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Rheumatoid Arthritis
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Posted 10/31/2008 5:18 PM (GMT 0)
I have been on Humira for two months (4 injections) and have felt do differences.  The first prescription cost $95.00, the refill was $895.00, the third will cost $1495.00, these costs are out of pocket costs, guess I reached the donut hole.  Am 71 years old, income doesn't qualify for many programs ($52,000 combined), not poor enough for aid not enough to be able to pay this easily.  Any suggestions?  REAS
Posted 10/31/2008 6:19 PM (GMT 0)
Hey Reas, did you call Humira and ask them? What about your rheumy?
Posted 10/31/2008 6:24 PM (GMT 0)
Hi there,

I'm sorry you're not having results with Humira, have you considered  Enbrel? Maybe contact your rheumy and see what their office has to say? I'm not sure what type of insurance you have but the increases in the cost of your Humira in terms of refills for the scripts seems extremely high??  I do know that Enbrel has a program if you don't have insurance of any kind they will help you obtain your prescription so maybe this would be an option.

Best wishes to you 

Posted 10/31/2008 9:23 PM (GMT 0)
Reas,
Call 1-800-4HUMIRA. This is a Humira support service run by Abbott for the patients taking Humira. This program among other things assists patients that are "underinsured" and have large out-of-pocket co-pays/costs. I know several people with Crohn's that have excellent help from Abbott in terms of out of pocket Humira costs. Give 'em call!
Posted 10/31/2008 9:27 PM (GMT 0)
My insurance is with an HMO, on the Senior Plan with Prescription coverage.  Never thought to ask Humira for help.  Going to see my Rheumy Monday, it will be interesting to see what they have to say. 

Thanks for the suggestions and encouragements some days, as I'm sure all know, aren't as easy as others.

REAS

Posted 11/3/2008 3:05 AM (GMT 0)
Can't comment on the costs because I live in Australia and luckily once approved for humira the government pays through medicare. I found the humira didn't work immediately for me, it was the three month mark by the time I realised just how successful it was. But a friend in England found it didn't work for him at all but enbrel is. So hang in there, there might be another biological agent that works for you. These insurance companies are the pits, so unhumanitarian for a so called health care area. Good luck.
Posted 11/4/2008 3:33 PM (GMT 0)
Found out more about the dreaded donut hole, which is why my Humira costs so much.  In case others don't know, when the prescription costs are $2510 (a combination of insurance and out of pocket) that's when you go into the "donut hole", then you have a total out of pocket cost of $4050.  Once you reach that limit all no prescription should cost over $5.00 and many will be $3.00.  Anyhow, that's the research I've done.

Went to my Rheumy yesterday, since the Humira isn't working yet, considering putting me on MTX also, or possibly switching off to Remicade.

I also have Crohns and Raynauds, along with RA. 

REAS

Posted 11/4/2008 6:18 PM (GMT 0)
I have never heard of this 'donut hole'.. did you call Humira?
Posted 11/4/2008 7:49 PM (GMT 0)
Hi Ducky, I'm retired have an HMO for insurance also receiving Social Sercurity. The Donut Hole has to do with Social Security/Medicare.
My deepest wishes are that no one ever get into the Donut Hole

REAS
Posted 11/4/2008 8:32 PM (GMT 0)
Not on MTX also, at the same time?

As for insurance, I almost cried when I first went to fill by Enbrel script the first time. My pharmacist called me and asked if I was sure I wanted to fill it because it would be very expensive - insurance would not pay anything. I asked how much and he said "eighteen ninety-five", and I was like "oh, $20? That's no trouble", and he said "no, $1,895.00".

Turns out my insurance would ONLY pay if I ordered the Enbrel from one of three approved pharmacies in the country. The insurance company had "pre-purchased" a bulk amount of Enbrel at a discounted price and distribute it ONLY through these three companies. Through these pharmacies I pay $10 per refill (i.e. $10 per month).

But, it took me two weeks or so to figure this out - nobody told me anything! And then it took like two months for the mail order pharmacy to get their act together and actually send me the stuff. It was a very very frustrating time in my life because the first "free" shot of Enbrel I took at the doctor's office (after years of MTX, Prednisone, Celebrex, blah blah blah blah) worked instantly like magic - and once you go off Enbrel for even a short time, it might not be as effective when you start back up...

So, try calling your HMO and asking them about stuff like this. Also, it might be cheaper to buy insurance that DOES have foresight like mine (BCBS) - my insurance costs are significantly less than buying Enbrel out of pocket.
Posted 11/4/2008 10:18 PM (GMT 0)
Leeloo67
I had the same experience with my Pharmacy and when I asked about the cost of the 3rd refill and was told it would be $1495. they said, oh no, must be a mistake, OMG, its not a mistake!
I tried calling Humira and couldn't get thru.
I did call my HMO, found that nothing they could do about the Donut Hole but IF approved they do pay in full for Remicade because its done at a hospital.
Because of both Crohns and RA, going to the Gastro Thursday, then the Rheumy and Gastro will figure out what's best.
For a change, I did swallow my pride and talked about how expensive Humira was, my Rheumy was amazed, guess no one had really talked cost before.

REAS
Posted 11/8/2008 12:26 PM (GMT 0)
Ides, thanks for the suggestion on calling Humira, they're sending an application form for me to fill out, hopefully it will get me thru December and then I can start fresh again with prescription help.
My Rheumy told me it could take up to 6 months for the Humira to kick in, guess I was hoping for a miracle before.
REAS
Posted 11/9/2008 3:08 AM (GMT 0)
Reas - I'm so glad that number worked out for you!
Posted 11/10/2008 6:21 PM (GMT 0)
It probably counldn't hurt to call Blue Cross and ask them how much a plan that would pay for Humira would cost.  My insurance cost is significantly less than the out of pocket cost that my medicines would be.  Can't hurt to at least call and ask!

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