This is an all call for anyone taking a brand-name drug, and living inside the USA, who have health insurance. I find that most of the brand-name drug companies offer co-pay assistance for the more expensive drugs. This includes many of the Biologics: Remicade, Humira,& Enbrel; as well as other namebrand medications that may have nothing to do with PSA, such as your blood pressure medication, your pain medication, or your brand-name NSAIDs like Celebrex or Mobic.
Where do I find these wonderful little treasure cards? Well the easiest place to look is online. Go online and Google search your medications name, and the words “patient assistance”. This should take you to the drug company’s website and their patient assistant page. Many of these places have discount cards that you can print out and take with you to your pharmacy. Some will ask for some demographic info first, and mail you a card to give the pharmacist. You can also share the numbers with your mail order pharmacy by phone. Some of the mail order pharmacies will want you to fax that card over, but it is well worth the time and $.75 at 7/11 to fax that little puppy to the company.
How much do these cards usually save people? Well, that varies, and depends on what the drug company is willing to give, but most of the cards will save you hundreds if not thousands of dollars per year. For example my co-pay for Humira was $50 from my insurance company. I got the co-pay assistance card and it drop my co-pay down to $10 a month. Another example is Remicade, my co-pay for this drug was nearly $300 a month. However with the Remi-start patient assistance program, I pay absolutely nothing. I also use the patient assistance programs for other medications that I take. One of my pain medications has a co-pay of $75 a month. But, I have a co-pay assistance card that brings my co-pay down to $10 a month. I have another medication, Lyrica, I take the brand-name medication. So, I have a patient assistance card from the drug company and it drops my co-pay from $75 to nothing. So, you can see that it is well worth the time and effort to go online and search these little treasure troves out.
One other caveat to most of these programs, is that it cannot be on Medicare or Medicaid. These programs are usually intended for patients who have health insurance, to help them with the co-pays. I think that stinks, but Medicare and Medicaid will not allow these sorts of coupons to be used for their patients. They consider it to be steering patients toward certain medications.
Anyway, I just wanted to share this with everyone so that they could save a little bit of money on their drugs. Have fun hunting, and I hope you get some great discounts!
Wow, Grumpy, great post. I think you should repeat the posting in the Newbies’ Guide section – lately, we’ve had several members mentioning the prohibitive costs of drugs. Don’t know if posting links, or just cut and pasting a repeat post into the sections would be better.
This is really important information for some of our members. Thanks for taking the time.
My Enbrel really did get approved today so I contacted Enbrel Support and all of my deductible will basically be paid by them!!!! The cost of biologics had been one of the deterrents for me and now that's something I don't need to worry about. Anyone new, when you do see your doctor and he/she is recommending a biologic, they have brochures which include a support membership card. Once the biologic has been ordered, you call the number on the support card and set up your "account". It's almost like a debit card with a nice sum of money on it. Now when the mail order pharmacy calls me to set up a delivery time for the Enbrel, I'm supposed to give them the membership ID numbers on that card and they will access that for payment of whatever my insurance won't pay. This is too good to be true! At least this is my understanding-moderators, correct me if I'm wrong.
Seenie said:
Wow, Grumpy, great post. I think you should repeat the posting in the Newbies' Guide section -- lately, we've had several members mentioning the prohibitive costs of drugs. Don't know if posting links, or just cut and pasting a repeat post into the sections would be better.
This is really important information for some of our members. Thanks for taking the time.
The prescription assistance cards pretty much work for anyone in the US with private health insurance (aka not Medi-caide/-care). I never paid a dime for Enbrel for 8 months and now I'm on Humira I pay $10 per month (typically--see below). When you call the online pharmacy they will likely scare the pants off you and give you our co-pay total excluding the Rx assistance. Just remind them nicely you have Rx assistance and they'll make the deductions. I have run into issues now and again where my pharmacy "forgot" to bill the Rx assistance and I simply refused to pay the pharmacy. I asked them to re-bill the Rx assistance program an, what do you know? $10 copay.
*There are some other weird things with the Humira assistance program. What they do is to deduct an amount from what you owe after insurance up to all but $10 of the post-insurance cost. , However, they give you a LOT more help on your first prescription of the year because they know you won't have met your deductible. My third bill of the year was odd because they gave me less help than the first month. That month ended up costing be about $60. But when I called to check they pharmacy and the Rx assistance program people were actually really great and helpful in explaining everything.
One last thing to mention, these cards have a fixed duration and you do need to renew your enrollment each year. Usually that's over the phone. Like Grumpy said, it is really worth doing. I applied for my Humira card online BEFORE I got my prescription from the doctor!
I’m not sure about Kaiser. They are a little different in many ways, but call your drug company’s assistance program and ask. They will know. It’s well worth the time you spend. I don’t see why it wouldn’t apply though. The disclaimer only mentions Medicare and Medicaid.
Coconut Girl said:
Do you know if this works for Kaiser members as well?
There is nothing weird about the Humira copay card. For some insurance companies, Humira cost more than other similar biologics. Sometimes you get the run around. The card gives you more money for the loading dose, and not for the regular dose. There is a max monthly payout, but since deductible is less they pay all but 10 USD.
I'm not sure about Kaiser. They are a little different in many ways, but call your drug company's assistance program and ask. They will know. It's well worth the time you spend. I don't see why it wouldn't apply though. The disclaimer only mentions Medicare and Medicaid.
Coconut Girl said:
Do you know if this works for Kaiser members as well?
That is typically true, but I fell into a gap with it and had to pay more than the $10 for one month. It made sense when they explained it, but it wasn't only $10 a month for me.
mataribot said:
There is nothing weird about the Humira copay card. For some insurance companies, Humira cost more than other similar biologics. Sometimes you get the run around. The card gives you more money for the loading dose, and not for the regular dose. There is a max monthly payout, but since deductible is less they pay all but 10 USD.
Oh yeah I did that with Humira a while ago I think methotroxate is on it too at least I think I remember seeing a discount for methotroxate on the back of the Humira card!.
That is typically true, but I fell into a gap with it and had to pay more than the $10 for one month. It made sense when they explained it, but it wasn't only $10 a month for me.
mataribot said:
There is nothing weird about the Humira copay card. For some insurance companies, Humira cost more than other similar biologics. Sometimes you get the run around. The card gives you more money for the loading dose, and not for the regular dose. There is a max monthly payout, but since deductible is less they pay all but 10 USD.
All the copay assistance cards have a payment cap (monthly or whatnot) and if you go over that amount your copay is going more than what is stated on the card. Also, you card is only typically good for 10k USD, so it possible to run out. This information is typically provided by the card provider.
My insurance won’t cover all of the cost of humira I had to get it from my Dr office. It was still like $900.00 and my methotroxate is $25.00 a month not too bad I guess. I’m about to lose my insurance though and Dr visits will be $140 plus paying for labs! So I’ve gotta find some insurance fast.
One other thing: it was all pretty much taken care of before I left the doctor's office. I had to wait a little while to start Humira, so I had to make a phone call to the patient assistance center when I did start it.
Just a reminder that these cards are available for more than just PsA drugs. Most brand name meds will have an assistance program. I just got a $10 card for a patient of mine for Januvia. It literally PAYS to take a look at all of your prescription drugs.
Losing coverage is considered a “life event” and opens you up to a plan from the ACA. The rates are income based and (depending on what your state decided) could even be subsidized. Go ASAP to https://www.healthcare.gov and fill out the application, pick your policy and make the first payment. Make sure that you look closely at what the policy covers and the docs that participate with the plan. Remember that cheapest is not always the best in this area. The “Bronze” plans will have a large deductible before most things are covered. A “Platinum” plan will have a larger monthly cost, but will give you no deductible, and lower copay prices. I don’t know how to emphasize enough that you need to get this done NOW, YESTERDAY, ASAP, STAT! You do NOT want to be out of insurance. Been there, done that, and believe me…it sucked!
As far as Humira, you definitely want to try to use the copay assistance card with an out of pocket like that!
Some docs are wonderful, and get the copay assistance rolling for their patients. Others? Not so much. Fly example, my dermatologist is excellent about coupons and samples. I always leave his office with a goodie bag. When I started Humira, he got the copay card set up for me too. My first Rheumatologists office was good about that too. When I switched to Remicade. My next rheum, didn’t do a thing. I learned that I needed to move my plan over, then had to figure out how to transfer the Remistart plan to the new office. He prescribed some new things and gave me samples, but never coupons, or even mentioned that there were coupons available.
It’s good to be informed since the docs don’t always help out on that front.
jennyb said:
One other thing: it was all pretty much taken care of before I left the doctor’s office. I had to wait a little while to start Humira, so I had to make a phone call to the patient assistance center when I did start it.
The methotrexate discount is likely offered by Abbott the maker of Humira since they are often used together. Methotrexate is now a generic drug, and is made by numerous manufacturers. Since it is no longer under patent, they aren’t making a ton of money on it, and don’t charge a ton for it. It’s usually not a very expensive copay. So, the manufacturers don’t offer discounts.
By offering a discount on both Humira and methotrexate, Abbott gets more patients interested in their drug over others on the market. Very savvy.
Amelia said:
Oh yeah I did that with Humira a while ago I think methotroxate is on it too at least I think I remember seeing a discount for methotroxate on the back of the Humira card!.
Losing coverage is considered a "life event" and opens you up to a plan from the ACA. The rates are income based and (depending on what your state decided) could even be subsidized. Go ASAP to https://www.healthcare.gov and fill out the application, pick your policy and make the first payment. Make sure that you look closely at what the policy covers and the docs that participate with the plan. Remember that cheapest is not always the best in this area. The "Bronze" plans will have a large deductible before most things are covered. A "Platinum" plan will have a larger monthly cost, but will give you no deductible, and lower copay prices. I don't know how to emphasize enough that you need to get this done NOW, YESTERDAY, ASAP, STAT! You do NOT want to be out of insurance. Been there, done that, and believe me....it sucked!
As far as Humira, you definitely want to try to use the copay assistance card with an out of pocket like that!