Copaxone

[dao30]

In was recently diagnosed with ms and selected copaxone.  Aenta, my insurance provider said my copay for my presciption would be $434.00.  This is a one month supply.  I told them to just cancel the order as I could not afford to take this drug for the rest of my life.

Anyone taking something that is not as outrageously priced?  

I feel fine just the funny feeling in my right hand and fingers is annoying.

[jensequitur]

Shared Solutions has two programs.  One is a financial assistance program that helps you with the cost of your copay - for example, my copay was $90, and they helped me out with $40 of it.  When I had problems affording the $50, I talked to my neurologist, who helped me with a complete financial assistance program that would allow me to get it for free.

However, Aetna is a complicated mess.  I have to get all my medication through their Specialty Pharmacy, not their mail-order pharmacy, which is confusing.  I've mailed my prescription to the wrong people at least twice.  I had to make sure that SS had the Specialty Pharmacy listed in their documentation.  Then I had to confirm that Aetna had the proper codes for giving me the discount, which was another big mess.  

I called SS and everything was free and clear - they were set to give me the medication for free.  Aetna, on the other hand, couldn't get its act together and wanted some sort of code from me for my financial assistance.  I called SS and explained the situation to them and got as much information as I could from them, then called Aetna back and gave them all that information, then told them that I had done all I could - it was up to them.

The problem is that it's per year.  If you applied last year and been denied, then you are eligible again in the new year.  And you have to make sure that all your pharmacy information is correct, because once you send it in, you're done.

Unknown314:  If you have a prescription for Copaxone, what I would do is call Shared Solutions and explain your situation.  There's two programs - one a discount program, and one is complete financial assistance.  They should be able to point you in one of those directions.  It sounds like you would qualify for complete financial assistance - they look at your income for the year, and if you're below 33,000 then you qualify.  I think!

MCBCON: It seems like you should be able to get complete financial assistance too, but you're going to have to get a prescription from your neuro.  Do you have a current neurologist?

Honestly, it's a good thing that I've been alert and focused the last few months, because I don't think I could have gotten this straightened out a year ago.

[MCBCON]

I tried several times to get help in getting Copaxone.  Always there was a reason I did comply with their guidelines.  Last time, about 6 months ago, the person told me to wait till i got on Medicare.

I tried to get prices for buying it, but they would not give me price unless I was buying it right then.  In searching the net for prices it ranged from $1400 for months supply to $3600 for a months supply.

Insurance companies get a a way better deal.

[Unknown314]

I have had MS for 3 years now! It has been a rollercoaster ride this last year. I tried to get help from Shared Solutions just to be denied with being offered a reason why. Mind everyone,I had to quit a $45,000 year job, very independent, and full of life. Now I am disabled and depending on friends and love ones. I have no way of getting the Copaxone until I am approved for Medicaid and Disability. I wish someone would have been able to tell me what to expect when I first received the news. I wish all of you Better Health and Love and Support.

[Lulu54]

One other fleeting thought - since you are new to the dx of MS, would you be interested in participating in a drug trial?  If I understand the protocol, your drugs and your doctor visits would all be covered by the company investigating new drugs.  If you do that, one of the possibilities is always there that you would receive a placebo and not the drug itself, but would that be much different that not taking the DMD's your doctor has suggested?  

You can read about the trials on line and who to contact through a govt. website.  


http://clinicaltrials.gov/


The MS specific trials are listed at


http://clinicaltrials.gov/ct2/results?term=multiple+sclerosis&recr=Open

there are 185 open trials listed for MS - maybe one of these would be of help to you and of interest?

good luck,
Laura

[monotreme]

Deb gave you great advice.  Please call the mentioned numbers.  There is help to afford the meds.

Elaine

[Deb61]

I want to springboard off of what Elaine said.  Have you checked to see what your maximum out-of-pocket is or if there's a deductible?  Your plan is ridiculously not right if there's not something that will eventually defray this cost somewhat.  

Also, do you have an opportunity to raise the level of your insurance (or even change it completely) any time this year?  Before I was diagnosed, I went from Level I to Level II (still can't afford Level III because I cover the family) with BCBS.  With Level I, I paid the full cost, until I met the deductible, then the plan paid 80% of the cost up to the maximum out-of-pocket of $1200 (then the plan paid 100%).  Now I pay a copay of $62.50 every three months for my Copaxone.  

You may also consider contacting Shared Solutions, MS groups (like MS Society, etc.) to help with this problem.  There's a thread I posted on, which I will try to find, in regards to this.  

I can't think of any drugs right now for MS (hopefully oral ones come out soon) that will help with slowing down (or possible haulting) the disease progression that are cheaper.  You may want to infer on the cost of Rebif, Avonex, and Betaseron with your insurance company.  You may also want to contact MS Lifelines (for Rebif),  Avonex (I think its MSActiveConnect), and BetaPlus (for Betaseron), too, to see if there's something they can do to defray costs.  

I'd call the Shared Solutions people first.  They may be able to help defray quite a bit of the cost.

Deb

[Bev707]

Check out LDN.  My husband has MS and has used nothing else for four years.  It costs under $70 for a three month supply.  His MS has not progressed - no new lesions - no flares and no new symptoms.We absolutely refuse to pay the ridiculous amounts of money that the traditional MS drugs cost and we just cant afford it anyway.
Good luck.

[sllowe]

Hi Dao,

I'm glad you were recommended meds, and you've gotten good advice above here ref. insurance.  I know you posted your brief story, and Doc Q responded.  I'm going to bump it up if you don't mind, so others can get read your story, get to know you a little better, if they've not done so.  

If I remember it correctly, your dx came quickly right? And, that you were not quite convinced of it.  I can relate, and it's ok.

Hope to see you around more, and that we can point you in the right direction where this is $$ concerned.

ttys,
Shell

[Lulu54]

Here's another site that gives more details for uninsured and underinsured patients needing copaxone - be sure to look at other sources of help besides the drug manufacturer.

http://www.needymeds.org/drug_list.taf?_function=name&name=Copaxone

[Lulu54]

The cost of this drug should not keep you from getting this treatment - the way our medical care is paid for in this country is another rant for a different day. My mother uses Enbrel for arthritis and it has made a world of difference, but it is expensive and she pays about $350 out of pocket each month too - and she is 85 years old!  

There are several organizations out there that will consider assisting with drug costs - yes, you have to fill out forms and jump through hoops to get the $$, but its worth it instead of deciding to not take the treatment. And they will assist with your copay cost is you do have insurance if you meet certain income guidelines.  You can find a brief blurb at about.com.  Good luck, Laura

http://ms.about.com/od/treatments/a/Copaxone_2.htm

"The patient support program, Shared Solutions, can help you determine if your insurance plan covers Copaxone. The website states: If you do not have insurance or if you need help paying for Copaxone, Shared Solutions can refer you to other financial assistance programs. To speak with someone at Shared Solutions, call 1-800-887-8100.Your doctor's office or the local chapter of the National Multiple Sclerosis Society should also be able to assist you in determining financial options for affording treatment. More Information: Copaxone is made by Teva Pharmaceutical Industries Ltd. For more information, visit the Copaxone website, or call Shared Solutions at 1-800-887-8100. "

[monotreme]

With a 25 dollar copay, is that a HMO??  Or Blue Cross?  My husband has been prescribed Copaxone and now he has met his maximum pay out for the year, but as of January, it will be 20 percent of the 2,000 dollars a month that Copaxone costs.  It could be as high as 400 dollars a month.

So please let me know what insurance has such a low co pay.  Maybe we will sign up!!

Elaine

[JENNIEO]

that's outrageous!  I take copaxone and it costs me a $25 copay, thankfully.  I don't feel very bad either, but I am keenly aware that now is the time to nip this in the bud before more lesions occur and then I don't feel so fine!  Aetna should be ashamed!!

-Jennie
dx'd rrms 8/4/08, copaxone