Increasing Inflectra dose

Is Express scripts who you get your drugs from? I would call them and get clarification, especially on "above your insurance allowance". That almost sounds like you could be hit with a big bill for the amount that is over your allowance. Definitely get clarification about that part.

I have a love/hate relationship with insurance. They are a real PITA to deal with, but I am very grateful for insurance because I could never afford Remicade without it.

Did you sign up for the stelara copay assistance program? I only paid a $5 copay for stelara with BCBS.

I’d worry more about the approval until July. Do they mean you can start it anytime before July? Or do they mean theyll pay for infusions up to July and then may not pay for anymore after July hits?
(Can you tell I don’t trust insurance?) 😉

Clo, Remicade is still the same -- a limit of about $20,000/year. The way it works for me is insurance pays first until I hit the max out of pocket for the year and then insurance pays everything. My max OOP is $3000 so my first infusion of the year hits that. The $3000 that I would have to pay is covered by Remi co-pay assistance (except $5). I think most co-pay assistance programs are pretty much the same. You can't get them once you are on medicare though so that is crazy. I am going to see if I can just stay on my employer insurance and skip medicare as long as I am working. I think as long as it's a big employer and good insurance I can do that without being penalized later. I need to do more research on all of that this year.

Rusty,

It's thru Janssen not BCBS. Google Stalera copay assistance. It takes you right to where the site will be. There is contact information there. (My phone won't let me attach)

Once you have been accepted then you contact BCBS and coordinate.

BTW.... I called BCBS and was told My total deductible does not take prescriptions into account. It does not apply... So now I am scrambling and researching too.

Clo

I enrolled in the Stelara co-pay program at their website. They said I will be getting a phone call from one of their representatives Monday. The website says it will be a $5 co-pay for the drug (as Sarah said it would).

Express scripts seems to be a mail order prescription arm of BCBS here in South Carolina. I spoke with them yesterday. They said they see the request for Stelara by my doctor but the authorization and approval has not been approved yet. I’ll call every two days and stay on it. Been down this road before with Inflectra.

I’m going to start a new thread. The adventure continues…