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1391695 tn?1298143389

Insurance Question

Am finding out the 'routine' of getting the Riba and Peg. Is it a safe assumption if you are covered for the Riba that you'll be covered for the shots?
15 Responses
87972 tn?1322664839
Not necessarily, Bree. Well, actually you might be covered, but to what extent is often the case. Some insurance policies cover the riba under their Rx plan but put the IFN into major medical, sometimes requiring 30% copay. That happened to me, and while I paid the first time out of pocket, the second treatment I went through the mfgr’s patient assistance program; they paid for 100% of both meds, with no copay or deductible to meet.

Also, these drugs often require prior authorization; sometimes that can take a week or more to arrange. It’s not quite like filling a prescription for penicillin or something; it’s often a bit more involved.

87972 tn?1322664839
If you run into seemingly insurmountable obstacles, here are the patient assistance program numbers just in case:

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

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

Just call the appropriate number, and the service rep will help you apply.

1391695 tn?1298143389
Yea I found out so far that I'm covered with the Riba, and am waiting to hear back about the shots. How much do these shots normally cost?
1391695 tn?1298143389

You mean you had insurance but still went to the program?
I guess you have to fall into some perimeters to qualify?
Thanks for the info, I'll see what happens with insurance and then go from there.
179856 tn?1333550962
You should be covered but most likely have a copay involved.  The riba without the peg makes no sense and would be worthless (unless you are trying to fight the bird flu) because it would not work in a million years.

48 weeks of the meds (both) I believe comes to about 20k however during the course of treatment many other drugs can be needed and I figure my 72 weeks cost about $200,000 for treatment.

However at the time I extended it was considered by Aetna (my insurance) experimental and they would not cover the additional six months.  Comittment to Care (I was on PegIntron) covered every single penny of the meds for me while my insurance covered the doctor bills, tests and other meds.

You should be fine either way.
87972 tn?1322664839
Bree, the patient assistance programs are set up to help with uninsured as well as underinsured. Yes, I had Medicare at the time and had Part D coverage, but the copay was really high; around $600.00/month if I recall.

They do have income parameters to qualify a patient; but these are income rather than asset based; you can own property, income property, business, etc; qualifying is based strictly on income…

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