Contacting someone for medical help

I will be starting treatment very soon.  I have an appointment at the end of the month w/ nurse-doctor.

My question is: Do they( doctors) start right away, once you commit to the treatment?
I do have BCBS, or should I be contacting the various drugs companies to see if I qualified for assisance.

I am really concerned about the super high cost of the treatment.
I heard that Pegasys with Copegus is a better treatment?

[antman]

hi Mari,
i think most ins. co's will pay for tx. i have a different ins. co. but they pay for evreything minus the co-pay. the meds are $35 co-pay/month. once you get all the tests done you usually can start in a few weeks. it seems to take forever to get started, then suddenly your a few months into it. that's the way it was for me. try not to worry, it's prolly not as bad as you may think. that's been my experience so far. good luck.

[would-rather-be-riding]

I am going on next week to get the ball rolling for me.  You won't be alone in this, and I am glad to know I won't be either!

[Myown]

I have BCBS also. I get the meds through the mail. It is called "Caremark." That is part of my insurance policy. It costs me $35 (or 45?) every 3 months. My tx is 6 months so that is very inexpensive.

If I would pick up the meds at the local pharmacy it would cost over $6oo per month. Call BCBS and tell them you will be starting TX and ask about the mail order and how much your co pay would be. If you have to get meds at pharmacy make sure to find out how much. When I called BCBS I had to talk to several people.

I am on Pegasus and feel fine, no sx. Everyone is different though. Some say Pegasus seems to be more tolerable out of the 2 interferons.

But make sure YOU call your insurance to check on the co pay.  

[Bill1954]

Hi Mari-

Some of us with insurance have problems with high co-pays because some policies consider self-injectables as a major medical expense rather than cover them under their Rx plan. For some of us, then, we have to pay a 30-40% co-pay.

At this stage of the game, probably best to call your agent or BCBS directly and inquire as to the specific coverage for these meds. Although you can try to call Pegasist or Commitment to Care for assistance, they can only give you very generic information until you present them with an actual prescription from your MD, a tax statement or other income verification, and a letter from your insurance company stating that your co-pay will be???-dollars/month. Although it's a good thing to be proactive in your health care, this may be one of those situations that will work itself out as you go. The folks at Commitment to Care are courteous and professional, and when the time arrives to take action, they move fairly quickly.

The general consensus seems to be that Pegasys seems to deliver easier side effects, but again, we're all wired differently. I did Pegasys last treatment, and was couched for the last five months of Tx. This time, Peg-Intron at off-label dosing has been quite tolerable, so I guess you won't know until you try. One thing to remember is that Pegasys is one-size fits all; you get 180 mcg/week regardless of your weight. Will this might yield better results for those of us that are less than average weight, those that are overweight may not receive full therapeutic dosage. These are things to discuss with your doc at the next appointment.

Best of luck and take real good care,

Bill

[FlGuy]

In other recent threads you mentioned the possibility of a trial.  Do you know which drug is being tested, the name of it?  If you are in a trial, usually all study meds are paid for.  But you need a lot more details before you decide on a trial or traditional treatment by your doc.  I've read here that the drug companies' assistance programs might be based on your insurance (or lack of it) company's coverage.

[Lilla]

I too have BCBS out of Florida; my plan is what they call Network Blue (Blue Options) and my pharmacy end of it pays 60% of drug cost while I have to cough up 40%. I've only been on tx for almost 2 months and paid $800 first month and $600 second month. I was told by BCBS that a place called Option Meds may be able to offer at a reduced rate; I called and it will still be around $600 per month for me.  I did call Peggassist and asked for patient assistance.  They told me I did not qualify, as, I'm assuming, my income is too much ( Ha! ).  I am a geno 2b so tx is supposed to be 16 week or 24 week -- I think it depends on what blood work reveals. I'm currently searching for a doctor that I can rely upon (hope he or she is out there).  Good Luck to you.  My sx have been mainly fatique and very emotional at times, while other times I could care less.  I do experience some muscle/joint aching.  

[Teufelhunden]

I have BCBS as well. Doing Pegasys with Copegus. Mine comes from CareMark out of Raleigh NC, next day delivery and I pay $90 every three months. In fact, when I started treatment, I took the prescription into my local CVS and they said because of the cost, they couldn't fill it so I ended up calling the 1-800 number and setting up my schedule with CareMark. So far no problems. Three shipments down, one to go.

[irishrayne]

Mari,

I'm glad you asked. I have an appt on the 23rd of April and I was wondering how it would all happen from that point (starting treatment and all )  I hope the insurance works out for you and you don't find yourself strapped for the cash to get your meds.
I will be treating at a learning hospital so maybe they will hook me up the day of. I kinda hope so. I've waited more than 3 years already.
How do you say your name?
My daughters name is also MARI and we pronounce it MARY.

[Proactive]

I also have BCBS with script rider(100 deduct and copay). You really need to look at your individual policy. My BCBS required prior approval for the drugs, a 12 week VL and a 24 week VL. Went in for a one hour training session, received a standard kit from pegintron
(DVD, info and various items) and a 7 day pillbox (a must have, IMO) Everytime I fill it up for the week, I think to myself, jeez, your getting just like your parents LOL!. Good luck, my meds come from Specialty Scripts (Rhonda calls to remind me it's time for a refill and set up a delivery day,these people are great), FedX is here like clock work..Actually pretty painless process in my case.

[jmjm530]

Often they just write you an rx for the drugs and you start when the drugs actually arrive after being cleared through the insurance process, etc. Or, if you treat in a larger, teaching hospital, they might just hand you some "in-house" drugs so you can start immediately.

-- Jim

[mari74]

Can you give me  the 1-800 number for Caremark?
I wwaited some 12 because I thought I was not able to afford the treatment.

Thank you  

[mari74]

Can you give me  the 1-800 number for Caremark?
I wwaited some 12 because I thought I was not able to afford the treatment.

Thank you  

[mari74]

How are you feeling with Peg& Cop?
Do I call Caremark first or do I call BCBS.

Thank you for your help

[Proactive]

I think you should start by calling your insurance company, they are generally very helpful. Thats what I did, imo, you need to get your ducks in a row. Tell them you are going to be prescribed for peg and riba and see what they say. Mine cast me 40$/month copay..Your insurance company will have a perfered mail order company. If your worried, call them and get an answer.