I have a couple of chronic diseases and have to inject myself with a medicine called Enbrel once a week. I tell you this not for pity or anything, but because that is what this post is about, the bad news and good news of using Enbrel.
Enbrel is a very, very expensive medicine. However, my medical insurance covers is and my co-pay is only $110/month. Added to the rest of the medicines I have to take my total co-pays each month is over $200. Monday I saw the dr. and he changed one of my medicines and added another and they run in the $30-50 co-pay range.
Well, I get to the pharmacy and the pharmacist tells me, "We did an audit of our medicines and inventory and reconciled it to our records. We discovered that we have been undercharging you for your Enbrel. We have been charging you for only one dose instead of 4 each month. So really we should have charged you $3,200 more. But since it was our mistake, we won't back charge you. However, from now on we will be charging you the correct price, $436.59/month."
Are you kidding me?! There is no way on earth I will ever be able to afford this. So I spent the rest of Monday in a real bad/sad mood. I cried and cried not knowing what I was going to do. It was even suggested to me that I was faking my symptoms. Then it was suggested to me that I was just lazy and why don't I quit crying like a big baby, get off my rear and get a real job so that I could purchase the medicine. Thanks for the support. This was a real dillema for me. Without the medicine, I literally cannot move and eventually my spinal colum and my ribs will fuse together, not to mention the effects of the other disease. So what to do, what to do. Change jobs, stop the medicine, quit living?
What I ended up doing was praying really hard that I could find a solution to this problem.
Forward to Tuesday afternoon. I called the insurance to see if it was really true that my co-pay was $430+. The helpful customer assistant tech that I talked to told me that yes, indeed, my co-pay for my prescription is $436.59. Then he said, "But wait, that is a specialty medicine and I wonder if it would be cheaper if you go through the specialty pharmacy. Let me look that up for you. Can you hold?"
I am thinking that if he could get it for even half I would be happy. He came back on line and said, "Ok, if you continue going to your neighborhood pharmacy a 1 month supply of Enbrel in your dosage is $436.59. But if you were to use the specialty pharmacy you can get a 3 month's supply for $25."
Are you kidding me?! I can continue paying over $400 for 4 injections or I can pay $25 for 12? I may not be a great mathematician, but this appears to be a no brainer to me. All I have to do is have my rheumatologist write me a prescription for a 90 day supply and fax it to the insurance. Then the insurance company will get the paperwork to the specialty pharmacy and my medicine will be delivered to my door.
Next thing I did? A prayer of gratitude for this wonderful solution to my dillema.
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7 comments:
sheesh! Glad it had a happy ending!
Man. Hook me up with some of those pharmacy blessings! I'm afraid we'll be in a similar situation in a couple of months...
Glad it wasn't just good news, but great news! AND you don't have to go back to the pharmacy for it. Score!
That's wonderful! So glad you've got a good deal on that. I used to have to have weekly shots of other stuff--it was only $40 a month. Then the dr prescribed what I needed to do it myself--$7 a month. But then my insurance put it on the list of not covered at all drugs, and I can't afford it any more. :(
Oh, and should I send my husband over with a baseball bat? You could point him in the right direction...
YEAH! Wow, moments like this remind you that you really are in the palm of his hand, doesn't it. Thank goodness for an astute tech and congrats. Oh, and a pox on whoever told you it was in your head.
Those mail order pharmacies can be a real pain, but for that kind of savings? bring it on! What a blessing! I'm pretty sure the makers of Enbrel have a patient asistance program if you are ever without insurance or underinsured for it.
Wow, Sandra. That's is an amazing miracle. Alvin and I are still reeling from the cost of his anti-rejection medication once his transplant is complete. We're going to call our insurance and see if there is a similar deal for Prograf and Cellcept. Here's hoping! If you hadn't blogged about this today I wouldn't have known to give it a try.
I hope you feel better soon. I'm so sorry you're having to struggle through this. Whoever told you to get a better job so that you can pay for the medication needs to be smacked upside the head. Seriously. I'll send Alvin over to do it.
I was cruising through and was interested in this topic.
Unfortunately, there are always good and bad stories about mail order pharmacies, the reality is the cost of many specialty drugs can be HUGE.
Many (or I should say most) pharmacies do not look into your benefits thouroughly, they simply run claims and tell you what you owe.
We have created Assist programs to help these situations. Not every pharmacy can fill everyones medications due to contracts etc.
However, every patient deserves to have all of their options given to them to make the best choice for their health and their financial abilities as well.
RHEUMAssist is a free service that checks out your benefits to find ALL the answers related to your prescriptions for Enbrel, Humira, Remicade etc.
check it out.
PS- There is no catch, it is really free :)
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