This Is MS Multiple Sclerosis Community: Knowledge & Support

I got a phone call and my co-pay is 30% which is $758.84/month. I am nausous.

They are referring me to see if I qualify for financial assistance which I am sure I do not.

It just gets better and better...

Edited to change the price since I talked to Blue Cross (pharmacy, not financial aid). Not quite as bad but I still feel pukey.

I thought my $525 for Tysabri was bad. Good lord. I hope something in terms of aid works out for you.

I called Blue Cross again and found out why it is so high. Since its an injectible, I am charged the rate for medical coverage (30% after deductible) rather than for Rx coverage which would be $30/mo!!!! WTF do they allowed to do that? Is that how insulin is charged?

Any idea when this med will be in pill form?

Anyone ever hear of a doctor precribing a med from out of the country?
The generic in Canada is cheaper so 30% of that would be closer to affordable.

I'm seriously thinking of divorcing if lowering my income will make a difference.

This is really crappy.

I'm not expert on how these insurance companies work, but I would just make sure there's no miscommunication going on. It almost sounds like they are quoting you a co-pay for an infusion, rather than a self-administered med.

I don't think there's a generic for Copaxone yet. I know the meds in Canada are probably cheaper, but I'm not sure how you would go about obtaining them.

I've got Blue-Cross and my copay is $30. Of course there are many flavors of this insurance out there, so who knows. But I agree it sounds like a miscommunication Fingers crossed!

Shared Solutions is also a resource for you:
http://www.copaxone.com/supportServices ... ssist.aspx

Just_Me,

I have been on copaxone for 3+ years. I have Blue Cross insurance through my husbands workplace. I live in Alberta, Canada, so I'm not sure if Blue Cross is the same everywhere? It is my understanding through my neuro (we were considering a self-employment opportunity), so we asked what it would cost us to get our own Blue Cross & I understood it was only going to cost an annual fee of about $500 to get the 100% coverage that I presently have.

Absentee's link to Shared Solutions is worth checking. I have been told in the past that if there were ever a reason that I could not afford the medication to let them know. I got the sense that they have resources. It's my opinion (& more importantly, the opinion of my neurologist) that my disease is in check because I got onto disease modifying therapy very early. Best of luck.

Deb

Shared Solutions told me Blue Cross said 30%. Then I called Blue Cross's pharmacy myself and they told me the amount of $757.84. I called member services & he told me at first it was $30 copay for brand name drugs after a $250 deductible but when I asked if it was $30 or 30% he put me on hold and came back and told me it was billed as medical since it was an injectible.

Still though - Are diabetic & others who need injections charged like that? I've never heard of it.

Deb (DLB) - Do you mean a $500 increase in premiums for 100% Rx coverage? I have an individual plan (self employed) and pay about $600/mo for me & my family because of my advance age (haha) of 46. I know plan rates are different in different areas and it goes up to another bracket every 5 yrs.

Absentee - What state are you, do you know what plan you have and is it purchased by you or an employer? I'd like to look it up & see what the wording is compared to my plan.

patientx - I wonder if you are right and the idyits I talked to think I'm going to have to have an infusiions rather than self-admin. But you'd think Shared-Solutions would know - they seemed to know about Blue Cross (knew the name of the pharmacy at least).

It was a couple of years ago that we inquired but as I recall the annual premium was around the $500. What I'm not sure about is whether or not it was 100% coverage?? I'm in Canada - where are you? We might be comparing apples to oranges...

Hey I am in Canada too my Copaxone is 15oo.oo per month and hubby and I really don't qualify for help if we decide to go that route it is $600 every three months but then I have to sign over all our benefits which is 40,000.00 per year make sense to you?? cuz I could go to jail and the governemt would pay??...

That's what they did to me too! Even though it's drug, they covered that one under "major medical". Pissed me off and I'm glad I don't take any of those anymore.

I'm in MA and yes it is provided through my employer. But it was the same while on Harvard Pilgrim (another insurer here in MA). It is just considered a prescription and $30 is the copay for this level of brand-name drug. Do you purchase yours on your own?

In case anyone who is healthy and without needs wonders if the US health care system is broken, it totally is. As if being hit with MS is not bad enough, insurance concerns on top of it is just insulting.

Two things -- I have Anthem and Copaxone is considered out of network. My policy has a million dollar out of network lifetime limit, then I'm done. At 30K a year, it adds up faster than you'd like. Just something to be aware of. BUT that's just MY policy. They're all different.
The good news is that pills are on their way. There's not a Copaxone equivalent but Cladrine may be available during the summer if its approved. The next one schedule to file with the FDA is Fingolimod. If approved, that will be available sometime next year, too. There are 3 other pills in Phase III trials, so there's hope that we can ditch the needles soon.
I haven't seen much info on what they're planning on charging for the pills, but I'd be surprised if they cost less than the injectibles.

I have an individual plan (self employed). I wonder if it makes a difference if I'm in CA.

I don't think people on insulin or other injectible drugs have this issue. Isn't that descrimination??

If they charge the needeled as medical and the pills as Rx, then it does make a difference.

This is what my policy info said:
Bc Form Slf-Admn Injectable Drgs Participating Provider 70%
But then the area for "mail order" said $30 copay.

I have a $5 million cap so I have a while before I use that up (hopefully!)

See, there's your good news for the day!
Even though I don't plan on taking Cladribine, you can bet I'll be on the phone as soon as the FDA approves it (fingers crossed, cuz others want it)to find out what they're charging.
EDIT: Lost part of my post Yes, the difference between pills and injectibles would make a really big difference for you. I still think we're going to be in for sticker shock on the price of the pills.