co-pays for tx???

[lmr28]

Does anyone have a general idea re: the co-pay for the riba and IFN?  My Rx was faxed in yesterday and the "specialty" pharmacy is calling beginning of the week to schedule delivery.  (IF the ins. co. does THEIR job, anyway. ~thankfully this new med team seems confident that they will take care of any ins. q's and problems!!!! Yippee!!!)
I just want to be prepared (and warn my husband) b/c I understand the tx is quite expensive.
Thanks!
~l.

[sfbaygirl]

I feel almost embarrassed to say my copays were only $10 a month for both. They don't charge for injectables.  This is healthnet, through my teachers union. I am on cobra now which we pay $1400. a month, but covers us very well. My hospital stay for a month, not counting Dr's was $230, 000. for the hospital. I paid $250.

May be hard to switch ins. co. now, but I sure would try. Liz,  can you get those drugs from Committment to Care, or Shering Plough?  Check it out, they are free!  

Linda

[susan400]

I've had different insurance companies over the years that I've done my different treatments.  Some of the copays were horrific!  Several times, I had the thing where since they were a 'non-preferred drug', 'non-approved drug', and a 'non-generic drug', it had to be constantly getting a special approval and my co-pays ran around $500.00 a month between the Interferons, Ribavirins, and then, later on Procrit and Neupogen.  For awhile there I was on Actimmune (Gamma Interferon)+Peg-Intron and Riba for one of my treatments.  Anyhow, this is often, not a cheap illness to treat.   Twice I was in a clinical trial, my first treatment I was in the original trial for the 1st combo treatment of Intron-A/Rebetrol and it was paid for because of being in the trial.  My last treatment was the Prove-3 and that was the trial, too, which was paid for.

Susan400

[dperry10]

I have Aetna HMO and my copays for the Riba was $10, and Pegetron was $15 a month., the Procrit was $25 every other week.  They came from the Specialty Pharmacy, delivered, and I approved no signature, as I come home for lunch every day away.   Plus of course the $30 co pay to see my GI , and again to see the Hemotologist.    So glad that is all over.     Its nice to have some extra change in my pocket..

[tahoeunicorn]

Patient Access Network Foundation will assist with the Procrit. They will make your co-payment amount for you. Their number is: 1-866-316-7263. They cover it under the anemia due to medication program. www. PPARX.com is a master list of a lot of different programs. My meds were $500 a month plus $220 for procrit through my insurance. I was able to get help with the meds through roche and PANF. I have several other numbers if you need them.

Good Luck

Lynn

[R Glass]

I have Blue Cross/ Blue Shield. My Co-pay for Meds alone is almost $500 a month

[jdwithhcv]

I pay $40/month for peginteron, $15/month for riba and $40/injection for procrit.  I get delivery and can request that they leave it without signature.  They can only fill 1 month at a time.

I notice that my injections have a pretty close use-by date so I can't stockpile too much.  If you can stockpile keep an eye on the dates and use them in the order received.

[GrandmaBRZ]

I was able to get a grant from Healthwell Foundation to pay for the procrit when i have to pay out of pocket because  i have reached the limit the ins. co will assist for the year.
Since I am on a medicare type senior plan insurance, after the out of pocket has been paid, then I go on catastrophic which lowers the copay considerably for the rest of the year.

Healthwell is flexible on inicome limits.

Healthwell is very accessible, i  did have to supply IRS from 2007.  I was ure the process would take forever, ;however, they said they would inform me of my status within 7 to 10 business days and they did.  You can speak to a live representative and they are very helpful.  They are  available M-F,9 - 5:30 EST.  You can also fill out app on line.  

Good luck.  Jenn

[Bill1954]

Hi Liz;

Here is the Procrit assistance application:
http://www.procritline.com/patientassist/patient.assist.form.PDF
I've never required Procrit, so I'm not familiar with their income criterea, but it's worth a try.

Take care-

Bill

[Liz50]

...seriously, I have been so depressed all day thinking about the huge amount of money we are paying for meds....and we are insured. (Humana, also, but the plan is written by Walrus' co, so we can't make any fuss..Humana just administers the plan)

Walrus has been able to work, makes too much $$ to qualify for any assistance program, so I went to work also, to ease the burden a little. Trust me, I tried everything and everywhere I could for assistance and it just isn't there for us.

I will check out the Procrit deal..luckily we have dodged that bullet, but Walrus is really dragging....don't know if Procrit would be the answer. We'll see what his new doc has to say. His hemaotocrit has hovered around 11 almost the whole time...but he is a big guy, don't know if that makes any difference. BUT he actually had to take a nap yesterday because his bath wore him out.(I really hope he was joking about that)

[Bill1954]

One of the problems that we experience is that some policies specifically exclude self- injectables from their formularies, although most of them DO pay for insulin. Go figure.The policy will still cover the meds, but they’re covered through the “major medical” rather than the pharmacy policy. This can leave the patient facing up to 30% co-pay for meds. I was paying about U.S. $600/month for much of last treatment, then called Roche’s Pegassist program, and they stepped in to cover the difference.

This time, Schering-Plough’s Commitment To Care assistance program has paid for the last 76 weeks of treatment for no cost to me.

This service is available to those that are uninsured, (in my case) underinsured, or are rejected by their policy for one reason or another. As pK mentioned check out other sources as well- I recall seeing thriftymeds.com as a decent source, and I think Procrit has a Patient Assistance Program as well. Unfortunately, most of us don’t discover these resources until we’re done with treatment :o). The patient assistance programs use primarily income rather than asset based criteria for assessment, and some are fairly liberal… it’s not just for indigent patient’s; they help the working poor as well.

Check these out, and let us know what you find,

Bill

[Xenigma]

I do get delivery service, but I have to be home to sign.
-------------------------------------------------------------------------------
I have delivery service as well, but I have a release
that I don't have to be home to sign. (I work)
Ask about a release so you don't have to be home.
Everything is packed in icepacks in a cooler and then in a box.
enigma

[dandyeasy]

I have the great HUMANA insurance plan (yeh right) , couldn't qualify for any assistance, failed the labwork for a drug study. I did 24 weeks of treatment with each month costing me $465.
Tomorrow is my last shot so the payment gouge is over for me.

Curascript calls the other day "it is time to reorder". I replied "oh no it isn't. Have a nice day".

[Liz50]

Thanks for the thoughts...and oh, yeah, when Walrus got the 1st scrip I went right to bat figuring out the best (and cheapest!) way for us to get his meds. We are actually going with the cheapest possible supplier, believe it or not.
I am amazed that so many of you are paying so little for these drugs??!! This just does not make any sense to me at all.
And it is the "fault" I suppose, if fault is the right word...of our ins, co. Walrus' company is self insured, so we do not have a lot of options. I am glad for those of you with the terrific insurance coverage....and cannot figure out why we are paying over 100X's what you pay for the same stuff.
We don't qualify for any financial aid....trials, nothing. Trust me, I looked into everything. Our mail order pharmacy doesn't handle this stuff, our local pharmacy's price was twice what we pay...so we go with Caremark, since that's who our ins is with.
Thanks, tho, for the ideas. Maybe they can help someone else.
Liz

[pKinCA]

Forgive me in advance if I am suggesting things that you have all already tried or things that don't pan out... but have you thought about these ideas:

1)  Costco -- I've heard that their med prices are super low.  I don't have experience with their pharmacy, but I was gonna try them if for some reason my meds were super expensive or I was denied...  I know you do not need to be a member to use their pharmacy...

2)  What about patient assist programs?  In other threads, Bill1954 has listed drug companies and telephone numbers... there are numerous web based organizations that can help too... i.e. rxassist.org

Liz and Walrus -- Push hard for the mail-in three month supply.  Maybe your dr's office can go to bat for you.  Try filing an appeal... Try calling as often as possible until you get lucky and get a real caring human being on the phone... I've often been called "a chihuahua" -- small, but persistent :-)

I'm sorry to hear how terribly expensive this is for some... really not fair at all...

[charm27]

When I started txing I had Vista. My co-pay would have been 585.00 with the Peg & Riba. I couldnt go that route obviously being alone and supporting myself. ( That would of been every month)

I changed insurance.
Its a wild and wooly world out there.

[Liz50]

... feel like crying. We pay almost $700 a month for Walrus' meds..pegasys and riba. We cannot use our 3 month mail order pharmacy for this (ins reasons, I suppose). Other drugs for other s/a's brings his total to about $850 a month. Jools....WE have the worst insurance!! I dread the thought he might need a ProCrit shot ($2000 a pop).....and that, as far as I understand, is OUR portion.
40 weeks to go..Walrus is understandably depressed, doesn't know if he can keep this up. I hope he doesn't read this post, he feels bad enough as it is how much all his medical care has cost us so far.

All of you with the great coverage...WOW, be grateful. We'll be almost $8000 out of pocket just for the Pegasys/Riba by the time he finishes.
Liz

[jools57]

I must have the worst insurance on the planet, (it's Hometown Health in No. NV) I was paying $322.00 for peg and co peg 1 month supply, then my husband filed for divorce and roche is now paying for meds thru their program. I have to pay $452.00 for my monthly procrit. I also pay COBRA $333.90 because same husband lost job at beginning of tx, and i needed the insurance for all those blood tests. I did injection 38 last night!!! 10 more weeks, woowhoo!!

[Bobby1952]

I have HIP insurance which covers my drugs as well. I pay $5 for a month of Interferon and $2 for a month of Riba. Depends on the Ins.

Bobby

[pKinCA]

Does your mail-in pharmacy fill 3-month prescriptions?  If yes, that is the best way to go -- lowest co-pay and you'll always have a big stockpile.  

That is how my rx was filled... At first I sent in only one month rx, but then I noticed online that they fill 3 month rx's, so when I called to make sure they received the rx in the mail, I asked about changing it.  They actually called my dr.'s office for me and doctor faxed over new rx.

(Medco charged me $10 for 3 months of pegasys and $40 for 3 months of ribavirin)

[lmr28]

I know they mentioned caremark is the specialty (ironic, term, huh!) pharmacy.  I do get delivery service, but I have to be home to sign.  It sounded like the nurse w/ the hospital  hep team was taking care of pre-approval. I better call Mon. to make certain.  

Good advice on stockpiling.  I would never have thought of that!

[Xenigma]

As spcecst said, wait as long as you can and stockpile some shots
and pills in case of a glitch w/insurance.
I had 2 boxes of Peg in the fridge before I started tx and I'm
glad I did.  One less thing to worry about during tx.
enigma

[Xenigma]

My co-pays per month are:
$25.00 for Pegasys and $7.00 for RibaPak.
($25.00 for Procrit which lasts 2 months now, I shoot every other week)

[spcecst2]

One little tip!! When you get the meds wait a couple of weeks beofre you start that way your refills will always be ready to fill and you'll have some left cause you don't want to be caught short in case there is ever a problem I always have at least four weeks left when the refill is due!!!!!!!!!!!!!!!!!!!!!!! And if you call it in tell them you only have one week left so they'll rush it, assuming you get delivery service!!!!!!!!!!!!!!!

[spcecst2]

All insurance is different cause my bcbs is 70 for three months worth of fun loving shots and pills!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Some drugs that go thru the "specialty pharmacy" need prior approval before they will fill the script!!!!!!!!!!!!!!!!!!!!!!!! medco, caremark etc.......