Biologic Copays

Good news!  My insurance company covers both biologics mentioned by my rheumatologist.  They require pre-authorization, but I expected that.  The process is not supposed to take more than 72 hours.  I think that means I won’t be able to get a shot at my next appointment, but will have to return for another appointment.  I wonder if there’s a way to expedite the paperwork?

As a few people pointed out (I really appreciate all the help), Enbrel and Humira have a variety of assistance plans.

Humira has a copay assist plan.  Here’s the link to their FAQ page.  It really appears that their goal was only to claim they have a web page; I didn’t find it particularly helpful.  As nearly as I can tell, they require a person’s financial information before determining qualification for any assistance.  They don’t give an abundance of information on their website, and I have to wonder why the plan isn’t straightforward enough to clearly explain.

Enbrel also has a support program to help with copays.  It does not appear that financial information is required.  For people with commercial insurance (not taxpayer-funded medical care), there are no out-of-pocket costs for the first six months.  After that, a maximum of $10 copay per month.  Can that really be right?

So, if I accurately understand the information on Enbrel’s website correctly, that’s yet another reason to choose Enbrel instead of Humira.

WHEW!  I can proceed with this treatment without putting my family in the poorhouse.

Things are looking up.

For those who have the Enbrel Support CoPay Card Program,
am I understanding this correctly?  Is it really that easy?

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6 thoughts on “Biologic Copays

  1. That’s great news! I’m glad the cost isn’t going to a source of anxiety.

    Over the years, I’ve found the Enbrel support services in general to be very helpful – whether I’m calling with a question for one of their nurses, or need to talk to someone about insurance. They’ve always been great.

  2. Sounds like you’re leaning toward Enbrel. Aside from the fact that their financial assistance program is so important (especially these days), I can defintely say that Enbrel has worked wonders for me. Can’t wait to see your posts when it’s time to start self-injecting, though… ;)

  3. WarmSocks, I’m glad for you. A lowered stress level sure can’t hurt when it comes to rheuma flares. Here’s hoping that you can get started on Embrel (if that’s your final choice) very soon.

  4. Having been on all three (Humira, Simponi, and Enbrel), all three offer a “card” that pays all or part of your copay for a number of months (up to a pretty sizeable limit). I understand that Humira, as well as some of the other drug companies, will provide financial assistance if your can’t afford your medication. You actually have to apply for that. The co-pay cards should be available from your doctor (that’s where I’ve gotten mine).

    If you rheumatologist has a sample available, they can give you the injection on your next visit while you wait for the approval process for your prescription to kick in.

    Sounds like things are moving forward. Good luck!

  5. I talked to my PCP about this a little bit at my appointment today (weird, because I felt better this afternoon than I’ve felt in over a month). I’ll ask the rheumy’s opinion before making a definite decision, but I’m definitely leaning toward Enbrel.

    Ya’ll have been incredibly helpful as I’ve sorted through various aspects of making this decision. Thank you.

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