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    Cost of Gilenya

    I was on Avonex but it wasn't working. A recent MRI showed a lot of new lesions, so my physician is now recommending this new oral medication.

    About how much does it cost?

    Thank you!

    #2
    The quoted cost without any insurance coverage is $4,000 every 28 days. However, most insurance will cover it. For me my coverage would be the same regardless of what MS drug I take: I'm responsible for a 25% co-pay that maxes out at $2,500 a year. So I'll pay $2,500 a year for it (the same as what I would pay for any of the other MS drugs). Most people that I've seen have lower co-pays at least percentage wise but not sure they have a cap. What I would do is call your insurance company and ask what it would get charged at. (Also some of the specialty pharmacies charge less than the full $4,000 for the drug.)

    Hope this helps in any way.

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      #3
      Thanks, that really is helpful.

      I was just doing some reading on this and $48,000 is shocking. I feel guilty even asking my insurance company to pay for it -- it will be a disaster for them.

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        #4
        I understand that feeling. I mean how is any drug really worth just under $150 per pill? But I don't the government is ever going to stop pharma from setting their own prices so what can you do?

        What really irks me is that Genzyme is thinking about providing their drug Campath for free to cancer patients, so Genzyme can jack up the price for a smaller amount of the same drug to MS patients.

        Novartis' pricing decision seems outrageous, but really it seems that way with just about all of them.

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          #5
          Originally posted by arjay View Post
          Thanks, that really is helpful.

          I was just doing some reading on this and $48,000 is shocking. I feel guilty even asking my insurance company to pay for it -- it will be a disaster for them.
          You need to get over that guilty feeling. Trust me, $48,000 is a very tiny drop in the bucket for insurance companies.

          Comment


            #6
            I just ordered a three month refill of Gilenya through MEDCO and the listed cost that my insurance plan pays is $11,543.08. My co-pay for the three months is $60.00.

            Comment


              #7
              Originally posted by Abby View Post
              I just ordered a three month refill of Gilenya through MEDCO and the listed cost that my insurance plan pays is $11,543.08. My co-pay for the three months is $60.00.
              Yep that sounds about right, it should be about $4000 per 28 day pack.
              I am truely blessed to have the health insurance I have, I pay $9.00 for 3 packs. (military insurance)

              CrazyCatLady
              MS Does Not Define Me.....My Love of Tea Does! LOL!

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                #8
                $3,957.22

                Way Too Much! My insurance was billed $3,917.22 & I only paid $40 co-pay for 28 pills.
                Andy

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                  #9
                  My insurance (United Health) uses CVS Caremark for their prescription plans. My plan pays 80% with a co-pay of 20% until I hit an out of pocket maximum of $1500 per year. My co-pay for my first shipment of Gilenya would have been $760 but I was approved for the Novartis Co-Pay Assistance program - they are picking up the co-pay!

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                    #10
                    Originally posted by tombo131 View Post
                    My insurance (United Health) uses CVS Caremark for their prescription plans. My plan pays 80% with a co-pay of 20% until I hit an out of pocket maximum of $1500 per year. My co-pay for my first shipment of Gilenya would have been $760 but I was approved for the Novartis Co-Pay Assistance program - they are picking up the co-pay!
                    Wonderful!!!!!!

                    CrazyCatLady
                    MS Does Not Define Me.....My Love of Tea Does! LOL!

                    Comment


                      #11
                      anyone

                      cost of gilenya insurance blue cross blue shield of texas would I call the ins. co. to see what they would pay if any
                      We have a 8,000.00 out of pocket before they pay anything

                      also should I check with my pcp bout starting it since I do have copd read up on gilenya poss. breathing problems
                      concerned with this side effect.

                      Apreciate any info yall can give me Thank you have a wonderful day and GOD BLESS

                      Comment


                        #12
                        Originally posted by ccsitter View Post
                        cost of gilenya insurance blue cross blue shield of texas would I call the ins. co. to see what they would pay if any
                        We have a 8,000.00 out of pocket before they pay anything
                        It sounds like you talked to someone who might actually know what they're talking about, but you might want to double check. I called Anthem BCBS three different times and got three different answers (no coverage, coverage with $30 co-pays and coverage with us paying 25% that's capped at $2,500 a year).

                        If it were me I would probably call again just to verify that this is indeed what your plan requires (to double check you can ask them to run a test prescription through, I know they can do it because the claims person I talked to did).

                        Originally posted by ccsitter View Post
                        also should I check with my pcp bout starting it since I do have copd read up on gilenya poss. breathing problems concerned with this side effect.
                        I was unaware of the breathing side effects until just recently. With COPD I would definitely talk with both your PCP and Neuro about this. You probably also want to find out how they would plan to treat any respiratory infections, bronchitis, etc. You also might want to get a guesstimate on recovery times.

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                          #13
                          payment assistance for Gilenya

                          see this link regarding thier policy for assistance
                          http://www.fiercepharma.com/story/no...lls/2010-10-07
                          Plan for the future, but not too hard; it’s not your decision anyway

                          Comment


                            #14
                            Originally posted by Abby View Post
                            I just ordered a three month refill of Gilenya through MEDCO and the listed cost that my insurance plan pays is $11,543.08. My co-pay for the three months is $60.00.
                            $20 a month fits everybody's budget.
                            Without hope there's nothing.

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                              #15
                              I called Empire bcbs. They said it is not formulary and therefore would require the dr filling out pre auth forms and then if it is approved then they could give me a cost not now.
                              I can't start till may so i wont no till then what i am doing. I first have to b off Ty for 3 months so i will be starting Copaxone till i can start Gilenya.
                              laurie f

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