OK,
I'm freaking out here. I just called to check on my portion of
the meds out of curiosity before my dr. appt next week. OMG, I'm
in a state of shock. My monthly portion will be about 0.00,
thats just for Enbrel or Humira. How does everyone do it?
I'm really scared, I just bought a house Sept 1, 2006 and just got
diagnosed Oct 9, 2006.
I need some ideas
Phatgirl2
Don't panic yet. Who did you call--your pharmacy or your insurance company? Who is your insurance carrier? Have you talked to your carrier about their mail order system? Mine would have been 0 if I'd gotten it from the pharmacy. But many large insurance companies have a mail order system. That's what you need! The same meds only cost me every three months. So what insurance do you have?If your RX benefit has a mail order (or internet order) I think you will be pleased by the huge price difference.try looking up the Encourage Foundation...they paid for my enbrel..and delivered it to my door every month....
I called my Rx, Express Scripts. She wasn't sure about mail order. The 1.00 cost is my 20%. I'm just so shocked about the cost. I do have a cap of 2500.00, which is good. I knew it was expensive, but I wasn't prepared for the cost. I will look up the encourage foundation, see if they can help me. Someone also told me to check with the Social worker who works with that Dr. If anyone has any other ideas, let me know.
Thanks, Phatgirl2
You need to call your insurance company. They contract with Express Scripts. My insurance contracts with Express Scripts for mail order and I don't pay anything for my prescriptions except postage. Express Scripts should be able to give you an answer. No answer isn't acceptable.Linda B is absolutely correct! Call your insurance company--not Express Scripts. They just send the drugs for your insurance company. And their answer was unacceptable.Thank you for the suggestions. I will keep digging. I can't imagine RX being that expensive month after month. I do have a cap on my RX cost, but I'll be broke before I ever get there. I will call my insurance co tomorrow and see what they say. Thanks for the ideas! I will also check the encourage foundation.
Phatgirl2
My doc gives me a card from Abbot (the company that makes Humira) that pays 0 of the medication and/or covers your co-pay on your insurance to 0.00. He gives me a new card when I reach my maximum. You have to take a quick survey (the same one you take when you go to the RA) but it is well worth it. There have been times when we have not had the money for our co-pay and that card saved my butt and I was able to get my Humira.Just a quick update.....I called again and double checked on my Enbrel or Humeria. It is a "tier 3" med, which means my cost is 20% of the cost of the med. My monthly cost will be between 0-300.00. I work for a hospital too! I'm so surprised that the meds are that high and that my insurance won't cover more. I am going to check other places, RX assistance programs, etc, to see if they can help.
the mail order program was not much better, i can get the monthly med for right under 0.00. So, I'll keep looking. If anyone else has any ideas, let me know.
Phatgirl2
Does anyone know why these meds are so dang expensive??My mail order option for the high tier drugs is very good - I pay 125 for a 3 month supply of most things. My co-pay at walgreens for 1 mo supply was 150. Can't believe your hospital didn't get a mail order plan... Those plans offer great savings because of the huge qty price break they get direct from the drug companies.
Express Scripts mailed me Enbrel for 125 when I was on that (3 month supply)
Take a look at http://www.expressscripts.com/
You will need to set up a login that id's your plan. They have a tool that will price your drug mail order - 3 month supply or 1 month at a store
Hard to believe your not getting good info by your calls...
By the way, my insurance was not a very good one but getting Enbrel through them was for a 3 months supply using Express Scripts. I would think that your insurance has something in place. I had to go on Enbrel because my insurance didn't adequately cover Remicade. You might ask for each of the medicines that the doctor is thinking of trying you on.
Deanna,
Thank you for the links. I am going to check there next. I'm not giving up. I have called express scripts twice and my insurance co once. The insurance co said they don't do anything with RX, because it is thru express scripts. Express Scripts said they use another company for mail order because they are injections. So, I called them too. I have talked to three different people and they have all given me quotes of over 0.00. I'm not giving up though, I will find a way.
Marian, Thanks for the website link. I have already been on there and they won't even quote you a price, you have to call them. I've done that twice. So, I'll keep you informed if I learn anything else. i'm just so surprised the meds are that expensive and that my insurance is so yucky. The good thing is that I have a cap on my out of pocket expense, but it's 2250.00, better than nothing.
Thanks guys and gals!
Phatgirl2
I am really annoyed with ins lately... they are such experts at ducking honest claims. You have to be a rocket scientist to foresee what they are likely to do to you. It sounds like they may be quoting you the mail order price 0- but then it should be a 3 month supply not 1 month (works out to .per month). That isn't so bad.
My friends husband has been dx with melonoma. (This is a deadly skin cancer) He is at stage 3c - very bad - spread to his lymph system. He is under going chemo this month in his DR office - 5 times a week with a office co-pay of . That's 700 for this month alone - there is no limit on office co-pays. Plus he will be charged 10% of the cost of medication until he hits 1000 dollar out of pocket limit. The 1000 part starts over Jan 1. Bill for this months treatment will be ,700.
We thought we had great insurance.... we do unless you get sick
I'm sorry to hear about your husband. I hope he feels better soon. Gosh, his co-pay is high too. That's just it, we all think we have good insurance until we need it.
I wish that quote was for 3 months, but it's not. It was Enbrel 50mg for 4 syringes, which is one a week if I understand it correctly. I think that is just a month's supply. I keep trying to find the silver lining in this, but I can't.
Phatgirl2
It just sucks that insurance companies are sucking people dry just for meds that can either prevent people from dying or to help people live as normal of a life as possible. It is pathetic that CEO's of drug and insurance companies profit off of the sick and dying. How can they possibly sleep at night? Oh, I know, they have no concious and can sleep while we are lucky to sleep at all and lucky to be able to go to sleep pain free or at least in less pain.
I think they should limp a mile in our shoes and wonder every day where we can trim our budget more and feel the pain we feel when we have to deny our kids something they want or in many cases something they need just so we can pay for our meds so we can be capable of going to work and taking care of our families.
Every time anyone lobbies the politicians of their state they get shot down in flames because of the drug and insurance companies paying the politicians (and they do this legally they just call it lobbying I call it bribery) to kill any health insurance act trying to be passed that would decrease their profits.
What are people and this world coming to???
I know what you are going through. I should be on Humira but can't afford the 20% copay of 0.00. I tried for financial assistance with Abbott Manufacturing but get this my husband makes too much money. They fail to realize that we have 2 kids (one in college) we pay 0.00 insurance premium a month and then I have to pay 0.00 a month in co pays for my meds I take now. Plus a mortgage etc etc etc. I have worked for months. I haven't paid in enough for disability.
My doc is sending me a card that is supposed to help with copay but I wonder if it is from Abbott if so I am so screwed.
Today I got a box from Fed Ex with the sharpie container. I called my mom and told her and all we can do was laugh about it. If I don't I will cry......
c
[QUOTE=Phatgirl2]Just a quick update.....I called again and double checked on my Enbrel or Humeria. It is a "tier 3" med, which means my cost is 20% of the cost of the med. My monthly cost will be between 0-300.00. I work for a hospital too! I'm so surprised that the meds are that high and that my insurance won't cover more. I am going to check other places, RX assistance programs, etc, to see if they can help.
the mail order program was not much better, i can get the monthly med for right under 0.00. So, I'll keep looking. If anyone else has any ideas, let me know.
Phatgirl2
[/QUOTE]
I work for a hosptial also. It's a children's hospital, and we don't carry enbrel in our forumlary..however, the director was willing to order it for me...not only that but also agreed to extend our normal 20% employee discount on it as well...so my cost is zero. I am very lucky to have such an arrangement.... Does your hospital offer employee discounts? Perhaps they can order it for you!
Claire,
I hadn't thought of that. I will check and see what my options are. Thanks for the great idea. I'm glad it worked out for you!
Phatgirl2
There is a service enbrel offers called enliven and part of what they do is help find ways to pay.
I hope you can find an answer that won't bankrupt you. 0 is not so bad when you pay out of a medical flex spend program that allows you to pay with tax free dollars. One of those spend it or lose it things. The tax break for me is about 30% - so the 200 would be more like 140.
Maybe you can set on up thru work for next year.
But it only works when you can plan for it...
You have an opportunity once a year to estimate your medical expenses that will be out of pocket. Then you have the money you think you will need taken out of your paycheck directly into this account. Your whole estimate is available right away. The only bad thing is that if you don't incur medical expenses by the end of the year you lose the money.
So lots of people like my friend - whose husband was dx with melonoma this year - only put away 0. How was she supposed to know they would face a deadly and expensive disease this year?
I am going to work on my flex spending for next year. I think that is a wonderful idea. I haven't given up hope yet and am looking into other funding options. I sure would hate to think that I can't get the meds I need to slow or stop the progression of this disease because I can't afford it. But, there are many others in the same boat as me, many worse than me. So, I'll keep plugging away.
Thanks for the idea
Phatgirl2
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