HealingWell
Search Close Search
☰

Paying for expensive medications!

Support Forums
>
Crohn's Disease
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 11/15/2012 2:06 PM (GMT -5)
Being new to the US and paying for my health care I was hoping you could give me some straight forward answers when I look online I'm confused and when I call my insurance I'm confused!

If I don't feel better soon my doctor wants to put me back on remicade he also mentioned possibility of Cimzia.

From why I am aware these are EXPENSIVE! I checked and remicade have a support system in place, are there requirements you have to meet to qualify for help? My step dad has a rather high salary, but it only just covers the costs of our family our life style school and my current meds! I feel bad I take up the majority of his earnings! But I also know we probably can't afford MORE medication expenses!

Any tips or info that I should know and probably don't would be appreciated so much!!! I feel so or of my depth here!

Thank you all :)
Posted 11/15/2012 3:26 PM (GMT -5)
I would ask your GI's office if they can talk to your insurance to find out how much would be covered for the Remicade, since they're the ones who have to set up with the infusion. I get confused when I call the insurance myself, too. They also might have a form for Remistart, which helps cover Remicade. As far as I know, it doesn't depend on salary. I'm not sure, though. I started to fill out the form but then my new insurance covers it 100%. Sorry, not sure if this helps.
Posted 11/15/2012 4:55 PM (GMT -5)
I am on medicare b/c I'm on social security disability and there are three parts to it.  Part A is hospital coverage, Part B is medical, and Part D is prescription drug coverage.  What I know about Remicade since I am on it is that it falls under medical not prescription b/c it's done in either a hospital or doctors office and is infused.  So it's not the type of medication you fill at a pharmacy and take.  The place where you are having the infusion should be ordering the medication and then billing it through your medical insurance.  I know there are some insurance companies that do not cover or cover a lot of the expense but I have seen on this site a lot about the remistart program.  I would call your insurance company and see how the infusion would be billed and if it's billed as a prescription contact remistart and found out if you're eligible for their help.  Also I don't know how high your step father's salary is but depending on your family size you may be able to get some sort of medicaid or family health plus.   Just make a couple of phone calls and hopefully you can get some answers.  Good luck to you :-)
Posted 11/15/2012 6:47 PM (GMT -5)
Thank you both really helpful!!

I think I will ask the doctors office to check, they will understand better! I'm almost certain we have coverage for all 3 parts I definitely know we have to prescription coverage already!

I'm current with BCBS and I spoke to one of my step dads colleagues and he said he pays the first $1000 I think, but that is still scarily expensive in my eyes haha

Have already looked into the Medicare etc pretty sure I can't qualify as a non citizen anyway!

But thanks again very helpful!!!
Posted 11/16/2012 9:06 AM (GMT -5)
If all you have to pay is $1000.00 for a deductible and then everything else is covered, you are doing very well by US standards. You can contact the drug company who produces Cizmia, and see if they offer assistance. Typically with insurance there is some sort of deductible, then many policies have you pay a percentage of the cost (co-pay) until you reach an out of pocket maximum. Then you get covered at 100%. Every BCBS policy is different as each employer negotiates individual contracts. So saying that you have Blue Cross doesn't help you to understand how much coverage you have. Your stepdad's employer should have a human resources dept, and someone there can possibly help you understand your benefits, or you can call Blue Cross directly. I hate the American health insurance system as it is very unfair to many people, but hopefully there will be positive changes with the Affordable Health Care Act. In the meantime, try not to feel guilty for needing your medicine. If your stepdad is making a good salary, hopefully he is happy to help.
Posted 11/16/2012 9:40 AM (GMT -5)
Let's see Remicade, Humira and Cimzia all have help plans. I qualified for all three, never any income questions of any kind. It's like the system is rigged, They take what insurance pays and the rest comes from their plan. Funny money.
I was taking Remicade, had to stop. Doc wanted Humira insurance co said no, why I have no Idea. They called in for Cimzia. finally OK for Cimzia. get a call back for Humira they want me to go with them got the card for discount. basically email address and insurance ID. I'm using Cimzia, right now, no bill yet not supposed to get one with card anyway a maximum of 5 dollars.
The 1000 dollars you referred to is probably an individual deductible and then there is a family deductible. All in all not a bad plan. It is better than mine. If you get the Remicade Avoid hospital infusion location, I had 2 infusions before I got a bill. Like 25000. I about had a heart attack seeing that one. after insurance it would have been about 10,000. Office infusion and remistart was next to nothing.
Get your dad to get the web address to your health benefits site you can learn a lot there. I just went through the enrollment online for mine this week, you dad might have done it or is about to do it it is a yearly thing most everybody goes through.

Better Living Through Chemistry

T
Posted 11/16/2012 5:22 PM (GMT -5)
That 1,000 was my my dads coworkers deductible I think. Our family deductible is very different, I know my individual deductible is over 1000 and our family is under 2000. Not exact on the figures my mum deals with those haha thank god!!

Thanks for the tip on office infusion, what is the difference though? Lol!

I think I will get someone who is likely to understand to contact my insurance company and translate maybe my boyfriends family or if not my GIs office, you all just use a lot of unfamiliar terminology!

When I moved to the US I was usin humira, I didn't do so well with it though and I sill have 3-4 pens left, is there something other than disposing of them that I can do before they expire in the next couple of months? I just want someone to use them as they're so expensive!

Thanks for ALL your help!!!!
✚ New Topic ✚ Reply