$5300 co-pay?

[toaofpooh]

Aenta only wants to cover 65% of Pegintron Ready Pin, leaving me with a $763.00 monthly co-pay. For 6 months, that’s almost $4600 out of pocket!  That's insane considering there is no guarantee that it will work. The pharmacist referred me to www.copays.org (Co-pay relieve Foundation) I understand you have to submit your application at the beginning of each month, before all the grant money runs out. Has anyone received help from this non-profit before?

The Riba is generic so of course it’s more affordable, but still the 15% co-pay for this is $110, making it $660 for the length of the treatment.

With my insurance covering 65% of the specialty drug (Pegintron) and 85% of the Riba and no help from anyone else, I’m looking at a total of $5300.00 out of pocket for only 6 months of treatment.
Can this be right?

[Bill1954]

The aid they provide is income, rather than asset based; so even if your home, etc, they might help.

Should have read:

The aid they provide is income, rather than asset based; so even if you _own_ your home, etc, they might help.

LOL, you’re welcome :o).

[toaofpooh]

Thanks everyone, this is very helpful info!

[copyman]

sounds about right. Someone needs very good insurance for it to cover all of the meds.

[FlGuy]

Go back to Aetna and have a conversation.  Make sure that they look at all elements of your insurance coverage; both prescription AND medical.  Although policies are different, Aetna covered my Peg as medical and there was no copay at all.  Keep at it, it's worth the effort.

And, the Bill info above.

[Bill1954]

Yes, this stuff can be pricey. Some insurance considers this under major medical rather than prescription drug coverage.

Call the manufacurer’s patient assistance program; they helped me and thousands of others get through this successfully. The aid they provide is income, rather than asset based; so even if your home, etc, they might help.

Here are some numbers to try:

Pegassist (Roche Pegasys system): 1-877-734-2797

Commitment to Care (Schering- Plough PEG-Intron system): 1-800-521-7157

Bill