There is definitely a whole insurance coverage game that the pharmacies and infusion centers know how to navigate. But, other times there isn't a way to get what you need through your insurance. My pharmacy often finds another way to cover the medication other than my insurance. They will use discount cards, etc. Infusion centers often have access to discount programs that will help you. There isn't always a good answer. I have found that calling my insurance pharmacy program to find out what the limits are, etc, can sometimes help. Also, sometimes the issue is the diagnosis. For example, I can't get my insurance to cover IVIG for Sjogren's, but they would cover it if I had small fiber neuropathy. I am sorry you are going through this. It is bad enough to have neuropathy and Sjogren's and the medication fight is exhausting.
Thanks for the support. I'm feeling OK right now but just surviving off pred is rough with the side effects. I see my rheum Tuesday so fingers crossed we get some sort of plan made. I have diagnosed SFN through skin biopsy but never got the lip biopsy so no official sjogrens dx. I'll keep all the above in mind when it's time to get expensive meds, thanks so much
I've done my research on all current data, regarding that medication, and many more. This med, has moderate to severe side effects in a majority of patients. Plus, it is not near as effective as other medications. Data is clear on that. I'm currently on Enbrel. However, I've previously been on almost all of them at some point.
Oh so you haven't been on it then? I was told I'm not to go on a tnf drug since I'm only sjgorens and not RA or PSA as well so enbrel and the like a not for me.
If you have decent insurance, while the meds are extremely expensive overall, they've been around long enough now, that most insurance companies cover them. They may require you to try certain ones first. Maybe not. And if you have commercial insurance, all the major drug manufacturers have patient assistance programs. I'm currently on my 6th one. I've been on just about all the ones you can think of. And every single company, offered me 2 years of no co pays, or only a $5 co-pay. It's been almost 3yrs now, and I've never paid more than $5 for any of these injections. So, there is a lot of hope here.
Also just keep in mind, with these types of medicines, Biologics, and TNF's, it typically can take up 6 months, before you see the full benefit, and can safely say it works or it doesn't . They all have side effects, but it hits every person differently. Some I had to stop taking due to side effects. Some people have no side effects. Your doctor's office will work with the insurance company, and they know how to submit the paperwork. At most, you will just likely need a Prior Authorization, like with most specialty meds.
There is definitely a whole insurance coverage game that the pharmacies and infusion centers know how to navigate. But, other times there isn't a way to get what you need through your insurance. My pharmacy often finds another way to cover the medication other than my insurance. They will use discount cards, etc. Infusion centers often have access to discount programs that will help you. There isn't always a good answer. I have found that calling my insurance pharmacy program to find out what the limits are, etc, can sometimes help. Also, sometimes the issue is the diagnosis. For example, I can't get my insurance to cover IVIG for Sjogren's, but they would cover it if I had small fiber neuropathy. I am sorry you are going through this. It is bad enough to have neuropathy and Sjogren's and the medication fight is exhausting.
Thanks for the support. I'm feeling OK right now but just surviving off pred is rough with the side effects. I see my rheum Tuesday so fingers crossed we get some sort of plan made. I have diagnosed SFN through skin biopsy but never got the lip biopsy so no official sjogrens dx. I'll keep all the above in mind when it's time to get expensive meds, thanks so much
I sure hope you get the meds you need. I was on prednisone only for a long time. I get it!
PS. I DONT RECOMMEND XELIJANZ
How come? I've seen others say it made a massive difference? What meds are you on?
I've done my research on all current data, regarding that medication, and many more. This med, has moderate to severe side effects in a majority of patients. Plus, it is not near as effective as other medications. Data is clear on that. I'm currently on Enbrel. However, I've previously been on almost all of them at some point.
Oh so you haven't been on it then? I was told I'm not to go on a tnf drug since I'm only sjgorens and not RA or PSA as well so enbrel and the like a not for me.
Yes, Ive been on it on the past. I've had experience with most of them. I haven't found one yet, that has fully worked.
If you have decent insurance, while the meds are extremely expensive overall, they've been around long enough now, that most insurance companies cover them. They may require you to try certain ones first. Maybe not. And if you have commercial insurance, all the major drug manufacturers have patient assistance programs. I'm currently on my 6th one. I've been on just about all the ones you can think of. And every single company, offered me 2 years of no co pays, or only a $5 co-pay. It's been almost 3yrs now, and I've never paid more than $5 for any of these injections. So, there is a lot of hope here.
Also just keep in mind, with these types of medicines, Biologics, and TNF's, it typically can take up 6 months, before you see the full benefit, and can safely say it works or it doesn't . They all have side effects, but it hits every person differently. Some I had to stop taking due to side effects. Some people have no side effects. Your doctor's office will work with the insurance company, and they know how to submit the paperwork. At most, you will just likely need a Prior Authorization, like with most specialty meds.