Medications and costs

Hubby went in to get his endicort last night and talked to the pharmacist about humira and was blown away. it costs 1500.00 month without health ins. we have a good plan but what would one do if you didnt have a job etc??? Its so worriesome because these disesases can makeit hard for ppl to work

Also in addition to your insurance the makers of Humira have a assistance program that is not financially based. It is called my humira and can lower the cost to 5 dollars. Most of the biologics have a program like this.

Yep, assistance program. Even with insurance my Remicade portion was 800 dollars. They set me up with a coordinator who asked me how much I could pay (with no wrong answer including 0). They even offered to pay my premiums for enrolment in a public insurance plan.

Why are they giving their drugs away? Who's paying?

I hear ya! I have no idea what I would do without my insurance. My Humira is $3296 per month. My insurance cap is $10 so that is all I have to pay...Thank goodness! I am also signed on with the Humira/Progress programs. They deal with my Doctors, pharmacy and my insurance provider directly, as well as provide journals, sharpe containers and any support I may need. It's a great program

Most (NB and PEI are the only holdouts I think) Canadian provinces have catastrophic drug coverage for expensive drugs. Not sure how the provincial programs programs work though.

The manufacture pays, for Remicade at least. They have a program called Bioadvance that they cover it through. Alberta also does not have catastrophic drug coverage. We have a public drug plan you can enrol, in but if you don't enrol and pay the premiums you are on your own.

If I'm a manufacturer of expensive drugs, why would I give them away?

I read that one reason a lot of people don't do EEN and EN is cost, which is ridiculous since it is so much cheaper than biologics. It's just that it isn't covered. Ridiculous.

I should say, usually not covered. It took us like half a year to get our insurance co to agree to pay for the Peptamen.

They get it at a reduced rate of $5 each and then they pay 80% of that. So, we only have to pay a dollar each, or $240 a month, which is actually a lot less than it would otherwise cost to feed our son, so I see it as "free".

We really had to fight for it, though.

They make buckets of money off of most peoples' insurance companies, so they can afford to essentially give medications away or discount them greatly to a select few. For example, I take Lialda. I pay a $75 per month copay. I think it's about $500 without insurance. My insurance pays the difference (likely they work out a sum that is less than the $425 difference, but still, the Lialda people get way more money from my insurance company than they do from me). And that's not even a particularly expensive med - when I was on brand-name Entocort (before the generic budesonide was available here), it was at least $1000 per month before insurance, but again, I was only paying $75 and my insurance paid the rest. And yeah, the biologics cost a lot more than that. These companies make money hand over fist and they don't want to look bad, so they offer assistance to people who need it because they can easily afford it. (I'm not anti big pharma, this is just my understanding of how the system works.)

Yes, it is ridiculous what is & isn't covered. A few years back when I had the pill cam, I had inquired about having the patency capsule (dummy pill cam that dissolves if it gets stuck) beforehand just to make sure the pill cam itself would pass through me okay. I was told no, because the patency capsule for some odd reason costs as much as (or possibly even more than) the pill cam itself and isn't typically covered by insurance. So, if I had the patency capsule, I'd be on the hook several thousand dollars for literally taking what amounts to one sugar pill. And if the pill cam had gotten stuck, my insurance company would have been on the line to pay whatever emergency surgery costs to remove it. Insane! It seems to me like the patency capsule should cost, like, a dollar. It's very odd how these things work.

Has anybody applied to Shire Cares recently? My insurance changed in 2015 which resulted in my Pentasa cost going from $75 a month to $925 (until reaching moderately high deductible & out of pocket). I've had my app in to Shire for close to 2 months with no decision. I've called them several times to confirm that they have all the required info. I asked if this was the normal time frame for a decision. Their response is that they are flooded with requests since a lot of insurance policies changed coverage January 1. Anyone else experiencing this with Shire or other pharm companies?

Our EEN or supplement all EN is covered but not through the prescription plan because as opp has said it still "food"
DS Humira is covered as is his other drugs but our copay is very high
The my Humira pkan only covers the difference for a shot every two weeks not every 10 days. - just found that one out.
Had to make more than a few phone calls to get some sorta coverage from my Humira since DS's dose went up.

My thoughts are the drug companies onky make money if people actually fill their prescriptions . Since the population base for biologics is small and the cost extremely high
-the companies know more people will take the meds if it's affordable to them and the insurance company is covering a lot of it
My Humira plan will not help with the copay on any govt program

We payed very little for remicade /Humira or EEN because of the plans we have in places