Shared Solutions called me today for all my info. She said she will call me early next week to give me the cost. She then said they offer financial assistance. So, I asked "roughly" what does she think will be my cost with my insurance. She said "typically" with my insurance, my part would be $2500.00-------PER MONTH!!
Does this sound right? That will be a problem, to say the least. Guess I shouldn't worry until I know for sure the cost, but at the moment, doesn't sound too promising for me.
Do other people pay this amount? More? Less? Just curious...
Perhaps they could lower the cost if they didn't give out this HUGE fancy book with the DVD and CD's?!
Do you think that maybe she misunderstood you? I'm on Copaxone and it cost about the same price. My copay is $15.00/month, my insurance covers the rest. I would call your insurance company and ask them how much it will be. If your insurance doesn't deal with shared solutions try calling Pression RX.
I'm on Copaxone and have a $30.00 co-pay. Shared Solutions called me and wanted me to know that they would pay the co-pay for me. I'm still waiting for the application. Also, the drug company that Copaxone comes from also has a plan to cover the co-pay. The price of Copaxone is 2500.00/mo that my insurance covers. Charley
Shared Solutions has a needs based discount program. You have to ask for the needs based discount. You need to apply asap because it takes a week and they will not cover Copaxone retroactively.
For example they o.k.ed mine the day after my prescription was filled so I had to pay my whole copay which was $300 for three months. They do have a lifetime cap on there assistance.
There non need discount has many loopholes. They keep saying I am o.k.ed but at the last minute I am not. They used to call once a week to say I was accepted and then say Iwas not. I told them they were sadistic. SS no longer calls now they send letters. I have to get Copaxone through Medco Accredo. SS does not work with Medco Accredo. They do not work with many other pharmacies.
Otherwise the MS Society may offer help you.
Teva makes more money on the Copaxone in the U.S. market than you can imagine.3.4 billion a quarter. Go to their web page for Stockholders. They say no other MS drug in history has made the money Copaxone has. Ironically if you are on any generic in this country Teva probably makes it to.
I like Copaxone do not get me wrong and will stay on it. Teva is a business and like the Medical Insurance Companies the stockholders are the bottom line.
My quoted price for Copaxone was $2880.00 month... After finding an insurance company to cover some of it my out of pocket was $484.00. I am actually glad I had a bad reaction to it and had to stop after 10 days. That was just totally unacceptable price. I am so glad some of you or rather most, can get a decent copay. $484 was more than my monthly house payment!
Michelle, as others have mentioned, this just doesn't sound right. Insurance companies foul things up all the time, so don't get worried yet.
For me, after 14 months on Avonex delivered in 90 supplies, I suddently needed 'prior authorization.' which apparently I was just supposed to intuit. That caused a huge runaround and a delay in shipment, meaning I was 4 days late in doing one dose. I'm still angry over that, angry at the way I was treated during this process, and angry that they used the opportunity to more than double my co-pay (though it's still amazingly reasonable).
The lesson for me from this is that there are a lot of incompetents handling insurance work, along with many who know what they're doing. So if something sounds wrong it probably is. Make sure you investigate this again, and make sure your doctor knows if you still have trouble, also, of course, Shared Solutions. My neuro's secretary told me she spends way too much time straightening out insurance messes, and I'm beginning to think she's right.
I agree with the others. You were given a price that is the total cost for one months' supply. This will not be what you have to pay, if you have insurance. You will have a co-pay.
I am one of the fortunate ones. I am on Social Security Disability and also on government or State insurance, because I am single and unable to work. I actually get a check called SSI. It's a supplemental income of $674.00 a month, with free medical care with no deductibles. I am extremely grateful for what I receive, of course, I have had others tell me that I earned the assistance, after working all my life. Nevertheless, I am grateful.
I hope they can get your insurance straightened out soon, so you will know exactly what your deductible will be. When I was on Copaxone, I had to get re-authorization for the drug every six months. I was only shipped one month supply at a time, by their chosen mail-order pharmacy.
Hey Michelle - lending more weight to her being totally off.
Like Ess says, they foul it up all the time - as do pharms. You typically should not pay more than what your prescription plan pays for name brand. Unless, like Lu's issue where it's considered formulatory - only way around that is if an exception is made on your behalf. And, that is done all the time.
If you are in this situation - please ask your physician to submit for one for you - there is a good chance it will be approved due to the limited drug options available to us MSers.
Please hollar if you need more info and we can dig for the criteria for this for your insurance company...
I hope that possibly you misheard them, because it doesn't sound right. My co-pays for meds are either $10, $30, and $50. When I was on Rebif my co-pay was $50/month and my insurance covered $2,190. Now I will be starting Copaxone and my copay for that is $30 and my insurance covers the remaining $2525.00.
Also if the quote they gave you IS true, contanct Shared Solutions and see if you can get into a *study* for some they will give FREE meds for the first year if you participate!
Hope this helps and you find a resolution.... In this economy NO ONE can afford that
The cost of Copaxone in Alberta, Canada is somewhere between $1400-$1600 month. This is mostly covered for all Albertans with RRMS through a provincial MS drug program. (the other first line DMD's are covered too). The program is not income/needs-based.
To get this coverage, one needs Blue Cross non-group insurance which is about $30 per month for premiums. The co-pay is a max of $30 per month. I am lucky to also have drug coverage with my employer plan; the two plans are linked so I pay zero co-pay for Copaxone; actually, for all my meds.
The most someone in Alberta without employer coverage would pay for Copaxone would be $60 month ($30 premium for the plan, which covers other meds and services too), and $30 for co-pay.
I've wondered why the cost of this med is so much lower here, in some cases half of what it costs in parts of the U.S.
It is cheaper in Canada because the Government negotiates with the drug companies which the U.S. does not even do with Medicare the government run health program. In the U.S. drug companies spend millions of dollars on individual lawmaker's campaigns and on lobbyists. The Drug companies and Health Insurance Companies practically own the U.S. government. Teva make more money on Copaxone in the U.S. then any other place in the World. Novartis has filed for a generic patent and Teva is fighting it in the U.S. Courts on the other hand they make generics of most of the generics in the U.S.
The argument has been the U.S. pays higher prices because of Research and Development. Teva is in Israel.
Also the advertising is expensive only the U.S. and New Zealand allows direct advertising to patients. Some Drs. are paid $5000 to use a drug. Pharmacies even tell drug companies how many times a Dr. prescribes a certain drug and then the Dr. is rewarded. Medical Journals are subsidized by pharmaceutical ads, the same journals which publish drug studies.
I have one Doctor who will not have anything to do with representatives from the drug companies selling or as they like to say educating him on drugs. BCBS will not allow him to be a provider for this reason.
Got a call from the specialty pharmacy tonight regarding Copaxone and when do I want it shipped.
I asked the dreaded question about the price. I feel very blessed and HUGELY relieved. It is a $5.00 copay for a 3 month supply. I hope I heard that right. I am pretty sure I did, and asked him to repeat it.
We will see, but for now I definitely like that price SO much better.
I have been on copaxone for almost three years. When I started I had a $50 per month copay. My health insurance provider signed with Acredo and when they did, the copay went up to $100 per month. Just this past fiscal year, they jumped the copay to 150/month. Who knows where it will go.
When it gets up to 250 per month, I think I will just take a short ride in a fast airplane.
we were on NORD assistance and when hubby got on ss disability we were kicked off we cant afford medicare insurance and so we do have medicare rx but they wont cover hardly anything of copaxone. I have tried everywhere and most insurance companies rates are way too expensive for us. we are just barely above poverty level. I havent tried the teva maybe they can help. Our cost right now will be$1750 per month then medicare will only cover the 750.its so frustrating
WOW! I had given up also because of cost for this drug. My pharmacy told me it was going to cost almost $4,000.00 a month for THEM! I didn't even think about being able to afford it after that. I am so glad I found your conversation oline. It gives me hope again, :)Thanks guys :)
SO THIS PASS MAY I WAS TOLD I HAVE M.S. I WAS SHOCKED! I DIDNT KNOW WHAT EXACTLY M.S. WAS...I HAD NO INSURANCE THRU MY WORK MY HUBBY HAD JUST LOST HIS JOB SO I QUALIFIED FOR MEDI-CAL...NOW THE WORKER IS TELLING ME I MAY NOT QUALIFY ANY LONGER CUZZ MY HUBBY GOT A JOB WHICH IM HAPPY CUZZ HE LOVES TO WORK AND FOR 10 YRS NEVER MISSED ONE DAY! MYSELF IM AN R.D.A, I BEEN HOME I HAD VISION PROBLEMS AND MY LEGS WOW! IT FEELS SOMETIMES LIKE I HAVE WEIGHTS ON THEM. I CALLED SHARED SOLUTIONS AND AFTER I GET THE NOTICE I NEED TO CALL THEM WITH THE INFO SHE TOLD ME ITS ROUGHLY $3000.00 FOR THE MEDS!! IM IN A PANIC! I CANT AFFORD THAT! I DONT WANT TO TELL MY HUSBAND CUZZ HE TO WILL PANIC...WHAT CAN I DO I WANT TO REMAIN HEALTHY FOR MY CHILDREN AND STAY AWAY FROM RELAPSING...PLEASE HELP ANYONE IF U HAVE AN ANSWER PLEASE!!
Hi and welcome to the MS forum here. First you have to stop and not allow yourself to panic about this situation. The insurance/money dilemma can be a nightmare and it does not help your health.
There are other drugs approved for treating MS - copaxone is not the only one available (I am on copaxone) and one, I believe it is Rebif, covers the copay for everyone who wants to take it. BUT The rules how they apply to people on government assistance (medicare/medicaid) are often different and I hate to speak out of line about it.
You should contact your neurologist and the local NMSS chapter for advice, too.
Do me a huge favor, and please starrt a new discussion about yourself and the help you need. This is a fairly old post and most people won't stop to read your comments. Once you start something new, many of the folks here will be happy to help you brainstorm solutions.
and That's with insurance - under the new health reform act Obama Plan. I have a 50% copay. My insurance will cost more come January and so will the copaxone. I can't afford either and have been without copaxone for quite seometime. Haven't been able to get any financial assistance through Shared Solutions - I was rejected.
I will have to pay about $3000 for a 3 month supply with my Copaxone in October when my insurance coverage switches. I opted for a lower level insurance which will actually be cheaper in the long-run. I will reach out of pocket in October and then after that, everything is paid for in full.
With my insurance, I have to reach the deductible and then I pay 20% of the drug cost. Since the drug is $9000 for 3 months and the deductible is $1500, I pay the $1500, then something like $1500 for the drug, so $3000.
So, it could be that your insurance coverage is something similar?
All of the manufacturers have patient assistance programs. Please call or have your mom call Shared Solutions and discuss all the options for help to cover this cost. They make enough money off everyone else, they have surplus to help others.
My insurqance is now being billed $3,700 per month for my copaxone - but of course they don't actually pay that much. Cobob may have been talking about a 90 day supply at that price, but I may be wrong.
Hi ! I have been on Copaxone for 10 months. I get it sent to my home every month from a specialty pharmacy through Shared Solutions. Everyone has been very helpful and cooperative :) I am blessed to have a good insurance policy with BC/ BS so I have a copayment of only $35 a month. I truly hope everyone who needs this drug will find an affordable way to get it.
the price of copaxone is about $3700 per month - my copay for prescription drugs is 50% so the cost to me is $1850 - I know the price will go up January 1st - it always has - when I started the drug in 2006 the monthly cost was about $1470. I cant afford the drug - the maximum shared solutions will give for copay assistance is $500 per month (which is alot of money but it still leaves me with a monthly cost of over $1300 - and that's just for copaxone!)
I am in a QHDHP (Qualified High Deductible Healthcare Plan), and have a health savings account. My deductible is $5,000. Prescriptions are covered, but there is no co-pay. It's just one of the things that can be applied to the deductible.
I am not on a DMD, and I haven't been diagnosed with MS. However, I have researched the cost. This year I hit my deductible in the summer. I went to my plan's pharmacy site and priced copaxone and avonex. Both would be free. I signed on as my husband, who has not met his deductible this year, and they would cost him over $2,000 for a 30-day supply. So the first couple of months would be horrendous, and then it would be free for the rest of the year for me. As it is, I'll be paying about $400/mo for my other prescriptions for several months, anyway.
You commented that the insurance companies don't pay $3700 per month for Copaxone. I agree they probably don't but where could someone get information about that? My insurance company wouldn't even give me the cost of the drug unless I ordered (and paid for) it.
Like2no, now is the time to be talking to your local NMSS chapter or the MSAA office there in NJ and ask what they know about assistance programs. There is no reason why anyone in this country is without a DMD because of the cost. There are asisstance programs available but it takes a very determined person to sometimes find it. Specifically ask the Shared Solutions people about the help through NORD - national organization for rare disease. SS/TEVA fund NORD heavily to help people who can't afford their drug.
Also, your share of the copay should be based on what your insurance actually pays. It should bethis less amount instead of 50% of the retail price. My insurance paid substantially less than that $3,700 and then if I had to pay a percentage it would be based on that new amount.
Please, please do not give up on finding a way to start your therapy.
Also, talk to your doctor about this problem. They may have other resources for you or a suggestion of a different drug with a lesser cost.
Thanks for your comments. I've even contacted the state insurance department over this (and was told I was getting a good deal!.....) They did tell me that the insurance company paid less than $3700 per month (which the insurance company claims the cost is.) Are there any guidelines as to what percentage of one's income is suppose to be used for medical expenses? I am suppose to be taking several drugs.
Happy New Year!
I wish there were such guidelines for aid in this country. It sure would make sense to me - but I don't know of any particular ones. A lot of what I see are based on federal poverty levels times a certain multiplier. My med center has those guidelines printed on their billing statements.
That $3700 sounds about right but definitely not what any insurance company is paying - that is the retail list price.
All those drug bills by themselves may not sound like much but if you are taking multiple drugs with high copays you can rack up a bill pretty darn fast.
To find out about the cost, go back to your specialty pharmacy and ask for an itemized statemnt of your account. That should show what the insurance company has paid - that is how I know about the contribution mine makes.
When it comes to talking to shared solutions, call over and over. Each person you talk to will havea different take on your coverage and what they can do to help. Sooner or later you will connect with a person who will really be able to help. Be sure to ask them if they can't help with the copay costs, what organizations you can contact.
happy new year to you as well - here's to getting this straightened out for you!
Insurance claims to have paid half, which is $1759.00. I've spoken to numerous people, all of whom have told me they've never seem a 50% copay for drugs.....As to income levels. All I keep hearing about is the federal poverty income levels as well. Soon the cost of my insurance premiums and my copays will equal my income after taxes!
Sorry I'm chiming in so late. Have you priced out the other DMD options? I'm in NJ too and am going to try to see if I can put my fingers on some of the info you are looking for. Just wondering too if the price of another med would be less costly in the end.
Thanks for posting your cost of supplements working for your MS. Copax is not an oral peptide, and therefore not comparable to those supplements you mention. However, if you have links to studies of MSers using oral peptides vs. sub Q or intra M disease modifiers, would love to read them.
We always interested in learning more of what's working for people.
Through my pharmacy company the cost without insurance or shared solutions is almost $4000. However with my insurance and the shared solutions program I only pay $30 per month. Doesn't Copaxone have a payment assistance program other than shared solutions which is for uninsured under insured individuals.
Copaxone does have a payment assistance program with Shared Solutions and they helped me out big time. It does help people with insurance.
Here's how Shared Solutions helped me--and they did big time.
This year, instead of paying an extra $300 cost differential between level 1 and level 2, I decided to go with the lower level, reach my out-of-pocket to pay zero (out-of-pocket is $1200 after paying deductible & co-insurance). Since Copaxone is so expensive, I met this deductible right away.
Here's the bottom line--Shared Solutions kicked in $1500 this last time. I paid only $1200 (a far cry from the $2700 I was going to have to pay). I am DONE with any more health care costs and medication costs for the year. I will be saving a lot more money this year than last going to a lower level (less expensive) plan that covers less, and thanks to Shared Solution's program, I am having to pay $1500 less than I thought I would have to pay, AND I'm saving much more money going to a cheaper plan.
Shared Solutions is awesome for having these programs to help people. I hate having to have expensive medicines for my disease, but they sure did take the sting out getting these shots (pardon the pun). Talk with them about your insurance coverage, etc. They may be able to help you out . . .
Call Shared Solutions and talk to their financial assistance team. They will help if possible. The program that limits the monthly co-pay to $35 requires you to get the drug through specific discount pharmacies. My insurance wouldn't agree to that but many do.
They offer other assistance programs based on the limits of your income. Be prepared to share general financial information with them about yearly earnings and yearly medical out-of-pocket costs.
You might be able to get other assistance from sources outside Shared Solutions. Check with your prescribing doctor (does he know you can't afford to take what he prescribed?) and/or the MS societies.
I, however, was on Avonex for 12 years and when my husband retired, our retirement insurance would not pay anything. Since, I did not have any other insurance I had to go off my shots. My cost would be $3300.00 per month and that was two years ago. I had no choice but to go off the shots then and have been shot free and I pray every day that I have no major problems. I was exhausted trying to find a way to pay but nothing came through. I can not get on our state insurance because we have a policy even though they do not pay for MS medication. Good luck finding somewhere to pay for this rich mans disease. Disabled in Oregon
I had the same problem which continues my saga....I will start on MediCare on 8/01/12...and cannot find a Prescription D provider to cover the Copaxone. I have been on Copaxone since 1998, and do not want to deviate from it. Because it works!!! So, when I call all the pharmacies...Walgreen's wants $103,000+ per month. Yes, that is right...with no insurance. When I had BC/BS provided by my employer, my deductible was $40/mo. Now, no insurance, I had to get the grant for one year. Now, I can't find any one to assist with my questions...including Shared Solutions. What happened with all these people. They never did this before. It was such a good program...and called all the time. Haven't heard from anyone in ages, and I agree with you on how expensive this is. If we aren't working, have MS...how do they expect us to come up with $2,000+ and $100,000+ per month? That is rediculous. Who can pay any of this?
Coincidentally, I'm starting Medicare on August 1, 2012 also. I'm trying to find a way to continue taking Copaxone. I agree, it seems to work pretty well but I just can't afford the enormous costs. Have you had any luck finding a way to pay for it once you start Medicare?
But look how much the insurance pays. My insurance (Thank god I live in Oregon and we have what the rest of the country turns down due to morons stressing about nonsense) through the Oregon Health Plan pays the entire thing but even they pay $4,500 a month.
I'm not a drug user and have no clue what drugs go for but isn't crack and heroin cost more than 30 shots at $4,500? What exactly am I injecting as even the price of gold is less than this drug for the amount that I get for that price.
MY INSURANCE BASES CHARGE AT $4000 PER MONTH. AFTER DONUT HOLE COST IS $220.00 PER MONTH. THIS IS THE BIGGEST RIP OFF BY DRUG COMPANIES. THIS DRUG HAS BEEN OUT OVER TEN YEARS AND THERE IS NO REASON FOR THES HIGH COSTS. ASKING FOR FINANCIAL HELP IS LIKE BEGGING. WILL NO LONGER DONATE TO ANY GROUP TO FIND CURES, AS ONCE THEY DO THEY SCREW THE PUBLIC THEY ARE SUPPOSED TO HELP
My husband has been on Copaxone for 1 year and had assistance. We were very blessed for that because my insurance company UNITED HEALTH EXCLUDES this medication and wont pay a dime. Copaxone has kept him out of the hospital this year. Unfortunatley when it came time to renew the assistance he was turned down. Not to sure why...we've lost our home, our car...and I now make less money. So last week he had to stop taking it. Just cant afford it. We were going through AssistRX which works with Shared Solutions. DOes anyone have any suggestions. He was doing so well. Being off the Copaxone really scares me....and him. Thank you
Hello, I am sorry that imam saying this, i do not have ms I was somewhat diagnosed with ms about a year ago, my doc prescribed copaxone. I have been taking it for the past year. Recently a different doc confirmed i do not have ms. Yes i feel fortunate but I do have almost three months of copaxone that paid for.
No need to apologize for your good news! I just hope you're able to look forward to a healthy future now and don't have to re-enter diagnostic hell.or adjust to some new disease process.
I believe the yearly raw billed price on Copaxone now tops $50,000 so there are, no doubt, many people who would consider themselves fortunate to be the recipient of the generous gift of three months of disease modifying treatment. You'll probably run into difficulty though since Copaxone is a prescription drug subject to specific dispensing regulations. Your best hope is probably if you met someone else in your time 'with MS' who feels comfortable with 'disposing of your excess'.
Hello. I was Diagnosed with MS in June and I panicked as well! My employer does not offer insurance AND I am single so I was able to qualify for State Assistance. Do some research..and there is A LOT, but there are a lot of programs that are willing to help. I have a friend who also has it and she gets help through MS Foundation because her insurance plan does not cover her meds. She is not on Copaxone....it begins with a B....Betaseron. Like I said, do your research. Yes, it's a lot to take in, but so worth it! Good Luck
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