Costs of Biologics | Arthritis Information


We are going thru the process of getting new insurance at our work place and a discussion came up regarding what plans cover biologics the best.  A rather sad discussion came to this:

How many out there are on biologics and how many would like to be on biologics but can't afford the costs because your insurance (or lack of) does not cover and does not cover enough of the costs?
I am on Humira, they have a patient assistance card. It had been covering the cost of my copay... basically 100 bucks. Last time Iused it though it only covered 50 bucks. If I could get by without taking Humira I would. I think the cost is just ridiculous.I'm on Enbrel and it's covered under our plan, with a .00/month copay and I feel very lucky that we're still copay and not coinsurance.I've been on Remicade since Mar 08, My insurance is BCBS the RD assured me that it would be covered. well they still haven't paid for any of the treatments! The Rd office said 3 months ago that when the insurance company was out of state that it takes longer to process. The insurance kept telling us the Rd needed to send more info.
 The Rd office is not asking for any payments as of yet. I called BCBS 2 weeks ago, they said we should know something in 2 weeks,well we haven't heard anything yet......

I'm really pissed off that the Rd office assured me that this would be covered, had it not been I would had not got the infusions. has this happened to anyone else??????
I have BCBS and they cover my Enbrel.  Jan, it's probably just red tape that's holding it all up.Sure hope you don't get some surprise bill from your doctors office Janiee.
When I was on Humira for two years I just paid 35$ a month. I had to stop for a year and when I went back on the pharmacy said "0 co-pay!" I said "WHAT?!?" My insurance increased the amount of co-pay on injectable medications like Humira. Luckily I also got the Humira assistance plan too and for 6 months it's nothing and the next 6 months is . Then I'll be back at 0 I'll have to cover myself. All in all I guess it's a bargin; but it's really high and I wouldn't want to be on it unless I really had to be. It makes my quality of life so much better so I'll find a way to pay the extra 0 a month. Much higher though and I wouldn't be able to do it.
I have been on Humira for several years and my insurance pays for all.  Copay was every 3 months, now it is every 3 months.  It is all thu the mail-more money a local pharm.  Frankly when I heard the price years ago, I just laughed and said "Yeah" never thinking the insurance company would approve it.  I am not sure it is really necssary but I have not stopped the stuff so I might see a huge difference if that happens.   The cost is redicious and if I the ins company did not pay for it--I would not be on it.   I am on Orencia.  My copay is 0 but I do have supplemental insurance to pick up some of it.  They will cover 2800 a year.  So, since I get it monthly, I still have a hefty copay.I have a Healthnet HMO that covers all my Humira costs - no copay.  I'm not sure why as the Leflumonide (generic Arava) copay is a month...but I'm not complaining!
Rebecca, if you have private insurance, contact Bristol Myers Squibb about their Commence Orencia program where they reimburse you for the copay.  It doesn't apply if you have medicare/medicaid or no insurance.  Edited to add: Here's the link:
I have BCBS PPO (which plan makes a big difference) and biologics are covered.  If I recall correctly, Enbrel cost me about /mo (4 doses).  Orencia costs me 0/mo (1 dose), but as I said above, the mfr is reimbursing that amount.  Rituxan cost me 0/dose.  That doesn't include infusion costs which were high in the hospital but only for a visiting nurse to do it at home.
InnerGlow2008-08-24 09:44:32[QUOTE=Linncn]I have BCBS and they cover my Enbrel.  Jan, it's probably just red tape that's holding it all up.[/QUOTE]
I'm praying that's what it is! So far the total is .000 I will not be getting any more infusions til this is settled. another thing is my insurance has changed and now have to get pre-approved again!
I get a 3 month supply (12 weekly shots) of Humira for .  If I took a biologic that was IV infused, I would pay nothing, BCBS would pay for it.

I have  BCBS for Medicare coverage and the biologics are out of sight.  I would have to pay 35% copay for some and 50% for others.  They have turned me down twice for meds for kidney disease and my nephrologist doc helped me to appeal and we lost.  They told me their guideline for med coverage is the same as Plan D but i'm not so sure about that.  I tried to switch over to regular Blue Cross and would get a separate Plan D some place else, but was turned down because of prior conditions.  You can't win sometimes.

so far, they've covered all but for every two months supply of enbrel..that's 8 shots.. I'm fearful that someday it (or another biologic) may not be available to me..
I feel for those of you who have to pay so much...

I am on Enbrel and they have a quick assist program that combined with my insurance allows me to only pay every 3 months.

I was given an card from my rd who got it from manufacturer. Humira and enbrel. Doesn't cost me anything,  yet. I quit taking humira after 8 months because it wasn't working. I have been on enbrel since Dec. and so far I don't pay anything. It's supposed to last a year. After that it will be 20% and I don't know how I will afford it. It would be 370.00 a month. I'll cross that bridge when I get to it. It's insane how much they charge for meds. Should be a law against it. Maybe someday.Enbrel co-pays have changed over the years for me - from 3000/yr to 30/month, now its changing back again to 200/month.
How many folks out there would be on biologics if they were covered are covered and affordable?
It seems the healthcare debate needs to be a bit more detailed.  Its more than just who has ins and who doesn't, its also about who has it and what, if anything, does it cover!
Ugh!  I just had to chime in on this one!  My co-pay for Enbrel is 9/month (for 4 injections)!!!  I didn't know about the co-pay assistance all of last year, so my monthly total for meds was coming up to almost 0 a month.  I'm glad I finally mentioned to my RD that the cost was really a struggle.  Thank doG for the Enbrel Quick Assist program!  I'm relieved to hear that most insurance carriers have much better coverage (since I'm looking for another job) and I'm also relieved to hear that the other biologics have assist programs (since Enbrel seems to have stopped working for me). 
In regard to Enbrel apparently not working for my anymore; I'm sure some/many of you have experience switching to a different biologic.  Any comments on how successful you have been in switching to a new biologic after the first one stopped working?
I started with enbrel 18 mo, switched to remicade  for 5 years, switched to humira 18 months ago. I recently went to weekly injections on the humira. So far I have had great luck at the start and then they just peter out. I think the dose on the humira had to be bumped because bad liver stats made me stop arava. At least that is what I'm telling myself.Fortunately we have Tricare for Life, which is retired military health insurance and I have Medicare which is primary and Tricare is secondary.  All of my prescriptions are covered under Tricare.  I didn't have to get Medicare Part D. At this point in time my monthly copay for Humira is .00.  I'm really suspicious that this could change at anytime.  Am always waiting for a letter from Tricare.   When we retired we thought we had all of our expenses budgeted but if Tricare changes and I have to pay a large copay then that will change our retirement budget drastically.  Lindy