Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
"Life is what happens to you while you're busy making other plans." -John Lennon.
I posted a few days ago wondering whether or not to continue my less-than-fabulous biologic. Came to the decision that I should probably stay on it until I see my doctor again. So, i dial the number for the specialty pharmacy.
Little Miss Sunshine tells me that yes, they can get that sent out, and that the co-pay will be $483. Why so much money, I ask her, as it's been $5 before. She looks at her papers and gives me this explanation: the co-pay card covers up to $4000/calendar year. That got used up when they billed the entire January amount to the co-pay card- about $2800-, and then the more typical amount for February and March. She was going to check, but it looks like I'm SOL for the rest of 2015 on Orencia. Much to my astonishment, I didn't hear back from her this afternoon.
Not being a 1%er, or even close, this just ain't gonna happen.
Anyone ever heard this nonsense from a specialty pharmacy before? Good thing I was toying with the idea of discontinuing it. Guess I'll find out whether or not it was doing any good.
I posted a few days ago wondering whether or not to continue my less-than-fabulous biologic. Came to the decision that I should probably stay on it until I see my doctor again. So, i dial the number for the specialty pharmacy.
Little Miss Sunshine tells me that yes, they can get that sent out, and that the co-pay will be $483. Why so much money, I ask her, as it's been $5 before. She looks at her papers and gives me this explanation: the co-pay card covers up to $4000/calendar year. That got used up when they billed the entire January amount to the co-pay card- about $2800-, and then the more typical amount for February and March. She was going to check, but it looks like I'm SOL for the rest of 2015 on Orencia. Much to my astonishment, I didn't hear back from her this afternoon.
Not being a 1%er, or even close, this just ain't gonna happen.
Anyone ever heard this nonsense from a specialty pharmacy before? Good thing I was toying with the idea of discontinuing it. Guess I'll find out whether or not it was doing any good.
They want you on it....they take the hit for the $4000, but that's at their cost, not retail. Then, they collect til you meet your deductible. When does your max out of pocket kick in? Mine is $6000. So once I meet that, it's covered 100%. But I think my friend's just keeps going at 10%...so he just gets another card when the $4000 is used up. Maybe look into it?
Like you said, bcatz, the amount they bill the co-pay card DOES go towards your deductible, so I'm close to having met mine for the year. I guess specialty pharmacy counts toward major medical, and not prescription?
depot
It's never reflected as such with my insurance.
I think I'm past my amount. Dreading that next order as they stated I was in the negative. Have yet to order off Orencia time being.
Well good thing the mistake was caught.
How can anyone afford to feel decent. So sad.
Sammy