Expensive Under Patent Prescription Drugs ( ulcerative colitis patient)

On Medicare now and reached the "donut "hole" in Feb, only 2 months into the new year!
As a result the price for my Apriso cost me between $350.00/$400.00 monthly and my Uceris between $600.00 to $700.00 for a 30 day supply until I reach $5800.00 out of pocket expenses to attain the "catastrophic phase of reducing the patented drugs and paying 5% of the retail price which is approx $1200.00 for the Apriso and $1700.00 for the uceris.
I know this may seem complicated and confusing to those of you who are under the umbrella of regular insurance.
To those of you in my position, you probably understand this financial hardship.
This is absolutely rediculous!
Why? Well that's obvious, but there are are other frustrations
Many of the manufactures offer discount cards than enable patients to
Pay as little as $10.00 monthly for the meds ( such as Apriso) to patients that have regular insurance that is not Medicare.
However Medicare patients are excluded from the same benefits, and must pay the astronomical financially devastating prices that I do.
The reason that they give is because Medicare doesn't want to pay for the brand name drugs.
Guess what? Medicare has to pay for similar prices to the companies that make the generic drugs as well.
So why are we not allowed the prescription discount cards from the manufactures?
If you are dirt poor in this country , the government will subsidies your meds, cut you a break but your annual income must be so low below poverty that you are not eligible.
This is broken, and makes no sence.
Why penalize the middle class until you are actually paying most of your annual income for meds.
Realistically, many people cut their dosages which we all know could put you in a bad flare.
Ultimately you may have to be hospitalized, become a burden to the system, and cause more of an expense to the ever growing bill at the taxpayers burden!
This is not a common sense approach!
I welcome your comments, and encourage others in this position to "ban together" to get our legislators to address this ever growing problem as more baby boomers enter the Medicare dilemma!
ALLOW US TO USE DISCOUNT PREscriptION CARDS ON MEDS THAT HAVE NO GENERIC ALTERNATIVES FOR MEDICARE!





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If I understand it correctly, which I think I do, the Republicans wanted those on Medicare to have the option of keep doing what they are doing now or choosing to opt into a private plan. It was never meant to force everyone into privatization but the liberals twisted the facts and turned them into talking points. In any event it is correct that Medicare is far cheaper than regular insurance, donut whole or not. I know that's hard to accept when the meds cost so much. It's not Medicare that rejects the discount cards, it is the drug manufacturers because they will only pay so much toward your prescription.

That is generally correct looking at only the big picture BUT one could argue that many of these other countries with national health systems don't have access to certain healthcare like machines, tests, and prescriptions that are available in the US and not available there, admittedly at a cost. Many post here from Candada, the UK, Australia, and others that don't have some of the options available that we do here. I know some would argue that the outcomes are either the same or better in other countries but that is also an average figure. Those in the US are lumped into one average figure but those here with better insurance (not necessarily the richer) fare much better than those in countries with a national health care system. Many in other countries have to wait for new meds that have already come out in the US.

My parents are retired, have medicare, and gap coverage through blue cross blue shield.

Thanks for all the replies.
As explained to me by a knowledgable pharmacist,and by the mfg rep of Apriso
( Valeant Irvine Ca) they would gladly partner with Medicare if able.
Apparently the Medicare system does not want to partner with any of the mfg's representing the discount cards because they consider it collusion .
I was told by the pharmacist that the Medicare system pays very high prices to the mfg who make the generics as well.
I am on an HMO Medicare and there is no prescription plan available that would be any more beneficial.
We who are on brand drugs with no available generic options are basically out of luck as things stand.
Are you aware that the price of the retail patented drug changes daily like a stock?
What you pay for that drug on any given day fluctuates.
Retail price is not what you pay online or what you pay in your local pharmacy.
Each retail store Walmart, Cvs, etc contracts that retail price with the mfg.
Apriso's retail price at present is approx $1200.00.
Once you reach catastrophic the price costs 5% of the retail price of the day you call in your refill.
You must spend $5800.00 out of pocket before you reach catastrophic.
The donut hole comes fast because as of now Medicare basis the donut hole on the RETAIL price of the drug, not your co pay out of pocket.
A chronic condition with lots of necessary drugs to keep you in remission ( not to mention when you are suffering with a flare) will cost me an estimated $20,000 this year out of pocket for me.
This includes infusions, hospital co pays, etc.
We need the same break that others are egible for to help us control these daily necessary meds.
If what I have been told so far is true,allow Medicare patients to take advantage of the discount mfg programs!
Also, even though Apriso is scheduled be out of patent in the year 2018, the retail price of the generic may be equally as high. I'm not talking about your co pay, just what Medicare presently bases your donut hole retail price of a drug.
So pray for donut hole to disappear!



EDJNZE

I doubt that manafacturers want to partner with Medicare. They price the drug high to rapidly recoop developmet costs and to satisfy investors who want quick profits.

There is no partnership with the insurance plans. My plan did not even know what the discount card paid. My copay was the same whether I paid it in full, or a 3rd party paid part of it. In fact, the amount the discount card paid got credited towards my cap - exactly as if I paid it all.

IMO they do this because most people would not put up with the copays. Their marketing would fail.

For institutional buyers, like Medicare, the army, prisons, ... etc - they do not offer any discounts because the system is set up to milk the government buyers. I realize Medicare recipients do make copays - but people in military service and prisons do not. (And, Medicare is phasing out the donut hole anyway. Also don;t forget that before Part D Medicare did not even cover drugs.)

Rather than having a lower price across the board, they choose to to set the price high, and then give discounts to the private sector. I am glad to get my discounts, but the whole scheme seems fishy.

I could be wrong, but I think you "knowledgable" pharmacist is just speaking anti government stuff out his butt hole. It is the drug companies - not the Medicare - who don't want to play.

I am on Medicare, with AARP as my drug plan.
While I was on Humira I had to pay $4700.00 co-pay!! I am now on Entyvio. An infusion given at the hospital and. Medicare pays the whole bill of $17.000 per infusion.
Have been on Entyvio for 7 months .
Crazy huh?

I do not know how it drops it form $500 to $10. Something is wrong with you figures. If you read the small print on the card, they pay upto $120 towards copay on a 30 day supply - but require you pay at least $10. SO you only get the whole $120 if your copay is over $130. You only pay exactly $10 if your copay was $130 or less. IF your copay was $500, you should result in a copay of $380. - could you double check the $500 with pharmacist?

I think Lonie meant to say copay instead of deductible. If you bought the Lialda with no insurance it would cost $500 but Lonie can get it with their insurance for a $150 copay, and after the discount savings card it was $10 that Lonie had to pay. I know those figures may sill be slightly off but maybe this year the discount card will pay up to $140, which would make the figures come out right. If I'm right on this then the answer to Lonie's question is that the drug company is still making $350 from the insurance company (500-150)and $10 from Lonie, for a total of $360, even though they coughed up $140 themselves - high enough for them to still make a profit, even though Lonie only paid $10.