Posted , 6 users are following.
I'm a "graduate" from PMR diagnosed a year ago with sero-negative RA. After a year trying to find the right dosage of drugs that now include methotrexate, plaquenil, and prednisone, my rheumy wants me to try Humira. Even getting past all the associated risks, I'm put off by the cost. My medicare Rx plan wants a $1500 co-pay for 2 injections. Any suggestions?
0 likes, 8 replies
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EileenH FLpanhndlKen
Posted
Sorry to hear that Ken and I remember you from the PMRGCA forum - but I'm not sure how many on this forum are in the US. Maybe someone is. Good luck.
FLpanhndlKen EileenH
Posted
Hi, Eileen, and thanks! Someday we Americans will catch up with the rest of the Civilized World with regard to healthcare ... probably not in my lifetime. We all have villains we deal with in daily life, and this week my list has a new and fearsome one: BIG PHARMA!
Gloria814 FLpanhndlKen
Posted
Once we have Medicare coverage paying for biologics becomes very difficult.Luckily my husband is still employed so I have his insurance coverage but soon will need to go on Medicare and I have had this discussion with my rheumatologist . I don't know if you have original Medicare,. Medicare advantage or part D but I found a helpful site called
Boomer benefits and their article entitled How does Medicare cover RA
That would also apply to other autoimmune diseases that need biologics medication.
My doctor did inform me that if I have the infusions or injections at their office then Medicare will use part B but you still have a copay. This is explained in the boomer article I just referenced.I am not certain but I think we would still need to pay a hefty copay. The copay you mentioned would not be affordable for us and I assume that is a monthly copay.
FLpanhndlKen Gloria814
Posted
Thanks for the reply, Gloria, and thanks especially for the Boomerbenefits recommendation! I've already been to the site and had some things made clearer. One is that the Humira coming as it has this time of year has kicked me into my donut, hence that $1500 copay. My pharmacist has found me another plan for next year that will, after a combined outlay of about $2500 in Jan/Feb, will settle down to around $300/ mo for the rest of the year. That hurts, but not as much as $1500/mo forever! Again, many thanks. Going to share Boomerbenefits with all my Plan D clueless friends!
Gloria814 FLpanhndlKen
Posted
Glad that the Boomer benefits helped you. I tried to find the article on Medicare and RA drug coverage but could never find the exact one again.I did read that in 2019 the donut hole is disappearing for non generic drugs. But supposedly it's a good thing. I still find it all very confusing.From what I understand specialty drugs like Humira cannot give you the discount if you have Medicare or Medicaid insurance.I have been on humira and cimzia for RA and crohn's disease
but had side effects of chest pain and shortness of breath that caused me to stop taking
diane77471 FLpanhndlKen
Posted
Hi, I'm not certain but seem to remember my humira nurse telling me that the company would cover all but 50.00. it's worth calling humira direct. The good news is that I've been able to get off all the other drugs since I started taking my bi monthly injections. Good luck
jo66120 FLpanhndlKen
Posted
I am on MEDICARE. if u have Medicare and supplement insurance your Part B of your Medicare will pay 80 % for infusions and the supplemental will pick up the rest. I have found that Medicare prescription Part D does not pay much for any pills or injections because the biologic drugs are in the Tier 5 of the insurance and the price is extreme. wait until u hit the " Donut hole". Maybe you would qualify for the program that Humira has to help offset the cost.
Anyway, the infusion drugs for RA are: Tocilizumab ( Actemra), Abatacept ( Oriencia ), Infliximab ( Remicade ), Rituximab ( Rituxan ), Golimumab ( Simponia aria) and I think Certolizumab ( Cimzia).
I have been on Remicade and now on Orencia, but Ithink in a few months my doctor is going to make a change and put me on Actemra, who knows.
I hope this is helpful. Good luck and I wish you well.
Guest FLpanhndlKen
Posted
Go to the Humira site and click on monthly savings for humira. It should be in the top box
(hopefully this makes it thru) I only paid 5$ for my shots and it was the auto inject pen. They are wonderful. The only question they asked was whether I was on goverment asst.
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