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Any luck w/ Simponi $5 copay card?

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Ulcerative Colitis
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Posted 4/27/2017 2:14 PM (GMT 0)
Hi,

I had my loading dose of Simponi last week at GI's office. I'm pretty sure they gave me samples they had on hand. I am due for my second does next week and would like to sign up for the $5 per injection card on their website. Has anyone used this with success? It seems too good be true.

Also, my insurance has denied coverage of Simponi as they require, for some reason, Humira before Simponi. The GI is appealing decision so hopefully I will be able to continue. I start tapering from 40mg prednisone tomorrow and need all the help I can get.

Thank you!
Posted 4/28/2017 10:48 AM (GMT 0)
I've used the patient copay assistance card for remicade known as RemiStart (there's a similar program for humira as well). Works great, same exact deal you're responsible for a $5 copay. My insurance had a $250 copay for injectable, speciality pharmacy meds and an annual deductable ($300 to thousands variable by plan) and RemiStart covered both copay and deductible when i timed it just right lol.

The annoyance with the copay cards is you cannot be simultaneously using a FSA or HSA with them. Check if you have one. It's a royal pain in the bumm if your work's health insurance automatically uses one.

Out of curiosity, why'd you choose simponi over humira? They're very similar and humira is the more common of those two.
Posted 4/28/2017 1:39 PM (GMT 0)
The way that I understand that it works is that your insurance has to agree to pay their contracted rate for Simponi and Janssen (Simponi) will pay your required portion(copay percentage or dollar amount) with $5 coming from you.

Since your insurance is not agreeing to pay for Simponi without Humira then Janssen probably wouldn't cover it under this program. They have other services/programs that might cover this.

The good news is that usually the insurance companies will relent once your GI files an appeal. When I was approved for Stelara I was rejected twice before my insurance company approved it. My GI had to get on the phone with them during a conference call with the insurance company doctors..... he explained this to me that this is what happens but I would get approved. Seems like your GI is confident that in the end you'll end up with Simponi otherwise you wouldn't have received the loading dose samples.
Posted 4/28/2017 1:47 PM (GMT 0)
Thank you ipoop! I hope it works like the Remistart program. I do have FSA but I think my hospital bill will use it all up before the simponi comes into the picture. I'm going to give it a try and see how it goes.

It was entirely my GI's idea to start me on Simponi. He told me I would likely do better on it than Humira. I admit I just went along with the doctors advice without question because I was just a few days out of the hospital and still very anemic and sick and wanted whatever was going to make me feel better.
Posted 4/28/2017 1:57 PM (GMT 0)
Thank you Keith. That really eases my mind.

It is totally backwards and probably wrong headed, but I think I resent the financial cost of this disease more than I resent the physical toil on my body!
Posted 4/28/2017 2:08 PM (GMT 0)
Jane,

I hear you; as of yesterday I have reached my out of pocket deductibles for the year ($3,000). No more deductibles for me.
Posted 4/29/2017 9:53 PM (GMT 0)
I've been on the Simponi co-pay assistance program since starting injections in July 2016. I was in a somewhat similar situation, getting out of a short hospital stint for IV steroids, and eventually tapering off 50-60mg prednisone (ugh).

If your insurance approves it, the co-pay assistance is a godsend, and it works like RemiStart. I met my deductible + max out of pocket for the year ($3500) in January for $10!!! While I certainly hope I don't require lots of medical attention this year, it doesn't hurt that I won't be paying for it.

You may have noticed there aren't many Simponi users on here. I found one thread when a UC'er found success with Simponi after 6-9 months. Slow and steady. That's what my GI predicted for me, and that is when I found relief. It was by no means immediate.

However I've had one minor flare on Simponi, reigned in by daily Rowasas, and unfortunately/sadly, I'm in the beginning of what seems to be a b*tch of a flare. I've been moving my injection up a few days in an effort to quell the storm a-brewin' in my colon, and my GI is planning to check my levels and re-evaluate in a few weeks. Hopefully I can hold out that long, or patch together a self-rescue with SCD. If not, alternate Simponi dosage, Entyvio or Remicade are likely in my future.

Good luck—I hope it works for you, and I hope you get the green light for the $5 program!!

Post Edited (LadyEllJay) : 4/29/2017 3:56:27 PM (GMT-6)

Posted 5/1/2017 3:05 PM (GMT 0)
Thank you LadyEllJay! Good to know you were able to use the Simponi copay program! I hope my insurance company can be compelled to do the right thing.

Sorry you are starting a new flare. Have you tried to Uceris. I had good luck with it the first few times I took it. Are you taking anything else other than Simponi? I am scheduled to remain on 4 Apriso daily while taking the month Simponi.
Posted 5/1/2017 6:59 PM (GMT 0)
Yes, and I'm not sure why my signature isn't showing... I'm also on Apriso and Rowasa after bouncing/failing my way through a host of other meds, including close to a year of prednisone.

Oddly, I'm relieved that instead of my GI tossing some steroids my way, he's instead calling for bloodwork, a scope, and switching off Simponi. While prednisone did *some* good in the past, it wrecked the rest of my body. I'll take the scope! Ha!

Didn't mean to hijack your thread. This has proven to be such a supportive space and helps me keep a sense of humor about it all.
Posted 5/1/2017 10:25 PM (GMT 0)
I've been on Simponi since 2014. It was my first and has been my only TNF antagonist. My Dr and I discussed the medication options and with my busy job that had me traveling often, Simponi was my choice.
I've used the co-pay card from the initial injection and have no issues. It did take about 1-2 weeks to get the prescription approved by Blue Cross and then to work out the kinks with the specialty pharmacy.
I changed insurance to Scott and white in Sept 2015, and they have been even easier to work with. The copay card works well, with no hiccups.

My daughter uses the same type of program for her humira injections.

Simponi has worked really well up until the past 4-6 months. My body is not responding like it used too.

My Gastrointerologist has added Lialda back into the game to see if it will help bring me out of this flare.

It's not working. I am dreading moving to an infusion or the painful humira injections. Two more weeks to see if the and died Lialda will work. Fingers crossed!

Good luck with everything!
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