Is anyone on Humira? How did you pay for it?

[mrs-b]

So I'm supposed to be starting Humira next week, and today I found out it's going to cost roughly $1600 / month - AFTER insurance. More like $6600 / month before insurance.

Does anyone else here take Humira and do you have better insurance coverage for it than that?

It was like a punch to the gut hearing this today.

 

[pearlsngems]

I don't take it but I know pharmaceutical companies sometimes help people who can't afford their meds.

From the Humira website:

"If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more."

HUMIRA® (adalimumab) - A Biologic Medication

Find information about HUMIRA® (adalimumab), a biologic medication. See Important Safety Information, including BOXED WARNING.

www.humira.com

 

[caf]

I have taken it.

Save on HUMIRA® | HUMIRA Complete

Learn how the HUMIRA Complete Savings card can help you save monthly on your HUMIRA® (adalimumab) prescription.

www.humira.com

I know Humira manufacturer covered cost between my insurance and what they charged.

I do try and pick my insurance based, in part, on pharmacy benefits. These high tier drugs could bankrupt us. FYI I’m on Rinvoq now. I have run through all the RA drugs and am hoping for genetic drugs soon.

 

[missy]

@mrs-b perhaps the patient savings card will help reduce the copay to a more reasonable amount.

Savings And Support Info | XELJANZ® (tofacitinib) | Safety Info

Find information on potential savings and support for Rx XELJANZ. Terms, conditions and eligibility requirements apply.

www.xeljanz.com

“Our Co-Pay Savings Program may reduce out-of-pocket cost for eligible, commercially insured patients prescribed XELJANZ or XELJANZ XR. Eligibility requirements apply. Once you have a Co-Pay Savings Card, call XELSOURCE at 1-844-935-5269 and say “Activate” to activate your Card. Eligibility requirements apply.

To speak with someone about your insurance coverage and medication costs, call 1-844-935-5269 and say “Representative.”
“

I hope this med provides you with much needed relief!

 

[caf]

@mrs-b - my rheumatologist’s staff has always helped with the co-pay help. Can you ask your doctor’s office to help?

 

[bright&shiny]

I have to second the manufacturer assistance. I take an unrelated medication and the manufacturer picks up the difference between my insurance coverage and my copay. And that’s a big number$!

 

[oakleaf]

Have you had the rx sent to a pharmacy yet? You will probably need to fill it at a specialty pharmacy and most of them work with the manufacturers to get a discount applied. If you do end up paying that much for it, you will likely hit your out of pocket maximum pretty quickly.

There is a lot of info here. https://www.humira.com/humira-compl...MIgeCH5IjF7gIVZlXVCh2TrAVyEAAYASACEgI51fD_BwE

 

[mrs-b]

Thank you, one and all. We only just realized this evening how much it was going to cost us out of pocket. I'll drop into the pharmacy and see what they can do for me.

 

[Polabowla]

Good luck! I hope you get it covered & that the medication works well for you!

 

[caf]

CarelonRx | PBM & Home Delivery Pharmacy (IngenioRx)

CarelonRx is a pharmacy benefit manager focused on people, not just prescriptions. Our expertise aims to improve health outcomes at all stages of healthcare.

www.ingenio-rx.com

This is the specialty pharmacy I get my drug from. I’m pretty sure I pay $5 a prescription.

Call your insurer too to see what specialty pharmacy they require.

Oh and good luck!

 

[kenny]

Perhaps look into changing your insurance to a good HMO with low copays for Rxs.

 

[katbran]

Gosh that's a fortune to have to spend ! I hope you are able to find a solution to this problem. very best of luck .

 

[TooPatient]

I am not on that, but do take a different $$$ med. Things I have learned:

1. My insurance only covers through one specialty pharmacy. I HAVE to use them or insurance covers nothing.

2. The manufacturer of my med has several different assistance programs to cover the difference between what insurance pays.

3. The Dr has samples available so I can get a few days of meds if there is a problem with my delivery.

4. The manufacturer of my med sent me a two week supply of the med to take while sorting out the pharmacy and payment stuff.


I get the impression these are pretty standard for many of the $$$ meds. Worth asking about. My Dr has a wonderful nurse who pointed me to all the resources available!

 

[Snowdrop13]

Seems astronomical to me. How is it $79000 per year before insurance? I just checked the cost in the U.K. and it‘s just over £9000 ie about $12000. Madness. I hope you manage to get it and it works well for you.

 

[Daisys and Diamonds]

Depending on the condition its free here, just a prescription charge and a doctor's visit
Im so sorry Mrs B
From what i just read its a good drug that treats awful painful conditions

 

[mrs-b]

Hi @Daisys and Diamonds - and thank you for that.

That's basically what I'd found for Australia, too, tho they're currently still using the older version (which has citrates and is very painful to inject). They're looking to switch to the citrate-free one soon, and that will be covered under medicare then, also. So if I ever go home to Australia to live (and I'd better!), I'll be in good shape.

We can afford Humira - and for that, I'm hugely grateful. But it just brought home again how unfair the disparity within healthcare is in this country. I'll also be looking for whatever rebates I can get, and I'd heard of them, so knew they were out there. The savings card thing is new to me, so I'll have to look into that, but I'm guessing we might not be too out of pocket when it all shakes down. Either way, I'm a lucky woman and there's light at the end of the tunnel.

 

[mrs-b]

CarelonRx | PBM & Home Delivery Pharmacy (IngenioRx)

CarelonRx is a pharmacy benefit manager focused on people, not just prescriptions. Our expertise aims to improve health outcomes at all stages of healthcare.

www.ingenio-rx.com

This is the specialty pharmacy I get my drug from. I’m pretty sure I pay $5 a prescription.

Call your insurer too to see what specialty pharmacy they require.

Oh and good luck!

Hi @caf - I'm locked into a specific provider with my insurance, so we'll talk to anyone we can. I've heard about the $5 per prescription thing - Humira touts it endlessly on its website - but no sign of that for me as yet. I've only just started looking, tho, so I'm hopeful.

@kenny - no chance of changing my insurance, and I'm pretty happy with them in general. I have PPO health coverage, and with all the stuff I have going on, I'm *endlessly* grateful for that!

@TooPatient - your situation and insurance provisos sound like mine. I'm guessing I'll be able to swing something - tho my Dr's office has been utterly useless so far.

@Snowdrop13 - to get it privately - no insurance - in Australia would cost me $12k US, also. Makes you wonder what the heck is going on here.

 

[mrs-b]

@oakleaf79 - thank you for that link - I spent a good while reading all its ins and outs last night and it was encouraging.

@missy - yesterday was the first I'd heard of a patient's savings card, but I suspect it might be useful for this situation and will have a significant impact. Anything that's means tested won't work for us - which, obviously, is a double edged sword in this specific instance - but it seems that this is more wide ranging than that, so I am expecting to be able to swing something. I've *really* got my hopes pinned on Humira for relief - Crohn's is exactly the circus you hear about - and more. Most people with Crohn's end up having colon surgery at some point, and I'd LOVE to avoid that! Big hugs to you, my friend! ox

@bright&shiny - that's very encouraging - thank you!

@caf - everything you said was useful - thank you! I'll let you know how I go. Worst comes to worst - we'll pay out of pocket. But that's a big hit to the jewelry budget!

 

[missy]

Hi @Daisys and Diamonds - and thank you for that.

That's basically what I'd found for Australia, too, tho they're currently still using the older version (which has citrates and is very painful to inject). They're looking to switch to the citrate-free one soon, and that will be covered under medicare then, also. So if I ever go home to Australia to live (and I'd better!), I'll be in good shape.

We can afford Humira - and for that, I'm hugely grateful. But it just brought home again how unfair the disparity within healthcare is in this country. I'll also be looking for whatever rebates I can get, and I'd heard of them, so knew they were out there. The savings card thing is new to me, so I'll have to look into that, but I'm guessing we might not be too out of pocket when it all shakes down. Either way, I'm a lucky woman and there's light at the end of the tunnel.

I agree it is very unfair the disparity that is healthcare in this country. Inexcusable. I am hopeful the savings card will help bring the cost down to a reasonable amount @mrs-b. And if there is still a problem please call the manufacturer and speak with them...often there is something they can and will do to help. Sending you many good wishes and hoping this medication brings you much relief and good health. There is a light at the end of that proverbial tunnel. I feel it. Big (((((hugs)))))) to you.

 

[MRBXXXFVVS1]

I'm hoping that once your out of pocket maximum is reached that you'll be fully covered. You can call your insurance to ask.

Another thing to consider is how much it would cost to privately buy insurance if they cover the medicine. If the premiums plus copays are less than your out of pocket, might be worthwhile. Will Medicare pay for it in the future?

One thing to note, signing up for a prescription savings card often means sharing your medical/health data with the manufacturer. Just something to consider.

Also, my best friend lost several doses (and several thousand dollars worth) of an expensive medication due to a refrigerator malfunction. The electricity going out can also cause issues. It might be worthwhile to have a backup refrigerator and/or backup power as well.

Sending positive thoughts your way and hope you feel better soon!

 

[MMtwo]

I cannot add to this thread on topic, but sending hugs to you for another bump in the long road. Sickness stressors are not conducive to wellness.

 

[Ariadne_Theia]

Have you signed up for Humira Complete? I just started Humira this month for my crohns. I would sign up either on the website or the app. To sign up for the copay card, you answer like 3 questions, do you have insurance? Thru work/healthcare exchange? Are you primary on it? and then I instantly got a card online. Then I gave the numbers to my specialty pharmacy and my co pay lowered to $5. Also it assigns you a nurse ambassador, who can help with figuring out how the insurance works. Since I wanted to social distance, my nurse guided me thru my first injections over Zoom. Also on the Complete you can request a sharps container and they'll mail you one with free returns when it is full which is also very helpful. I ended up downloading the app so it can send me notification reminders about when to take it but on the website you can sign up to have them email or text reminders to you. I've only taken the first loading dose so far but I'd love to help if I can.

 

[Tekate]

Save on HUMIRA® | HUMIRA Complete

Learn how the HUMIRA Complete Savings card can help you save monthly on your HUMIRA® (adalimumab) prescription.

www.humira.com

people may have posted this already, but good Lord that is expensive, although my rosacea medicine is 800.00$ a bottle, I can get a generic made that is almost the same for 40.00$ a bottle, not as good as the real thing, BUT it takes the red and pumps away or lesser..

 

[MMtwo]

Save on HUMIRA® | HUMIRA Complete

Learn how the HUMIRA Complete Savings card can help you save monthly on your HUMIRA® (adalimumab) prescription.

www.humira.com

people may have posted this already, but good Lord that is expensive, although my rosacea medicine is 800.00$ a bottle, I can get a generic made that is almost the same for 40.00$ a bottle, not as good as the real thing, BUT it takes the red and pumps away or lesser..

Oh my! I won't refill my rosacea script for this reason. It feels frivolous and wrong. Can you share the name of the reasonably priced medicine?

 

[caf]

Have you signed up for Humira Complete? I just started Humira this month for my crohns. I would sign up either on the website or the app. To sign up for the copay card, you answer like 3 questions, do you have insurance? Thru work/healthcare exchange? Are you primary on it? and then I instantly got a card online. Then I gave the numbers to my specialty pharmacy and my co pay lowered to $5. Also it assigns you a nurse ambassador, who can help with figuring out how the insurance works. Since I wanted to social distance, my nurse guided me thru my first injections over Zoom. Also on the Complete you can request a sharps container and they'll mail you one with free returns when it is full which is also very helpful. I ended up downloading the app so it can send me notification reminders about when to take it but on the website you can sign up to have them email or text reminders to you. I've only taken the first loading dose so far but I'd love to help if I can.

^ This!

@mrs-b If you didn’t already have Crohns, the uncertainty of this drug situation would cause you to get it. Joking!

I’m sure the thought of trying Humira is worrisome enough. Please know that, in my experience, the shots “sting” for just a second or two. They are easy to give yourself. These meds take awhile to “kick” in. Everyone has a different level of “success” with them. These autoimmune diseases suck. It sucks to have to take a drug that you don’t know will help. But until AI diseases have individually directed meds, this is what we have!

From what I see on PS - you are a strong, intelligent and thoughtful person and You have the loving support of your family and friends. You have determination. Those things will help you! By tomorrow I suspect you will have more answers.

Thinking of you and I promise you this will get easier in time.

 

[whitewave]

One of my husband’s prescriptions was $1800 a month but it went to our deductible. So we just paid it and hit the deductible in March and then everything was paid out at 100%. We also have a HSA we could get reimbursed from if we wanted. Sometimes we did and sometimes we didn’t.

Good luck!

 

[Tekate]

Oh my! I won't refill my rosacea script for this reason. It feels frivolous and wrong. Can you share the name of the reasonably priced medicine?

Hi, my dermatologist has it made, I get it from a compounding pharmacy and it's delivered to my house, I'll post a pix of it tomorrow, it's 30$ a container, I've stopped it because I have so much of it, I was used to paying tons of money for this stuff before I went to this derm so I only used a light amount 1x a day, the evening wash I used water and a teeny bit of mild soap, my cleaner is a knockoff of Avar https://avarinfo.com/about-avar/

the product I used to use was from Walgreen's only and it was in a urea lotion, that was the best of the best but this knockoff works well enough, I can get breakthru if I'm stressed or in the sun too much..

 

[yssie]

I have only one completely useless comment:

How in F***ING HELL can our supposedly-advanced society possibly excuse making healthcare this complicated to navigate and expensive to achieve!?

And here I thought my other half’s medication regimen was convoluted. It’s not. I’m sorry to everyone in this thread who speaks from personal experience - you deserve better.

 

[Karl_K]

I have only one completely useless comment:

How in F***ING HELL can our supposedly-advanced society possibly excuse making healthcare this complicated to navigate and expensive to achieve!?

And here I thought my other half’s medication regimen was convoluted. It’s not. I’m sorry to everyone in this thread who speaks from personal experience - you deserve better.

Legal medicare fraud. They bought enough politicians so they can not negotiate the price of the drugs then they raised the prices of even common drugs thousands of dollars and medicare aka taxpayers pay it.
Everyone else including insurance companies and patients can get discounts and pay much less if they play the game.

 

[MMtwo]

Hi, my dermatologist has it made, I get it from a compounding pharmacy and it's delivered to my house, I'll post a pix of it tomorrow, it's 30$ a container, I've stopped it because I have so much of it, I was used to paying tons of money for this stuff before I went to this derm so I only used a light amount 1x a day, the evening wash I used water and a teeny bit of mild soap, my cleaner is a knockoff of Avar https://avarinfo.com/about-avar/

the product I used to use was from Walgreen's only and it was in a urea lotion, that was the best of the best but this knockoff works well enough, I can get breakthru if I'm stressed or in the sun too much..

Thank you, Bayek! I'll ask about this next time I visit the dermatologist. I am over the moon that I finally found a sunscreen that works with my skin; Biore UV Aqua Rich Watery Essence SPF 50+. It is neutral, non-greasy, and leaves no weird cast or film. I picked it up through Amazon, but the package is in Japanese, so there is that.

Please excuse the threadjack!