Insurance and Copaxone

[jmerced]

Hi,

I just switched insurance plans. I was talking to the pharmacy that delivers my copaxone, and the person I was talking to said that the cash price is $10,000. For a month? Does this sound right?

I mean, obviously I don't have to pay that, but I'm trying to go back to Shared Solutions and ask for them to pay my Out of Pocket Maximum of 5k, instead of my previous assistance amount of $3500. I can't afford paying $1500 of it on my own! And if they're getting $120,000 a year from my insurance company... 5 grand seems reasonable.

Any input??

[MrsBones]

Hi,

I just switched insurance plans. I was talking to the pharmacy that delivers my copaxone, and the person I was talking to said that the cash price is $10,000. For a month? Does this sound right?

I mean, obviously I don't have to pay that, but I'm trying to go back to Shared Solutions and ask for them to pay my Out of Pocket Maximum of 5k, instead of my previous assistance amount of $3500. I can't afford paying $1500 of it on my own! And if they're getting $120,000 a year from my insurance company... 5 grand seems reasonable.

Any input??

Could they have quoted the pricing for three months instead of one? That would sound closer. I've heard the cost quoted between $3200 to $4500 per month, but never as high as $10,000.

Call the insurance co and the pharmacy again and double check. SS will also do their own checking if your insurance has changed. Pre-auths may be required,etc...stuff they need to check on/deal with.

Also, will they still be your specialty pharmacy with the new insurance? That makes a difference, too.

[LisaL77]

My neuro said Copaxone costs $25k per year. My very first question was "Is it covered under BC/BS???" He replied yes. Weird.

[heliotrope]

Call your insurance, not the pharmacy. Keep in mind, the insurance company negotiates contracts with the pharmacy. If you don't have insurance, you don't have that contract - hence a "cash" price.

[jmerced]

We're all good! Shared Solutions has got my back.

Thanks guys.

[poohb3ar]

yeah!!!

so glad it worked out for you!
copaxone was my DMD that i liked best but had to quit because of the high cost and am now not taking anything which is scary. but i just can't afford too and the Avonex and anything like it my body started rejecting and making me worse.

stay healthy!

[LisaL77]

I'm on a high deductible plan. My employer contributes $2600 and I contribute $2400 over the course of the year.

My employer graciously front-loaded my Health savings account with their $2600 and agreed to take $750 a pay period from me until my $2400 is satisfied. This will take 6 weeks.

I hope I have enough in there when Shared Solutions comes. They can't even tell me how much it will be yet.

[marybenes]

I encourage those on Copaxone to check with Shared Solutions about their patient assistance programs.

[its2much]

Is there anything new with thieir assistance programs?

When I last spoke with them the maximum copay assistance they would give (when you have insurance) is $500 per month. As I said many times It really doesn't help me when my out of pocket copay is over $2150 per month.... It's crazy, if I had NO insurance they'd give it to me for free.....

[GracieBH]

Whenever I see questions about the costs and insurance to cover the DMD's, it's really heartbreaking. To know those of us with MS are being drained from our finances by medicines that cost up to $5000 a month.

I just ran into this issue and have been without my meds for 3 days now and the stress is so high on me right now that I have no energy and just actually start sobbing.

As I'm sure many of you understand it's like waiting to have the rug pulled out from under you. Every year the cycle starts trying to get my medication and basically throwing myself at their mercy to say yea or nay.
Just isn't right.

[ME610]

I am very LUCKY to have WONDERFUL insurance. I pay $40 for a 3 month supply of copaxone. Included in the delivery is what the insurance pays minus my co pay.... a three month suppy is nearly 12K.

It astonishes me how expensive this drug is... and how much it has increased since I started four years ago.... but I guess everything else has increased in price too.

I am convinced that the price of the drug has increased due to the number of people out of work or without insurance. Seems to me that Shared Solutions is taking atvantage of the insurance companies.

Shared Solutions has contacted me about assistance paying my co pay.... I have declined each time. While it would be nice NOT to pay $40 four times a year, I could never afford to pay for it out of pocket and feel for those of you who have to foot more of the bill.

BTW my insurance company sends me a spreadsheet of costs each year.... my drugs cost me nearly 60K... most of which was Copaxone.... which was darn close to my yearly salary. I will be so screwed WHEN my insurance changes.

I am thanking God for good insurance while I feel for all of you without decent or no insurance!!

[its2much]

Cost of Copaxone

Here's another kicker with the cost of copaxone with my 50% copay. I called the state insurance department in my state to inquire/complain about my cost. I was told - "what are you complaining about - you get a 50% copay"! Wow like I was getting over $25,000 when I have to pay out that $25,000 per year plus the costs of other drugs and medical expenses and annual health insurance premiums (this under the "low cost" Obama health care reform) of $10,000 per year!

[its2much]

jmerced is shared solutions now paying your total copay - out of pocket?

We're all good! Shared Solutions has got my back.

Thanks guys.

[kgrant2]

copaxone copay

Just talked with shared solutions this morning. They are willing to pay $2500 toward my first rx of copaxone and I have to pay $1500. They told me the cost is $4000 per month. my deductable is $5000 with a $7000 out of pocket maximum per year. After the first month I will pay $35. Needless to say I was quite pleased when they called me back. A few weeks ago all they would assist me with was $500 per month...no way can I afford my high deductable and copay...so I told them that I was quitting copaxone and was very upset about it. I couldn't' believe that they are now coming back with giving me $2500 and only charging me $35 thereafter. I asked what happened so quickly for this to change and the woman told me that they just received this new offer. I thought it was weird, but will of course take it. Also, the reason why Copaxone is so expensive is because half of Teva's income/profit for the company is because of the sale of this rx. No other company will make this because of the expense, expecially when other companies are working on oral meds. When those come out the cost of copaxone will drop. Until then, they know we need this med and don't care if they bleed us dry.

[BigA]

Teva aren't the most generous. If they can make money overall, they'll help you pay down your deductable. The problem can be that when you don't have insurance anymore, you can't get Copaxone. It's unfortunate.