Medicare an Avonex

[akafearless]

Okay I must be doing something wrong on the criteria...trying to pick my coverage for 2014 and can't find a plan, etc that covers Avonex better than tier 5 with a 33% copay. I asked Humana for an exception. It was denied, Avonex is a speciality drug. I'm like well duh! She's supposed to send it to me in writing.
What does everyone else use or do?
Thanks.

[kmallory1]

I'm dealing with Medicare part D and Tecfidera, basically the same problem. Last year I had group coverage for prescriptions.

With the high co-pay on tier 5 drugs, you hit the donut hole, go through it, and into catastrophic coverage in the first two or three months. Then your co-pay is 5%, which is still high for Tecfidera.

My total out of pocket for a year will be over $5,000, most of it has to be paid in the first few months of the year.

The Tecfidera $10 co-pay program from Biogen is not available if you are on Medicare.

You might check with Biogen and see if they have any programs for Avonex.

[bubblebabe]

I don't have Medicare but I do have Humana so maybe this will help.

I just started Avonex 2 weeks ago and the day my doc said I was going on Avonex I went home and made an account on their website. Then they sent me a welcome package and I called the number inside to find out about price and when it would be delivered.

My new case manager handled everything and kept me updated by email. She set it all up with Humanas Right Source RX Specialty Pharmacy and told me that Humana would pay %75 so my copay is %25 of the cost which came out to $1101.00!!
After choking on my coffee she asked me if I wanted copay assistance and I said yes absolutely!! Biogen is paying all of it except $10, so my monthly copay is $10!!
Then a few days later Rightsource called to setup delivery, easy peasy, I did really nothing and she did it all.
Oh and I actually didn't even pay the $10 for the first month, first month was free!!
On their website I printed out a form that gave me the first month free and I just filled it out then faxed it to my doctor with a note telling them to fill out their portion and fax to Biogen for me.

So that's my story, hope it helps but either way please contact Biogen they will most if not all of your copay. There are also other places that will help, there is no reason for your to pay that kind of money each month.

Good luck and keep us posted