Coverage for Copaxone

A board to discuss the Multiple Sclerosis modifying drug Copaxone

Coverage for Copaxone

Postby Wendy7062 » Fri Jun 22, 2012 6:56 am

I have been recently diagnosed w/MS and my neurologist prescribed Copaxone as treatment. Unfortunately, my ins co will only cover 1/2 of the script cost ($2500.00) and I am responsible for the other 1/2 ($2500.00). This is not affordable to me. I have tried everywhere to try to get assistance with the cost of this medication, but because I live in the state of Massachusetts and the way the new Healthcare Reform laws are written, I am not eligible for any assistance. I've tried the MS Society, Shared Solutions, Patient access network, Mass Med Line, MS navigator, Mass connector, needy meds.org, Partnership for prescription assistance, client disease fund and the Copaxone hotline to no avail.
Does anyone know who I can contact for assistance in this state????
Thanks for your tips!!
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Re: Coverage for Copaxone

Postby lyndacarol » Fri Jun 22, 2012 3:46 pm

Welcome to ThisIsMS, Wendy. Although I do not know of any assistance available in Massachusetts, and although you did not ask for this information, please allow me to say: Do not panic if you are unable to afford Copaxone. Many of us opt not to take any of the approved medications for MS, not only because of cost, but because we have not found them to be effective. Personally, I believe that diet (that reduces glucose and insulin in the bloodstream and detoxifies the liver) can be more effective than medication. I find the story of Dr. Terry Wahls and her dramatic improvement of MS with diet VERY interesting: http://www.TerryWahls.com
My hypothesis: excess insulin (hyperinsulinemia) plays a major role in MS, as developed in my initial post: http://www.thisisms.com/forum/general-discussion-f1/topic1878.html "Insulin – Could This Be the Key?"
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Re: Coverage for Copaxone

Postby shaight » Sat Jun 23, 2012 5:40 am

big pharma at it's best. greed.

keep fighting for help on this. don't take "no" once, make them tell you several times. squeaky wheel...

the MSsociety has a tremendous amount of money, but they don't seem to focus enough in the right areas. i don't get it.

copaxone costs my insurance 14k for a 3 months supply...supposedly.
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Re: Coverage for Copaxone

Postby its2much » Sat Jun 23, 2012 9:14 am

Wendy - I wish I could help - I've been unsuccessful in finding help to cover the cost of copaxone for me. I also have a 50% copay - UNBELIEVABLE!!
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Re: Coverage for Copaxone

Postby shaight » Sun Jun 24, 2012 6:10 am

i received a letter from shared solutions yesterday. i'm invited to the local marriott to hear a neuro speak and receive complimentary dinner. really!? so, they can't help those in need to receive meds, but they can pay some neuro, pay for a conference room, and pay for a bunch of meals. i feel like going just to sound off at how ridiculous the whole thing is. we are such a backwards society sometimes.
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Re: Coverage for Copaxone

Postby NHE » Sun Jun 24, 2012 1:23 pm

shaight wrote:i received a letter from shared solutions yesterday. i'm invited to the local marriott to hear a neuro speak and receive complimentary dinner. really!? so, they can't help those in need to receive meds, but they can pay some neuro, pay for a conference room, and pay for a bunch of meals. i feel like going just to sound off at how ridiculous the whole thing is. we are such a backwards society sometimes.


Hi Shaight,
Here are some books which discuss the pharmaceutical industry which you may be interested in reading.

Books on the pharmaceutical industry:
While many good things have come out of the pharmaceutical industry, I feel that it's important to view it through the eye of a skeptic. These books will help to illustrate why.

Selling Sickness by Ray Moynihan and Alan Cassels.
link to review

Overdosed America: The Broken Promise of American Medicine by Dr. John Abramson.
link to author's website

The truth about the drug companies by Marcia Angell.
Dr. Marcia Angell is a senior lecturer at the Harvard Medical School and former editor of The New England Journal of Medicine. In this book she gives an inside look into the pharmaceutical business. link to review


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Re: Coverage for Copaxone

Postby LR1234 » Mon Jun 25, 2012 1:17 am

Teva's patent expires this year and there will be nothing they can do to stop generic cheap versions being put on the market.
One is due for release 2013. http://www.globes.co.il/serveen/globes/ ... 0&fid=1725
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Re: Coverage for Copaxone

Postby shaight » Mon Jun 25, 2012 5:59 am

NHE- thanks for the info. honestly though, i cannot read those as my stress level doesn't need to get any higher due to my MS!

it's good to see that their patent is expiring, hopefully this will be available to those who want it.

we always have whole foods, supplements, exercise, and a positive attitude...it can do wonders.
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Re: Coverage for Copaxone

Postby DizzyDean » Sat Jun 30, 2012 2:45 pm

One possibility is to obtain the drug through a Canadian or overseas mail order pharmacy. I have looked at this out of curiosity, but haven't had to "go there" yet. From what I recall the packaging is different - you typically obtain boxes of 28 rather than 30 syringes. Perhaps it is packed that way in other countries.

Its unlikely your insurance will cover any of the cost of the drug, if obtained that way. But its also likely that the cost you'd pay is less than the portion of the US cost that you pay now.

Be aware of the fact that there exists a so-called "generic copaxone" which AFAIK is sold primarily in India. I'd tend to stick with the genuine Teva product.

I also recall that this is somewhat of a legal grey area, so make sure to check into that aspect too.
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Re: Coverage for Copaxone

Postby DizzyDean » Sat Jun 30, 2012 3:27 pm

Ok, the OP's situation really bothers me so I took some time to research this.

The OP says she's in MA. The bronze level plans shown on the MA Connector health insurance site seem to have 50% co-insurance for the highest listed Tier - Tier III drugs. I assume copaxone is one of those. So, $2500 / month seems plausible. But the annual out of pocket maximum for this insurance policy is $5000 for these plans and it says on the policy summary that this includes RX co-insurance. Which seems to mean that if you're paying $2500 a month for copaxone you would quickly qualify for a higher reimbursement rate when the out of pocket maximum is reached.

Looking further on the MA Connector web site, it appears that by obtaining the cheapest silver health plan the copay on a Tier III drug goes to $50 / month. You'd have to do the math, but I strongly suspect that it would be worth it to pay higher premiums to get this cost reduction in copaxone.

I hope I'm not mistaken and copaxone is really a Tier IV drug (some insurance policies have a 4 tiered RX drug system), so I specifically drilled into the Harvard Pilgrim Health Care website and looked at a list of drugs and tiers. On that site, copaxone is shown as Tier III.

I notice that the MA Connector site discusses that open enrollment is coming soon, so this may be a good time to re-evaluate your present coverage.

I also scanned the web for Canadian pharmacy prices on copaxone. The going rate for boxes of 28 syringes seems to be perhaps $1100 to $1200 per month. Not clear if that means Canadian or US dollars. Again, one would want to consider if this is "generic copaxone" and that you aren't going to get in legal trouble getting it this way.

Of course, if you can't pay it none of this matters.

I'm not trying to be critical, I'm a fellow copaxone user and trying to be helpful.
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Re: Coverage for Copaxone

Postby zipfed » Thu Jul 05, 2012 5:54 pm

Shared Solutions offers a program that has a $35 per month copay. I sign up 2 months ago as my copay was up to $900 per month.
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Re: Coverage for Copaxone

Postby DizzyDean » Fri Jul 06, 2012 9:14 am

zipfed wrote:Shared Solutions offers a program that has a $35 per month copay. I sign up 2 months ago as my copay was up to $900 per month.


I think Shared Solutions limits their copay assistance to $500 a month. Has it changed?

Also, on the sharedsolutions website, the terms and conditions say "This offer is void in Massachusetts or where otherwise prohibited by law, taxed, or restricted." which would be a showstopper for the OP.
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Re: Coverage for Copaxone

Postby its2much » Sun Jul 08, 2012 3:41 pm

So does anyone know why Shared Solutions won't help people in Massachusetts? Also, I've never received anything from Shared Solutions inviting me to dinner, lunch, etc. I get those mailing from Rebif all the time.
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Re: Coverage for Copaxone

Postby Wendy7062 » Sun Jul 08, 2012 5:33 pm

There still has been nothing I can do to get the Copaxone covered. Now I'm working with 2 state Congressman's offices as well as a Senator's office to see what can be done. Ridiculous that there's nothing that can be done in this state but if I were poor I'd have this script covered 100%. There's something wrong with this system.
Working on getting this figured out!
Thanks all on all the imput!!
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Re: Coverage for Copaxone

Postby DizzyDean » Mon Jul 09, 2012 7:27 pm

@Wendy7062 - have you checked into upgrading your health plan (to silver or higher)? According to the MA connector website, as of July 1 open enrollment has begun. This seems like the path of least resistance to getting your copay down.

@its2much - the lack of a copay assistance program in MA is more than likely due to some legalistic nuance of the Romney-Care health insurance system in place there, but I can't say that for sure. BTW, Shared Solutions does sponsor periodic talks by MS docs, nurses, etc. and if you live in the area where these events take place you should receive invites. I've been to several of these over the last 5 years and they have been quite informative. I don't see this on their website, so give them a call and ask for what's in your area.
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