Cost Of Meds

[michelehen]

Good Morning everyone, got a call from a Pharmacy last night sitting up for my medications to be delivered
and then went on to get my info and said my insurance approved everything and it will only cost me $29.00
a month??  My Doctor said this would cost about 50K, alittle confused, will I get hit with a bigger amount for meds
somewhere down the line?  They will be delievered this Tues, and was told to start on Friday night since I work
M-F.  BTW I use Tricare, thank you for any info.

[pooh55811]

I agree, contact the drug companies for assistance. I posted in your other/original thread and there is some contact information there.

I used Walgreens (my doctor insisted). My doctor uses only this one particular Walgreens. The doctor's office faxed the order and any necessary paperwork to the pharmacy. The pharmacy did all of the leg work. My treating team said that the pharmacy has always been able to get the meds covered, either by the insurance co. or with drug company assistance or with coupons. But, the pharmacy did the leg work. They new what needed to be done and how to do it and they knew the ins and outs of the insurance companies.

This is the Walgreens I use. They handle a lot of Hep C meds and cases. They ship it overnight by UPS. They ship it Monday and I get it Tuesday. The Pegasys has to be kept cool so it cannot be traveling all over the countryside for days and days. It has to be overnight shipping. I don't know where you live

825 S 8TH ST STE SL10
MINNEAPOLIS
55404
[phone]

I don't know where you live and what would be feasible, but your doctor should be helping you with this and a good pharmacy will know what to do also. I did not have to do one thing. They arranged everything. However, I am not sure all pharmacies are equal when it comes to knowing what to do or how to do it.

If you live anywhere near Minneapolis or in MN or a nearby state, and you decide to use this particular Walgreens, talk with Baron, the pharmacy tech. He knows how to arrange everything and get approval.

[Dawn703]

Have you contacted the drug companies. i know that Incivek and I do believe Pegasys offers assistance. Not sure what happens since you do have ins, but it's worth inquiring about. Also, have you asked you GI/hepatologist for any suggestions?

[Dawn703]

I have Cigna OA Plus

[Jolima]

Where did you get the 3 medications? I was gonna get my incivek from walgreens but the total is 21,000 per month and my copay is 9,000. I was wondering if other pharmacy has different price for this drug.

[Jolima]

What is your insurance company. My copay for incivek is 9,000 per month and I have aetna.. I haven't started the tx yet coz I can't afford it.

[Jolima]

What issuance company do you have? I have aetna and I found out 2 days ago that my copay for incivek is 9000 per month.

[Jolima]

What issuance company do you have? I have aetna and I found out 2 days ago that my copay for incivek is 9000 per month.

[Jolima]

What insurance company do you guys have?. I just found out 2 days ago that my copay for incivek is 9000 a month! I have aetna. Pls help everyone.

[rog1958]

cool, just signed up for the incivik text reminders

[JasmineT]

For incivek, the manufacture offers up to 20% towards co-pay regardless of your income.  The doc gave a simple form to sign when they put in my prescription.  Perhaps you already signed for this and it was handled by the pharmacy.

http://www.incivek.com/copay-assistance-program

[michelehen]

Thank you all for being patient and answering all my questions - this site is a life saver.....:)

[Idyllic]

Oh, I forgot to add check your copies to be sure wqhat all is being supplied, covered and paid for since estimates are just that: estimates :)

[Idyllic]

Your doctor's gross estimate of your meds before insurance reimbursement for six months of treatment to include 12 weeks of Incivek, the Peg & Riba for 24 weeks sounds about right.

You will receive an EOB (Explanation of Beneifits) from Tricare &/or a similar statement from the Specialty Pharmacy. It will show  the total cost of the meds, the Insurance reimbursement, adjustments & the amount due (if any) from you. It is usually pretty easy to follow & you will get a good Idea about how it all works. Plus you may even be able to access your account on your insurance company's web site. Then there is always calling the customer service number on the back of your card and simply having them walk you through it.

It's a good idea to have a general idea how your insurance company reimburses especially if you need rescue meds to help with the sides or perhaps other meds or services.

[Dawn703]

I was told by my ins company that my meds cost 20K a month copay was $75 went down to 2K when I didn't have to order my incivek my co-pay now is $40 a month. I think ins companies are just making you aware of the actual cost of the drugs vs your copay. Anyway. I know a lot of people who work Mon-Fri start there treatment on Friday, but I chose Thursday and glad I did. My worst sides from interferon took place two days after my shot. I also read of that happening to others. I was sooo sick for two days. That said, I only had the bad side effects for the first 4 weeks or so, now none to speak of, just insominia on shot night itself and occasional headache.

[michelehen]

I thank you very much, they said the Pharmacy put in an order for 6 months supply, I will get a montly supply delivered every tues. and the cost is $29.00.  Also I will be starting on the same meds as you pooh.  

This is the best site I have found with such caring folks, I;m sure I will drive you all nuts with questions.....thank you again

Michele

[frijole]

You can see from this thread how widely varied insurance coverage it. As horsepwr said, the costs given to you by your doctor were the retail cost of the meds.  I too was stunned at how cheap the meds are.

I pay $10 a month for the Ribavirin and $40 a month for the Procrit  and Neupogen (what are called rescue drugs).  However, I have coupons for the Victrelis and the PegIntron that cover my entire co-pay.  These coupons are not income based, and can be found on the Victrelis and the PegIntron websites.  I think Vertex offers a coupon for Incevik but I know of none for the Pegasys.  These coupons are only available to cover copays are not available if you are on medicaid or other programs.

[LookingForward12]

My co pay for Incivek, ribavirin, and interferon was only $90 a month.  Of. Ourse, I pay $80 a week for bloodwork and had to pay $800 for my hospital
Stay when I was transfused.... I'm not sure how much the Procrit cost me.

[pooh55811]

Insurance companies vary widely in their coverage. Some are better than others for medication coverage. The drug companies do offer assisitance with the cost of medications if you qualify. If you have not contacted them, it would be a good idea to do so.

[bbj2856]

Gosh u all did good my first month with rib an peg. was 1169. I think or close second month was 1939.  then i got a break 3rd month was like 350. 4th was was near. 200. this month the 5th month was 169..  dont really understand why change so much but  sure was glad

[pooh55811]

"my insurance approved everything and it will only cost me $29.00 a month??  My Doctor said this would cost about 50K, alittle confused, will I get hit with a bigger amount for meds
somewhere down the line? "
-------------------------------------------------------------
It is unclear which medications you will be taking. It sounds like you will be taking Pegasys, Ribavirin, and a protease inhibitor (Incivek or Victrelis).

Your doctor was giving the cost of the meds if you were paying out of pocket (with no insurance or assistance). Depending on which meds you are one, his figure is low.

However, if the pharmacy said your insurance company approved the medications and that your payment will be $29 a month (your co-pay), then that is what you should be paying. There should be no surprises. Most pharmacies will not send out Hep C medications until they know they will get paid. It is a lot of money so they don't take chances. They check with the insurance co. to be sure you are eligible and approved for the meds and then they check with the patient (you) to be sure you can afford the med co-pay.

Just for comparison, I was on Pegasys, Ribaviron, and Incivek. The total monthly cost for all three meds was about $25,000 a month for the first 3 months (with the Incivek). My co-pay was only $70 a month. Once the Incivek dropped off, then my co-pay went to $25 per month.

If you want to be double sure, then you can call the pharmacy back and double check with them.

Best of luck with treatibng your Hep C.

[bjack59]

In my case, my insurance paid for all of the medication except a $60.00 deductable a month.  You can call for verification. Good luck!

[hrsepwrguy]

The costs of the two therapies are similar, provided patients remain on the drugs as long as permitted. The price of telaprevir is $49,200 for the course of treatment, and boceprevir costs between $26,400 and $48,400 for the full course. Those prices do not include the cost of pegylated interferon and ribavirin

http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Clinical&d_id=50&i=August+2011&i_id=758&a_id=18855

"will I get hit with a bigger amount for meds"

If you end up needing any rescue meds that cost might increase as some of them can be quite expensive as well, that is a question you would have to ask your ins co