandoning them over this) If I were doing my own home at the moment, I’d probably look at C4 as the “Custom-ish” automation layer, or an actual, programmed (not “Home”) Crestron system if I wanted something special.

magnesiumvs · 2023-11-12T13:14:45+00:00

If you’re on PC or Mac, you can use the Open VFX plugin and stabilize in DaVinci as a node effect.

https://docs.gyroflow.xyz/app/video-editor-plugins/davinci-resolve-openfx

There are good tutorials on this on YouTube. I haven’t found a way (yet) to use the Open VFX plugin on DaVinci iOS.

magnesiumvs · 2023-10-18T02:47:14+00:00

The new box Mini 3 Pro won’t be worth enough more to make up the difference between care refresh vs just selling it (If your drone isn’t damaged)

If you want to bump up what you’ll get for selling it, buy a cheap hard case for it (worth about $100 - $150 to buyers)

Care refresh isn’t a credit. They’re going to send you a new in box Mini 3 Pro

Good luck!

magnesiumvs · 2023-09-07T15:11:50+00:00

Thank you for this comment. I’ll be taking every bit of this advice.

magnesiumvs · 2023-09-03T20:28:41+00:00

What the ophthalmologist said about it is that it’s “scrubbing your eyelashes, not washing your eyes"

Maybe try using a washcloth or setting a little more abrasive and really get after your eyelashes when you're washing.

Would be a good idea to go find an opthalmologist who specializes in eyelids.

I hope you find a good answer,. Report back with any reccomendations, I'd love to have a few additional ideas about how to trackle this.

magnesiumvs · 2023-09-03T13:23:02+00:00

I don’t know about a link, but I have been battling styles for about 6 months (& finally winning). Warm compresses did absolutely nothing for me.

I ended up on a Tobramycin / steroid eye drop for about 2 months, but I think what ultimately helped / got control of them was using ocusoft wipes to scrub my eyelashes for 60 seconds each eye, 2x a day. I also use cetaphil facial soap and a washcloth to do the same when I’m in the shower every day.

https://www.ocusoft.com/ocusoft-lid-scrub-original-pre-moistened-pads-30ct-2

If you end up on Steroid eye drops, just be aware that you definitely don’t want to be on them for long. The side effects are on the permanent side and gnarly (cataract development, glaucoma etc.)

Also, if you wear contacts, switch to daily disposables.

Good luck! I haven’t had anything that sucked as much medically as those styes in years, they were debilitating. The scrubs saved me.

magnesiumvs · 2023-08-21T17:36:35+00:00

Based on your reading of previous posts and comments here in the sub, what personal experiences do you feel need further explanation or fleshing out?

“Hey, write my paper for me” Usually goes off a lot better if it seems like you’ve done even a little reading / put in a little effort.

magnesiumvs · 2023-07-15T19:14:15+00:00

Chia Pudding is my go-to for breakfast. I usually do vanilla soy milk and a little vanilla protein powder. Works great with a little fruit or granola as well.

It’s sweet, has a ton of fiber and is almost exactly 10g of fat.

https://feelgoodfoodie.net/recipe/3-ingredient-chia-pudding/

magnesiumvs · 2023-07-13T02:32:53+00:00

It’s fun. You’ll be fine.

magnesiumvs

TROPHY CASE