In order to manage my ADHD symptoms, I take methylphenidate daily. My medication helps me to slow down the chaos inside my mind and provides me with the ability to kind of feel normal for a few hours a day. My ADHD devil is mostly an expert in overthinking, making everything I do extremely complicated and without my medication I would go crazy by the chaos inside my own mind, by the never ending dialogue of doubts and distractions that is able to hold me back on everything I want to do.
My methylphenidate is important to me, without it I would drown inside my own mind the way I used to when I was younger. Unfortunately, not everyone sees the importance of my medication, for the pharmaceutical industry, the government and the pharmacies pills are money. It turns out money is more important than the goal of their business, it turns out medication is no more than a pay-check instead of something that is there to make people feel good and this has been causing me a lot of stress in the past six months.
Keep Health Affordable
I live in the Netherlands, where everyone is obliged to have health insurance which should result in “free” health care for everyone. We don’t pay for doctor visits or most of our medication, instead, we all pay over €100,- each month to cover most of our health expenses and usually this system works very well. Knowing that whatever happens to me won’t harm my savings account, knowing that I am taken care of provides a lot of security, something less to worry about.
However, slowly over the past years, things are changing resulting in more and more rules regarding health expenses. It turns out the medical world is in a bit of a financial struggle and in order to keep health insurance affordable for everyone, health care has to become as cheap as possible. As a result, contracts and rules appeared, making sure that only the lowest price of care will be covered by insurance companies, or so they say..
Different Recipes for One Pill
In reality, covered medical care is not truly about the lowest price, instead, the whole system of health has become a strange network of secret contracts between insurance companies, pharmacies, care givers, the pharmaceutical industry and the government. You might think there is nothing wrong with these contract, you might believe I should not complain but instead be happy with the luxury of being insured, however, for me, all these contracts prevent me from getting the medication I truly need each day. Methylphenidate is produced by many different companies that all have their own recipe for this ADHD pill. They all contain the same crucial chemical, however, the rest of the stuff inside the pills is different for each company.
The first time I discovered this was about two years ago, when my pharmacy switched the brand of my pills from Mylan to Sandoz. At first I did not see any harm in this, I did not even think about it and I just took this new brand in the same way I used to take the previous one. But about a month later, I found myself in a state of complete restlessness, like I had 10 cups of coffee every morning, my hearth was beating like crazy, I was anxious and nervous all the time and there was just too much strange energy inside me to keep my focus on anything. I felt terrible.
After contact with my doctor and pharmacy I found out how different the two pills had been. Yes, they both contained the same amount of methylphenidate, however, all the other, but crucial, chemicals inside the two pills differed. It turned out that the two different pills work completely different when it comes to duration of the effect and the dosage per hour, that are determined by the side-chemicals inside the pills.
The rule regarding the effect of medication says that the amount of active and available methylphenidate per time unit should be between 80 to 125% of the original, Ritalin. But I am not used to Ritalin, instead, I’m used to a pill that is somewhere within this deviation, meaning, that a change of pills will not lead to a maximum of -20% or + 25%, instead, the difference between two generic pills can be as big as 45%, something which is way too big to call it a similar pill if you ask me.
Fighting For My Medication
Two years ago I was able to convince my pharmacy, doctor and insurance that Sandoz was just not the pill for me, with blood pressure and hearth rate as clear proof. I even remember the shock of all of them once they found out what a change in brand of medication was able to do to a person, shocked by the extreme difference in ingredients of the two pills. Health care acknowledged that the two brands produce two completely different pills and I was allowed to stick to the one that works for me.
But 2020 came and rules and contracts got even more vague and strict. As a result, my brand of methylphenidate is no longer covered by my insurance, or actually, my insurance will only cover my medication when they pharmacy agrees on giving me there pills, whole the pharmacy will only give me the brand I need when my doctor prescribes them, however, a prescription including a brand name, provided by my doctor, is not enough to cover the medication I need.
I have no one to blame, since they all blame each other and no company wants to take responsibility and they only way to get the medication I need, is to pay for it myself, something that makes me furious. I pay €145,- every month to be free of other medical expenses, and most of my life, my only expense has been my medication. But since January, I have to pay another €25,- each month for the one thing I am paying my health insurance for and this makes me extremely angry. Why do I pay €1.750,- a year for my health if this does not even provide me with what I need to stay healthy?
All of this frustration made me curious about the costs of my medication, curious to find out how much money it will cost my insurance to provide me with what I really need. However, this search is when my true anger towards the modern medical world started. It turns out that the brand that I’m supposed to take is actually more expensive than the brand that makes me feel good. A pill of Sandoz costs €0.06,- while Mylan is only €0.05,-, 17% cheaper for the pharmacy, which turns out to make a good amount of money when I pay for my medication myself.
Politics is what is going on here. I believe health care in the Netherlands has become too much about agreements and contracts. Maybe pharmacies get a bonus for every million Sandoz pill they give away, maybe the government gets part of the profit from Sandoz or maybe they are just really good friends. I don’t know what is going on here, but whatever keeps me from getting the medication I need is something that does not at all consider wellbeing or honesty but instead there seems to be some hidden profit that is more important than anything.
After months of phone calls leading nowhere, months of listening how everyone blames the other company while all of them understood me but were just unable to help me. I started calling all the pharmacies in the city I live in to figure out if there was one that could provide me with the medication I need. Unfortunately, Sandoz turns out to have taken over the city, having contracts with almost every pharmacy I could find, while the brand I prefer might soon go bankrupt since there is not one pharmacy that contracted them.
Luckily I found 1 pharmacy just 15 minutes away, that does not force me to take the brand that harms me, instead, they have a brand I have never tried before but seems to come close to the brand I used to take. I picked up their medication without paying and I will start taking them from today, hoping that everything will turn out fine and I have found what I need, until everything will change again in 2021.
Medicine Should Be About Health
This whole thing frustrates me, it makes me feel powerless in a fight that’s needed for my own health. I feel unheard, I feel that money and rules are going way too far in this world and I get angry about how unimportant well being seems to be for the medical world. I really hope that the methylphenidate I have now will make an end to this exhausting fight, however, it is scary to put my own mental health on the line for this. I shouldn’t have to.
I understand that we all should make buts where possible, I believe it is a good things id we all try to keep the costs of health care down and I am completely open to do so, to try. However, I believe there should be boundaries, there should be room for exceptions. Every person on this planet is different, making it impossible for care to be uniform, we are far from similar and there is nothing that could work for everyone in the same way. We should not spend more money than needed, however, we should acknowledge that sometimes it is needed to spend more for one person compared to the average. Health should always be the main priority and exceptions should be allowed when they are truly needed.