Insurance payment for injections

[Ugean]

Going on Medicare with a Humana medagap open enrollment plain. Has anyone had a problem with insurance not paying for Lucentes injections or any other type . Thanks

[Retired130]

Hi. My wife is on Medicare but does not have Humana Medigap. She does have Blue Cross Highmark Blue Care PPO Medicare Advantage insurance. She is getting Eylea injection in one eye. The Eylea injection alone (not counting doctor's charge testing & administering shot) is around $1875 an injection. Her insurance covers all but about $450 of this. However, the Retina Specialist giving the tests & injections got her enrolled in a grant program through "Eylea For You". This grant covers all but $5 of her $450 copay. The grant is for $4200 for a calendar year, so thank goodness she is getting less than 10 shots a year as $4200 would not cover the copay for a 10th, 11th, or 12th shot for a calendar year.

You should ask the doctor giving you the shot if Lucentes participates in a grant program or if there is a private grant program to cover some or all of the copay costs that your insurance does not cover.

[ColWi in reply to Retired130]

Wow tha tis great I get the same shots in both eyes. Can you tell me did you contact the company to see about the grant. Yes that medication is crazy expencive.

[Retired130 in reply to ColWi]

No, I did not contact the company. The Retina Speicalist's office staff took care of submitting an application & the Dr signed it. I do know that the grant is for my wife's specific doctor, so if she ever changed doctors, the new doctor would have to submit an application for my wife for the new doctor to be paid by the grant. The money does not come to us - it goes directly to the doctor. I assume you will need to ask the doctor or business the doctor works for to investigate if there is any kind of grant program for Lucentes or he/she may already know if one exists.

I did some research on the internet & this site might be of help to you. lucentis.com/wet-amd/financ...

[ColWi in reply to Retired130]

THank you so much. THere is a program for Elyea. I am going to look into it. Wow would this be amazing if I qualify for this. I get injections in both eyes every 6 weeks. My out of pocket is 6,700 so boy would this make a difference. Thank you for the info to look up.

[Lexxxus]

Hi, I am on a medigap plan and so far I've only had to pay a $20 office visit.

That is the reason I went on a medigap plan, I only have a $183 deductible

for the year and otherwise no out of pocket. I pay more for a premium but it is well worth it. I did get grant money before Medicare which saved me a

Ton of money. I've been getting Lucentis shots for 2 years now, I tried Eylea before that but it didn't seem to help.