Eyela and BlueCross Blue Shield insurance

[ColWi]

Is anyone dealing with the new BlueCross Blue Shield announcement about directly paying specialty pharmacy for your Elyea medication. I would appreciate any information you have on this. I get injections every 6 weeks that means $4,000.

[RP1944]

Do you live in America. I’m sorry but have no knowledge of how things work there. Hopefully there will be someone who does.

[Shimano]

In uk injections are free so we are very blessed. Mind boggles at what it is costing you to retain your sight. All the best.

[Pidgy]

If you live in Canada your private insurance such as Blue shield may pay a portion and trillium would pay the difference depending on your income. At age 65 it becomes free.

[zoey_s]

I live in the US and I have Humana as a supplement to Medicare. My Dr uses AVASTIN , which I think is a generic for Elyea and the insurance pays. You might ask your Dr is that is so and if it would be an option for you.

[Ayralin in reply to zoey_s]

Eylea is brand name of aflibercept [generic].

Avastin is brand name for bevacizumab [generic].

Lucentis is brand name for ranibizumab [generic].

I live in USA. I have Medicare & supplemental UCare Minnesota insurance. They pay the accepted portion for my Lucentis, leaving an actual copay of about $330 each injection. A program called "Good Day" by the drug company who owns Lucentis helps by paying part of that remaining amount. I end up paying a copay of $50 each injection appointment. Medical insurance in the USA is an out-of-date system, resulting in giant profits for Big Pharma and insurance companies. We need a single payer system. Example; my injection bill from December 2021 Injection drug cost billed to Medicare & insurance is $3000. Plan approved amount paid is $1671.98. Billed to me [but paid by drug company plan] is $334.40.

[ColWi]

I am in the US and am not at the age where I get medicare. So am still paying for regular insurance. I am getting njections on the 29th so will be talking to my dr to see if I have to go back to AVASTIN. I don't think it is the generic form but I will ask. I had been gettig that medication before but was breaking through the medicine. That is why we moved t the Elyea. But if I can't afford it I can't afford it. This is just a new thing that Bluecross Blue shield has decided on this medication this year. That medication is $1,900 a vile and I need 2. No way I can afford $4,000 every 6 weeks. I talked to them and they said they are doing this with other expencive medications as well starting this year. I'll ask my Dr. on the 29th what we can do. I have lost most of my central vision in my left eye it is 20.400 and my right eye is 20/150 I believe.

[Ayralin in reply to ColWi]

To help clarify:Eylea is brand name of aflibercept [generic].

Avastin is brand name for bevacizumab [generic].

Lucentis is brand name for ranibizumab [generic].

Our USA insurance programs should NOT be dictating which medication our doctors choose for us. Can your doctor send in an appeal?

[51classic]

I'm in the US and just had my 6th Eyelea injection on January 11, 2021. After reading these posts, I called the Retina Center and was assured by multiple staff members that there had been no change to my BCBS Basic insurance coverage for Eylea. Fingers crossed that they are right! I'll do a follow-up post if anything changes.

Happy New Year to everyone on this awesome site!

[ColWi]

Thanks that is what I am finding as well. I am in Nashville and the Vanderbilt hospital has a specialty pharmacy so they are helping me. Also what ever specialty pharmacy you use ask them to help you sign up with the company for discount. They will pay $15,000 fo the year beyond what BCBS is willing to pay so that may help you as well. Talk with you specialty pharmacist they can help set you up.

[Tessa83]

I feel blessed that I live in the uk I have had 31 injections in my right eye and 7 in my left.