Aa
A
A
A
Close
Hepatitis C Community
13.4k Members
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?
Thanks,
Bree
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.

--Bill
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.

Bill
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?
Bree
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.
Bree
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…

--Bill
Have an Answer?
Top Hepatitis Answerers
317787 tn?1473362051
DC
683231 tn?1467326617
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Answer a few simple questions about your Hep C treatment journey.

Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
image description
Learn about this treatable virus.
image description
Getting tested for this viral infection.
image description
3 key steps to getting on treatment.
image description
4 steps to getting on therapy.
image description
What you need to know about Hep C drugs.
image description
How the drugs might affect you.
image description
These tips may up your chances of a cure.
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Here’s how your baby’s growing in your body each week.
These common ADD/ADHD myths could already be hurting your child
This article will tell you more about strength training at home, giving you some options that require little to no equipment.
In You Can Prevent a Stroke, Dr. Joshua Yamamoto and Dr. Kristin Thomas help us understand what we can do to prevent a stroke.
Smoking substitute may not provide such a healthy swap, after all.