Gilenya co-pay assistance

[04blackcobra]

I received a call from the co-pay assistance go program that my UHC insurance would no longer participate in this as of January 1 2013. I have called UHC and had to leave a message and wait for a specialist to call back and that was 3 days ago and no call. Has anyone else received such a phone call?

[metwo]

I received a call from the co-pay assistance go program that my UHC insurance would no longer participate in this as of January 1 2013. I have called UHC and had to leave a message and wait for a specialist to call back and that was 3 days ago and no call. Has anyone else received such a phone call?

I haven't received a call about the co-pay assistance program changing at all. I'm not sure what UHC is. Is that your insurance provider? Did Gilenya say what that means in terms of you getting your medicine?

[jaman111]

I received the same call last week when I called Gilenya back I was told the UHC was no longer participating I asked if UHC was the only insurance that was doing this and was told yes. I was saving an extra $600 a year through this program i will miss it.

[jimmyd787]

Copay assistance

I have bc/bs. I was told I'm good to go
For any co-pay assist program I want.
I also work for "big pharma". Thanks in advance
For not flaming me.

[mdyogi]

Co pay assistance

Yes, I got that call too. Anyone know what recourse we have?

Is this a precursor to them not covering it?

Anyone out there with different insurance that is still participating in copayment assistance program?

Thanks.

[onlyairfare]

I have BC/BS and Gilenya is covered; I have the co-pay assistance even though I didn't ask for it.

UHC (United Health Care) may have decided that since other patients have to pay co-pays for their meds, it isn't fair to exempt MS patients. This may be a state regulation (UHC is in many/all states, but may be able to follow the regs of their "home state") or a federal regulation. Either way, some insurers have found a way to allow waiving of the co-pay.

In order to appeal the denial of co-pay assistance, you would need to know why UHC has decided not to participate in the program. It might depend on whether you have a group plan (employer-sponsored) or individual plan.

The UHC website has information on their specialty pharmacy programs which includes conditions such as MS, and they tout that they save employers $3.10 per employee per month. For many MSers, exclusion from the co-pay assistance may mean that they don't get Gilenya because they can't afford it. Meanwhile the payer saves the $40,000+ per year they would have paid for their share of the Gilenya cost.

That's what you are up against in your appeal.

[04blackcobra]

the higher ups at optum rx the pharmacy that contracts with UHC told me that UHC feels that Novartis is charging too much for the medicine. I not sure if this is some game to get Novartis to lower the cost or what. It would be nice if Novartis would offer us a voucher or coupon the cover the co-pay.

[onlyairfare]

the higher ups at optum rx the pharmacy that contracts with UHC told me that UHC feels that Novartis is charging too much for the medicine. I not sure if this is some game to get Novartis to lower the cost or what. It would be nice if Novartis would offer us a voucher or coupon the cover the co-pay.

Seems like that would be the sensible thing for Novartis to do. Many MSers won't take Gilenya at all if they have to pay the whole co-pay.

I guess Novartis will have to calculate which would cost them more - lowering the price to UHC or forgoing the co-pay revenue from some patients.

[ozarkcanoer]

Medicare and Gilenya co-pay

I have been on Gilenya for two years. I have also been on Medicare for two years. For the first year Novartis covered my whole co-pay and I was a happy camper !! However last winter when I was refilling my Gilenya prescription, the Curascript representative told me that Medicare does not allow drug companies to help cover prescription costs. So now I am paying $$$ for my Gilenya. Has anyone else run into this and if so do you have any more info ?

[mfog023]

So far I have not run into my insurance not working with copay assistance but I have other issues that could result in with getting my Gilenya. The Arizona Educators was bought by Meritain Health who works with Catalyst/Catamaran Rx. They decided that Gilenya would be moved to a non-preferred drug and suggested Avonex, Copoxone or Rebif. I took Copoxone and failed as well as Rebif. Plus, I had a bad skin reaction to both. My issue is that they are called those 3 comparables to the Gilenya which is not true as we all know. They don't even play in the same stadium. This is due to start in January but when my doctor tried to start the process to get a prior auth. they said the system would not be set up until January 1 leaving us with less than 30 days. Having the Gienya as non-preferred will result in a much larger copay which I can easily assume is unaffordable. I called Novartis who does a $75.00 copay already for me to ask about getting additional funding but they can't give me an answer because again the insurance company can't give any additional details. Hoping they can help but I could be off Gilenya which has worked really well.

I have put in a complaint with my state insurance corporation about the insurance trying to suggest comparables that are false as well as the delay they are causing. They will contact my neuro. who is willing to work with them angry about the insurance company decision. Every state has one of these corporations which you have a right, especially against UHC, to put in a complaint which has to be addressed.

[04blackcobra]

I just received a letter with a debit card for the gilenya. I'm not sure if it was directly from novartis or the co-pay assistance program. It states it can be used to cover up to $12,000 a year in co-pays. however now I have to send it the receipt monthly showing what the co-pay was and it was paid

[MSRSX]

This is odd I have UHC as well, and never received a call about this.

It was odd to begin with, as I never applied for or asked for the co-pay assistance it just automatically happened. I pay $90 for 3 months and Novartis was pay 1/2 of that. If they took it away that's fin with me, I am sure the money could be used for someone who has a higher copay and needs the help.

My specialty pharmacy is Medco, not sure if this makes a difference.

[Leeaura]

This whole copayment assistance program is so weird. I,too, didn't have to do/ask for anything.

First, I received a letter from Anthem approving coverage of G and telling me my copayment would b $150 ea month. Assume my doc contacted them. Then Novartis called asking millions of questions but nothing about insurance/income. Next, Curascript called. They were ready to ship 90 days for the same $150 and I hadn't even taken my first dose yet. They had in hand a debit card (from the copay assistance program) good through 2014 that covers 100% of my copays.

WTHeck? If others aren't receiving these same benefits, please call The Go Program to see what can b done. BTW, my doc will hand-out a 30-day supply to anyone that needs it whether for cost reasons, shipment delays, etc.

[ovifan08]

I too was told my copay would be $150 but the copay assistance would cover the first year, maybe longer. Can't complain about that. Though....i'm hoping the "maybe longer" will happen.

[moredebris]

I'm one without insurance since we moved to a different state. Didn't know we'd lose insurance. It's been very slow getting the neurologist here to give diagnosis, even though 3 ms specialists in the other state told me I had it based on the MRI and my symptoms. I believe it's taken this long because of the $$, even though I told them we'd sell our extra car to pay. I can't drive anymore anyway.