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Entyvio cost with insurance (USA)

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Posted 10/12/2014 4:56 PM (GMT 0)
Hey all... some questions to those in the US who are on Entyvio with insurance through their employer.

Did you sign up for Entyvio Connect (financial assistance)? I received my bill from the hospital for the 1st infusion. The charge came to $2-3K after insurance paid its share. Did you have to contact Entyvio Connect to get them to reduce your cost to the program's $50 per infusion?

The Entyvio Connect program states the $50 per infusion help is for every 8 weeks. Those of you who are on Entyvio know that the first few infusions are done more frequent than every 8 weeks. Do you the know if Entyvio Connect covers all the infusions?

I'll call Entyvio Connect on a workday, but for now stress/anxiety brought these questions to you folks.

Also, I was curious about this: these drugs are so expensive. My insurance shows one infusion is almost at $15k. I'm always worried my employer will find a reason to fire/layoff me because I cost too much. Is it reasonable to worry about getting let go because of my health cost? My employer is a multinational company and it has lots of employees.

Thanks, all.
Posted 10/14/2014 12:17 PM (GMT 0)
You must call Entyvio Connect immediately. They will guide you through the co-pay assistance process. However, I don't know if you had needed to sign up with them before your first infusion for it to be covered. Entyvio Connect covers all infusions, even the loading dose, which is more frequent than every 8 weeks. I signed up for Entyvio Connect before I started getting any infusions. They have already paid for the first two infusions, leaving me with only a $50 charge for the drug costs. Please be aware that they will only cover the cost of the drug - the cost of the infusion process itself is NOT covered by Entyvio Connect. You quoted a $15000 infusion cost - that seems extremely high. Is that what the hospital charged or what they were paid by insurance? The drug itself is only $5000 per infusion. My infusion center charges only $150 for the infusion. There is a $6500 annual cap on what Entyvio Connect pays. I hope you have an out-of-pocket max on your insurance.

Regarding your last questions, it's not legal for your employer to lay you off because your health care costs are so high. However, I'm sure they can always find another reason to give if they want to do so. Don't lose too much sleep on it; if you work for such a large company I'm sure there are plenty of people more expensive than you on their payroll.
Posted 10/14/2014 3:59 PM (GMT 0)
Just responding re: drug costs. My hospital is charging $17,349.40 per infusion. That's the drug cost, not including the other charges (that adds about another $1500 to the total). I am sure my insurance has negotiated a lower price than that (and while I am enrolled in Entyvio Connect, I won't be taking advantage until next year as I hit my yearly out of pocket max with my insurance before my infusions began), but that's what the Cleveland Clinic is charging for Entyvio. So, $15K isn't necessarily that high.

(though yes, I think it's pretty freakin' expensive)

dustydesk, I hope that you've managed to get things sorted with the Entyvio Connect folks. I agree with Bania re: your job and health costs...I'd try not to worry too much about it.
Posted 10/15/2014 2:46 PM (GMT 0)
Hospitals are way worse about inflating the costs vs. what they actually get paid. My infusion center actually hits it pretty close to the mark. It will vary slightly, but any insurance will pay right around $5000 for the actual Entyvio drug, per infusion. (And regarding the cost inflation, I've found Quest Diagnostics to the be the worst, percentage-wise. They'll charge $250 for a blood test and get paid $12 for it.)
Posted 10/16/2014 12:29 AM (GMT 0)
My Aetna bill shows approximately $6500 per infusion (as billed by my GI). My insurance pays 90% then Takeda assistance pays the rest except $50 (my responsibility).
Posted 10/17/2014 1:03 AM (GMT 0)
Thanks all for the helpful words.

I talked to Entyvio Connect and my out-of-pocket cost will only be $50 per infusion (whew!).

Now I want to know if Entyvio will help me... which I'll just have to wait and see.

Thanks.
Posted 10/17/2014 3:13 PM (GMT 0)
Be patient while waiting for Entyvio to work. It could be up to 10 weeks or even longer. Very slow-acting drug, unlike the anti-TNF's.
Posted 10/20/2014 6:18 AM (GMT 0)
My doctors office had me sign some paperwork and said they would take care of getting me set up with Entyvio Connect, but Saturday I got a huge bill from there office lets just say I'm more than a bit annoyed. It says my share for just the drug is $1,240. Not the $50 dollars I was expecting. I hope this is false because the bill only showed charges for my first dose and I've had three already and can't afford to pay this. I hate that I feel like I spend so much time trying to read my bills and figure out what they are all for and then spend hours on the phone between doctors offices, my insurance company and other programs just to get it to a reasonable price.

Sorry for my rant but I just got done laughing at my stack of medical bills I cant afford to pay on my part time barista salary. If I can't laugh about them I would be crying so I guess laughing is good
Posted 10/20/2014 3:05 PM (GMT 0)
My infusion center did the same thing, sent me a very large bill. I called them and they said just to ignore any bill that seems very high. That's quite a tight ship they're running there.
Posted 10/22/2014 1:43 AM (GMT 0)
redrox, I say don't stress about the infusion cost. If you signed up to entyvio connect, it shouldn't be more than $50 per infusion. Remember, this drug is new so these places are probably still working at setting the payment correctly... at least this is the gist I got from the phone calls I had to make.

It sucks we have to stress about money when we already have our health issues to worry about :\
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