“I mean, I get but… but you sure, dude?”

So, I haven’t made any secret about having what many would call “mental health struggles.” I don’t find this something to be ashamed or embarrassed about — if I had diabetes, I wouldn’t be embarrassed by using insulin. If I don’t have enough serotonin or dopamine, I’m not embarrassed by supplementing those, either.
Most medicine is pretty much fixing malfunctioning levels of various horrible meat fluids, whether they’re in the blood, pancreas, liver, or brain. The human body is a soggy box of horrors.

(Really, though, I’m not super fond of the euphemism “mental health struggles” either. I came out with funky brain stuff, and I’ll likely die with funky brain stuff regardless of how much therapy, medication, yoga, supplements, special diets, et cetera that I use. Rises and falls in this aren’t because I’m not struggling hard enough, or I’m losing some kind of struggle. Them’s just the breaks, you know?)

Anybutts, I’ve been using a very common SSRI for years to help blunt the worst of it, and it’s helped. The only trouble is, since it’s widely available in a generic form, I’ve been getting those generics. This isn’t a big deal, usually, except for every couple of months when I go to refill my medication.

Generics are generic because they can be produced by companies other than the brand owner, usually for a fraction of the price. This means that pharmacies can fill their generics from whichever manufacturer is currently cheapest (or at least not straight-up out of stock). As a result, if you use a common generic medication on an ongoing basis, you’re likely to get meds from a number of different manufacturers over time.

“But J., what’s the big deal? It’s all the same, right?”
Helas, it is not. Generics have to be bioequivalent to brand-name medications, but that’s it. The inactive ingredients (the stuff that actually dictates how fast the medication breaks down, and how quickly or how well your particular body absorbs it, et cetera) do not. This means there’s also no objective “best” generic, because everyone’s personal biochemistry reacts to these inactive ingredients in different ways. You wouldn’t want to give someone with celiac disease a pill that used wheat starch as a binding agent, for example.

This generally isn’t a big deal for most medical conditions, but it can be a very big deal for drugs to treat or mitigate mental illness. For example, my last bottle of pills came from Camber, whereas the one before was from Aurobindo. I had Lupin before that. Every time I get a refill from a different manufacturer, I have to go through an adjustment period. Sometimes, it’s easy. Sometimes, it’s not. Sometimes, it involves resigning myself to having terrible stomach pains, increased panic, or dangerous ideation for months and hoping I’ll get a different manufacturer on the next go-round. It’s not fun. It’s not helpful. It’s not safe.
For some reason, I hit a heavy, long, difficult period of what I call The Ennui shortly after I started taking Camber’s pills. This happens sometimes.

But this is going on seemingly forever. Flatness. Anhedonia. Withdrawing from life. Nothing seems to move the needle even a little bit. It’s not as if the medication isn’t doing anything — if that were the case, I’d be curled up terror-breathing with tetany. But whatever it is doing is Weird and Bad.

“But J., pills are unnatural anyway! Our ancestors didn’t have pharmaceuticals! Just do what they did!”
They fucking died, Sharon.
That’s what they did.

So, not exactly wishing to go the ancestral approach just yet, I call my doctor. No problem. This happens. It’s a thing. Generics are not all equivalent, and there isn’t really a way to go, “Hey, this manufacturer’s meds suck for me, and I need the ones from this one.” All you can do is get them from the actual brand name, consistently, so you don’t have to readjust every time you refill. Once you know how the brand name medication works for you, you can have some consistency. So, my doctor filled out a new prescription and designated it “brand medically necessary.”

And my health insurance (through United) doesn’t want to cover it.

This isn’t my first brush with this sort of thing. When I was diagnosed with pseudotumor cerebri (intracranial hypertension), I was referred to a neuro-ophthalmology specialist — someone who specializes entirely in the connection between the brain and eyesight, who’d know better than anyone what was going on.
And Blue Cross wouldn’t cover it, so I didn’t get to go. Would I have saved more of my vision had I been able to? Would I still have developed Charles Bonnet syndrome? I guess we’ll never know!

At this point, I’m not sure what else to do. A significant part of me is very close to calling United and saying, “Look, I understand. The brand name is way more expensive. However, in light of recent events… you sure, bro?”

If you’re in a similar position, you probably get it. A friend of mine who has experienced in the medical field recommended a service called SingleCare that’s a) highly rated, and b) able to help discount prescriptions and find the pharmacies with the lowest prices. They even help with brand name medication. Even with their help, the specific medication I need is still priced well out of my price range, but they can be a lifesaver for a huge number of other people.

Anyway, rant over. With luck, I’ll be able to get this sorted out. Otherwise, I guess I’m hanging on and desperately hoping that we’re back to Lupin or Aurobindo next time around.