Acromegaly Support Group
Acromegaly (from Greek akros "high" and megas "large" - extremities enlargement) is a hormonal disorder that results when the pituitary gland produces excess growth hormone (hGH). Acromegaly most commonly affects middle-aged adults and can result in serious illness and premature death. Join the group to discuss symptoms, diagnosis, and treatments.
So, we finally got prior authorization for Somatuline Depot. Imagine my shock, when the pharmacy told me we'd be responsible for over $1,400 a month toward the cost of the drug. How does everyone afford this? Am I missing something? Unfortunatly, the insurance companies system is down at the moment, so I'll have to call back later. I'm hoping this goes towards our out of pocket, which still stinks, but it's better than being responsible for $18,000 a year. Anyone have any suggestions to lower the cost of the drug?
We (for the moment) have Amerihealth, which covers the whole thing with no co-pay. However, we will need to change insurance in 6 more months, and I will likely be going through this process again.
HOWEVER, I can tell you that Somatuline Depot does NOT go through the normal pharmacy part of our insurance. It somehow goes through a specialized pharmacy & gets paid under a different provision....possibly under hospitalization. I recall it being a number of phone calls to our insurance company to get it figured out, & the entire thing was weird. The pharmacy calls me each month to schedule the shipment.
The injection gets delivered to me since the first one went to the University of Pennsylvania (where I am treated) & they lost it. Then I take it to the dr's office to have it injected (which is my choice. I do NOT care to give myself a needle each month). There is no charge for me to have the nurse at my endo's office do the injection, but I do need to make an appt with her each month. And, my referrals need to be current and open for the injection to be paid each time.
Also, as Tmed told you, there are programs for name brand meds to offer you assistance. I have done it for my aging parents and for my daughter when one of her epilepsy drugs went generic & we needed to maintain the name brand & insurance wouldn't pay. The programs do change, but they are there for the looking. I just checked my bookmarks & do not have the site I used in the past. But, try googling. $1400 per month is exhorbitant...been there!
Somatuline Depot is considered an 'orphan drug' for acromegaly.
http://www.raredr.com/articles/somatuline-rct-meets-primary-endpoint-treating-neuroendocrine-tumors
I don't have time just now, but I do a lot of this sort of research for my daughter. But, if you can, try googling things like 'orphan drug insurance reimbursement' etc. You may be able to challenge your insurance company on some federal rulings. A quick search showed that Medicare D now covers orphan drugs.
I have been to battle with my insurance company many, many times. And, I have won a few. But, you need to do some legwork. If you think there is an untapped artery, your state should have a Department of Banking & Insurance (or similar) to help you through the process.
Orphan Drug status is different from Specialty Drugs as far as the federal government is concerned.
http://www.panfoundation.org/medications-covered
They helped me with copays for a couple years now. I didn't know about the grants and service for the first year I was on Sandostatin, and I ended up paying $5000 out of pocket that Paient Access Network could have reimbursed me for.