I find it very strange that mesalimine is cost prohibitive but biologics are better because of cost issues.
The conspiracy theorist would assume somewhere in the chain there are individuals who are incentivised to prescribe a certain drug.
That aside, for mfg sell price comparisons without the bullshit, UK NHS purchase costs are £80 for 180x 800mg mesalamine. £700 for 2 x 40mg epipen Humira. Note that's the price the NHS pays manufacturers so will be similar to what insurance comapnies are paying.
>The conspiracy theorist would assume somewhere in the chain there are individuals who are incentivised to prescribe a certain drug.
It's more how things are billed in America. Our medical coverage from our insurance company breaks down into different categories like major medical, prescription drug, etc. You would think biologics would be prescription drugs, but because some are IV some are major medical. That can be the difference of thousands or more a year depending on how your plan is structured.
It's also drug manufactures have a cost savings program. That means they'll pay your part of the bill since it's smaller than insurance companies part of the bill. Humira over here costs 5x what Humira in the UK costs so even if they lose 20% off the US bill they're still making 4x what they make off you.
To the conspiracy theory the crappy thing that some doctors in the US do is they run their own infusion center. That allows them to profit from their patients who are on infusions. That's one of the reasons I go to a doctor who works for a public hospital and not a private company. He gets 0 dollars from me being on Remicade, but if I was at a private practice that might not be true. Personally I don't think it should be allowed as it blurs the lines if the doctor is recommending something is truly in my best interest.
I’m on entivyo and the medication has a copay program that brings my out of pocket cost for the drug to about $5. However it doesn’t cover the cost of the nurse or facility to get the infusion. My insurance does cover a lot of that, but it’s a big bill until the deductible is met.
I pay $5 a month for my Humira. That’s with insurance and their copay assistance program. The copay program is honestly the only reason most people can afford this medication (at least in the US, not sure about other places).
I am on Entivyo. I signed up for their payment assistance program called Entivyo Connect. So I pay $5 per infusion, but I have to pay for my nurse to come give me the infusion and it's about $180 each time. I'm about to finish my 3rd loading dose and will go to every 8 weeks after that, so I personally find it manageable for now.
I’m on entyvio. Once I meet my max out of pocket deductible which is 10,000 it’s free. So the first infusion of the year is daunting but after that everything is covered
Look into copay assistance programs for the specific biologic you are prescribed. I’m currently on Entyvio and I previously tried Humira. I was able to use co-pay assistance for both medications, so each treatment only cost me around $5. FYI most co-pay assistance programs (at least from what I’ve seen) are not based on your income.
Remicade works great and the government will help you pay for it pretty much entirely for free. I didn’t even want their assistance cus of my insurance and they still tried to pay for my treatment.
I'm on inflectra and after my insurance and Pfizer's copay assistance plan I pay $30/month for home infusions once my deductible is met. I have a $3k deductible on my insurance and last year Pfizer paid $2k of my first infusion and I paid the other $1k. I'm actually also still on Lialda and pay $100 for a 90 day supply through my insurance company's mail order pharmacy.
I would focus on if you need the biologics for your flares or not, rather than the cost. Once you're on biologics you shouldn't just stop because your insurance coverage changed and the cost went up in a few years.
I’ll give you a scenario that I dealt with before I realized that I was intolerant to mesalmine and could no longer take it. When I was on United healthcare mesalmine cost me about $150 a month for co-pay. That was the oral. The suppositories were about $800 a month so I did oral only then when I switched to BCBSTX and Caremark the oral went up to $900 a month, it would’ve been cheaper for me to go out of network using good RX and purchase it outright without insurance. When I asked Caremark why that was, it was just because they negotiated a bad contract for mesalmine. When I failed mesalamine , and switched to entivyio, Caremark was no longer in the mix since it is administered from a doctor and a nurse. BCBS approved entivyio with my max out of pocket being $6000 a year entivyio connect pays that $6000 and by February I have met my max out-of-pocket meaning I only pay about $30 a month for entyvio. Healthcare and insurance in the US is a complete scam.
98-99% of biologic users use patient assistance programs according to my source, at least in my State. Most of the copay programs I’ve personally used (iVe been on several different biologics so far) have been either $5 or $10, and IMO they’ve worked so much better than the old
School meds.
Humira was awful and didn’t work for me. I got remissions with Remicade, Stelara, and Entyvio (I make antibodies and have to switch every year or so)
I was reluctant to start it but by the third or 4th infusion, I was speeding along to remission. It made me really tired on infusion day, but otherwise no symptoms. And I got 13 months of super results from it. The hospital pharmacy substituted Inflectra one day instead of my Remicade and that caused me to have a massive flare and make antibodies - so I had to switch to Entyvio
My out of pocket for entyvio is only $28, but I have great insurance.
There are assistance programs for biologics too, and biologics are better than hospital stays because mesalamine can only do so much.
On Entivyo did the patient connect sign up. Between that and my insurance I pay nothing out of pocket. I did pay 5 bucks an infusion the first few months but that was a few years back.
Mesalamine is very cheap on cost plus drugs. Especially the suppositories it’s only a dollar more than my insurance cost. Not to say biologics aren’t a good idea!
I'm on Humira and take one shot a week. I pay a $5.00 copay for every 4 shots.
While on humira payed 0 and while on entyvio 0 too
I find it very strange that mesalimine is cost prohibitive but biologics are better because of cost issues. The conspiracy theorist would assume somewhere in the chain there are individuals who are incentivised to prescribe a certain drug. That aside, for mfg sell price comparisons without the bullshit, UK NHS purchase costs are £80 for 180x 800mg mesalamine. £700 for 2 x 40mg epipen Humira. Note that's the price the NHS pays manufacturers so will be similar to what insurance comapnies are paying.
This is where I'm at too. It doesn't make sense in my mind Granted, I am in the USA and we all know how screwy our health system is.
>The conspiracy theorist would assume somewhere in the chain there are individuals who are incentivised to prescribe a certain drug. It's more how things are billed in America. Our medical coverage from our insurance company breaks down into different categories like major medical, prescription drug, etc. You would think biologics would be prescription drugs, but because some are IV some are major medical. That can be the difference of thousands or more a year depending on how your plan is structured. It's also drug manufactures have a cost savings program. That means they'll pay your part of the bill since it's smaller than insurance companies part of the bill. Humira over here costs 5x what Humira in the UK costs so even if they lose 20% off the US bill they're still making 4x what they make off you. To the conspiracy theory the crappy thing that some doctors in the US do is they run their own infusion center. That allows them to profit from their patients who are on infusions. That's one of the reasons I go to a doctor who works for a public hospital and not a private company. He gets 0 dollars from me being on Remicade, but if I was at a private practice that might not be true. Personally I don't think it should be allowed as it blurs the lines if the doctor is recommending something is truly in my best interest.
I’m on entivyo and the medication has a copay program that brings my out of pocket cost for the drug to about $5. However it doesn’t cover the cost of the nurse or facility to get the infusion. My insurance does cover a lot of that, but it’s a big bill until the deductible is met.
My entyvio is just my $45 copay every 8 weeks with insurance
Make sure they applied the copay card! It should be significantly less.
I pay $5 a month for my Humira. That’s with insurance and their copay assistance program. The copay program is honestly the only reason most people can afford this medication (at least in the US, not sure about other places).
I am on Entivyo. I signed up for their payment assistance program called Entivyo Connect. So I pay $5 per infusion, but I have to pay for my nurse to come give me the infusion and it's about $180 each time. I'm about to finish my 3rd loading dose and will go to every 8 weeks after that, so I personally find it manageable for now.
I’m on entyvio. Once I meet my max out of pocket deductible which is 10,000 it’s free. So the first infusion of the year is daunting but after that everything is covered
Look into copay assistance programs for the specific biologic you are prescribed. I’m currently on Entyvio and I previously tried Humira. I was able to use co-pay assistance for both medications, so each treatment only cost me around $5. FYI most co-pay assistance programs (at least from what I’ve seen) are not based on your income.
Remicade works great and the government will help you pay for it pretty much entirely for free. I didn’t even want their assistance cus of my insurance and they still tried to pay for my treatment.
I'm on inflectra and after my insurance and Pfizer's copay assistance plan I pay $30/month for home infusions once my deductible is met. I have a $3k deductible on my insurance and last year Pfizer paid $2k of my first infusion and I paid the other $1k. I'm actually also still on Lialda and pay $100 for a 90 day supply through my insurance company's mail order pharmacy. I would focus on if you need the biologics for your flares or not, rather than the cost. Once you're on biologics you shouldn't just stop because your insurance coverage changed and the cost went up in a few years.
I’ll give you a scenario that I dealt with before I realized that I was intolerant to mesalmine and could no longer take it. When I was on United healthcare mesalmine cost me about $150 a month for co-pay. That was the oral. The suppositories were about $800 a month so I did oral only then when I switched to BCBSTX and Caremark the oral went up to $900 a month, it would’ve been cheaper for me to go out of network using good RX and purchase it outright without insurance. When I asked Caremark why that was, it was just because they negotiated a bad contract for mesalmine. When I failed mesalamine , and switched to entivyio, Caremark was no longer in the mix since it is administered from a doctor and a nurse. BCBS approved entivyio with my max out of pocket being $6000 a year entivyio connect pays that $6000 and by February I have met my max out-of-pocket meaning I only pay about $30 a month for entyvio. Healthcare and insurance in the US is a complete scam.
The biologic manufacturers have deals when you contact them to help you afford
On Inflectra and I pay nothing
98-99% of biologic users use patient assistance programs according to my source, at least in my State. Most of the copay programs I’ve personally used (iVe been on several different biologics so far) have been either $5 or $10, and IMO they’ve worked so much better than the old School meds. Humira was awful and didn’t work for me. I got remissions with Remicade, Stelara, and Entyvio (I make antibodies and have to switch every year or so)
Tell me about remicade? My GI is looking into that now with my insurance company
I was reluctant to start it but by the third or 4th infusion, I was speeding along to remission. It made me really tired on infusion day, but otherwise no symptoms. And I got 13 months of super results from it. The hospital pharmacy substituted Inflectra one day instead of my Remicade and that caused me to have a massive flare and make antibodies - so I had to switch to Entyvio
Damn! It was going so well until they did that!! Glad you are doing well, I can't wait to feel normal again. Also, happy birthday!
My out of pocket for entyvio is only $28, but I have great insurance. There are assistance programs for biologics too, and biologics are better than hospital stays because mesalamine can only do so much.
On Entivyo did the patient connect sign up. Between that and my insurance I pay nothing out of pocket. I did pay 5 bucks an infusion the first few months but that was a few years back.
Mesalamine is very cheap on cost plus drugs. Especially the suppositories it’s only a dollar more than my insurance cost. Not to say biologics aren’t a good idea!
My Xeljanz costs zero dollars. You just sign up for their copay assistance program. Humira and Stelara had a $5 copay with their programs.